Since considering civility when it was presented at a Freedom to Speak Up Conference https://www.civilitysaveslives.com/, rudeness and manners and the impact on those around us continues to be important.

We recognise that different cultural norms and those with neurodiversity may be disadvantaged within this convention. We also need to consider how  teaching negotiation skills is critical as part of communication and leadership of teams.

Research increasingly demonstrates that civility is not simply a matter of workplace culture but is a patient safety issue.

One of the most influential studies in this area, The Impact of Rudeness on Medical Team Performance by Riskin et al. (2015), exposed clinical teams to either neutral comments or mildly rude remarks from an observing expert during a simulated deteriorating patient scenario. Independent assessors, blinded to the intervention, found that teams exposed to rudeness performed significantly worse in both diagnostic reasoning and procedural tasks. Information-sharing and help-seeking behaviours were also negatively affected.

These findings support a growing body of evidence that effective communication is fundamental to safe care and that incivility undermines team performance, decision-making and ultimately patient outcomes.

As the Civility Saves Lives movement highlights, incivility often emerges when people are stressed, unhappy or rushed. Yet the consequences extend far beyond a momentary lapse in manners. Disrespect erodes psychological safety, damages relationships, increases stress and creates environments in which people become less creative, less engaged and less willing to speak up. Some quietly reduce discretionary effort; others leave altogether.

If we accept that stress is inevitable within health and social care, the challenge becomes how we respond to it. One area that receives surprisingly little attention in professional training is negotiation and conflict resolution.

When faced with disagreement, individuals typically adopt one of five approaches:

• Competing – prioritising outcomes over relationships; a win–lose approach.
• Collaborating – valuing both outcomes and relationships; seeking win–win solutions.
• Accommodating – preserving relationships by yielding one’s own position.
• Avoiding – withdrawing from both the issue and the relationship.
• Compromising – finding a middle ground where both parties give something up.

Whilst each approach has its place, collaborative negotiation is often the most effective in complex healthcare environments because it creates opportunities for innovation rather than simply determining who is right.

More advanced approaches, such as Marcus, Dorn and McNulty’s Walk in the Woods model, provide a structured framework for resolving conflict. The model encourages parties to:

1. Understand each other’s underlying interests.
2. Identify areas of agreement and disagreement.
3. Generate new and creative solutions.
4. Align priorities to reach a mutually beneficial outcome.

At its heart, the model recognises that conflict is rarely resolved through positional arguments alone. Sustainable solutions emerge when people understand one another’s perspectives, build trust and focus on shared interests rather than individual victories.

When frustration becomes normalised, rudeness often follows. Left unchecked, this can develop into toxic workplace cultures characterised by fear, bullying, burnout and psychological harm. These cultural conditions inevitably affect quality, safety and organisational performance.

Improving culture therefore requires more than policies and procedures. It requires attention to our human relationships. Kindness, respect and empathy are not soft skills; they are foundational safety behaviours. Through role modelling, coaching and creating psychologically safe environments, we can strengthen our ability to understand ourselves, understand others and work together more effectively in the service of those we support and build our understanding of negotiation skills to create new conversations.