Statement on Harassment Incivility and Disrespect

Developed by: Ad Hoc Committee on Harassment, Incivility, and Disrespect
Original Approval: October 23, 2024

ASA statements of interest:

Statement on Physician Well-Being
Statement on the Culture of Safety
Statement on the Fundamentals of a Safe and Healthy Workplace for Anesthesiologists

The vision of ASA is to be a world leader in improving health through innovation in quality and safety. The ASA has a distinct role and opportunity to set a leadership compass for workplace excellence by promoting and supporting innovation that maximizes professionalism through respectful behaviors. We seek to establish work environments that prioritize patient safety, foster engagement, enhance well-being, and promote the recruitment and retention of our workforce.

Harassment, incivility, and disrespect (HID) – whether from patients or health care professionals – impact clinician and patient health.^1-3 The spectrum of these disruptive behaviors negatively affect personal and team performance through adverse safety consequences including poor information sharing, compromised decision-making, diagnostic error, and burnout.^4-8

The experience of HID is pervasive in anesthesiology, with data and surveys revealing rates that are at least equal to, if not higher, than average for our profession compared to other specialties.⁹ The following principles are set forth as critical individual and organizational commitments supportive of the ASA mission of a future for anesthesiology built on respect, civility, and inclusion.

Organizational Commitment:

For each health care organization in which anesthesiologists are members, the ASA recommends a commitment to the following principles and actions for the benefit of patients, anesthesiologists, and all members of our care teams.

Create and employ an organizational strategic plan to eliminate HID, including these elements:
- A statement of commitment to eliminating HID
- Clear, consistent standards of behavior
- Policies to address HID including but not limited to:
  - Reporting
  - Actions to be taken when HID is reported
  - Preventing the weaponization of the reporting system
  - Due process and protection afforded to all parties
  - Clear appropriate action against HID
  - Prohibiting retaliation
  - Supporting those harmed
Implement a confidential reporting system, with expeditious and timely
- Confirmation to the reporter of receipt of the report
- Investigation
- Follow-up action
- Notification when action has been taken
The system should be transparent in aggregate reporting to the entire organization – with data elements such as the number of reports, types of reports, and actions taken.
The organization should investigate the barriers to reporting and actively seek solutions.
- Where barriers to reporting are significant, an anonymous reporting option should be available. Examples include but are not limited to:
  - providing a system with a Report ID and password where the unidentified reporter can receive follow up or be invited to answer clarifying questions when they log into the report’s account
  - utilizing an independent third-party provider.
Ensure a group of individuals in the organization with relevant expertise are managing this comprehensive strategic plan. These individuals should have adequate authority and resources to implement the plan, along with commensurate support for their time.
Enforce leadership and organization accountability to address HID including, but not limited to, the process of investigation, due process, remediation, counseling, and escalation of consequences in proportion to context and patterns of behavior.
Review metrics of HID events, the reporting system, retaliation reports, and other outcomes at least annually.

Individual Commitment:

Individuals should prioritize professionalism by practicing healthy workplace etiquette which includes being respectful of those around them, having self-awareness of their habits and biases, being proactive in mitigating harmful biases, and being attentive and responsive to organizational harassment policies.

Other practices that show an individual’s commitment to a safe, civil, and inclusive workplace include:

Building cordial professional relationships with colleagues by finding common ground
Refusing to initiate, participate, or condone HID toward others
When witnessing HID, being an “upstander,” providing support, protecting the person experiencing HID, and reporting to the appropriate party when safe to do so

When individuals of an organization follow these professional commitments, teams and organizations report increased professional satisfaction, decreased burnout, enhanced physician well-being, and improved patient safety.¹⁰

Selected Bibliography:

Douglas P, Mack M, et al. 2022 ACC Health Policy Statement on Building Respect, Civility, and Inclusion in the Cardiovascular Workplace. J Am Coll Cardiol. 2022 May, 79 (21) 2153–2184
The Joint Commission R3 Report on Workplace Violence Prevention Standards. Issue 30, June 18, 2021. https://www.jointcommission.org/-/media/tjc/documents/standards/r3-reports/wpvp-r3_20210618.pdf
National Academies of Sciences, Engineering, and Medicine. 2018. Sexual Harassment of Women: Climate, Culture, and Consequences in Academic Sciences, Engineering, and Medicine. Washington, DC: The National Academies Press. https://doi.org/10.17226/24994
Cooper WO et al. Association of Coworker Reports About Unprofessional Behavior by Surgeons with Surgical Complications in Their Patients. JAMA Surg. 2019;154(9):828–834.June 16, 2019
Katz, D. et. al. Exposure to incivility hinders clinical performance in a simulated operative crisis. BMJ Qual Saf 2019 Sep;28(9):750-757) DOI: 10.1136/bmjqs-2019-009598
Porath, Christine, et al. Incivility in the Front Lines of Business. Harvard Business Review December 2022.
Riskin, A Erez, A, Foulk, TA et. al., The Impact of Rudeness on Medical Team Performance: A Randomized Trial. Pediatrics September 2015; 136 (3): 487–495. DOI: 10.1542/peds.2015-1385
Riskin A, Erez A, Foulk TA, Riskin-Geuz KS, Ziv A, Sela R, et al. Rudeness and Medical Team Performance. Pediatrics. 2017 Feb 1;139(2):e20162305. DOI: 10.1542/peds.2016-2305
Lautenberger DM, Dandar VM, Zhou Y. Understanding and Addressing Sexual Harassment in Academic Medicine. Washington, DC: AAMC; 2022. https://www.aamc.org/data-reports/faculty-institutions/report/understanding-and-addressing-sexual-harassment-academic-medicine
Rehder KJ, Adair KC, Hadley A, McKittrick K, Frankel A, Leonard M, Frankel TC, Sexton JB. Associations Between a New Disruptive Behaviors Scale and Teamwork, Patient Safety, Work-Life Balance, Burnout, and Depression. Jt Comm J Qual Patient Saf. 2020 Jan;46(1):18-26. https://doi.org/10.1016/j.jcjq.2019.09.004
Lautenberger DM, Dandar VM. The State of Women in Academic Medicine 2023-2024: Progressing Toward Equity. Washington, DC: AAMC; 2024.
Lin, DM, Lane-Fall, MB, Lea, JA, Reede, LJ, Gomes, BD, Xia, Y, Rock-Klotz, JA, Miller, TR. Workplace Violence Pervasiveness in the Perioperative Environment: A Multiprofessional Survey. The Joint Commission Journal on Quality and Patient Safety. Prepublication online August 2, 2024. doi.org/10.1016/j.jcjq.2024.07.010