The Impact of CREW
This chapter draws from a research program led by the author and colleagues to enhance the quality of workplace environments. It included an intervention study to evaluate the Civility, Respect, and Engagement at Work (CREW) intervention from the Veteran’s Hospital Administration. This project applied a modified version of the process in five Canadian hospitals. The chapter explores the background research with reference to the Risk Management Model. The chapter ends by considering strategies for enduring improvements in workplace civility.
KeywordsVeteran Health Administration Unit Manager Work Engagement Turnover Intention Affective Commitment
Evaluating CREW in Canadian Hospitals
A meeting of university researchers and chief nursing officers of Nova Scotia health districts explored possibilities for working together on action research. We were developing a proposal to the Partnerships in Health Services Improvement program (PHSI, pronounced fizzy) of the Canadian Institutes for Health Research (CIHR). The conversation ranged through leadership, burnout, and work engagement among other topics, but eventually reached a consensus on workplace incivility. Each of the health districts had problem units. Some units were toxic. These seriously problematic units had raised challenges for leadership for a long time. They had tried many strategies to address these problems, including imposing discipline on individuals with abusive behavior, transferring troublemakers elsewhere, and sending in new leadership. Although these actions would give temporary relief, they never produced enduring, satisfactory results.
We explored the literature on workplace mistreatment and found concern for alleviating the problem and calls for action to develop effective interventions. However, we found very few examples of systematic approaches to addressing the problem. We could not find any examples of controlled quasi-experimental studies in organizations that had produced convincing evidence of any method’s effectiveness. Finally, a member of our team connected with the team from the Veterans Health Administration (VHA) who are the authors of Chap. 5 in this book.
In the summer of 2008 with funding from CIHR and others we embarked upon our first round of CREW with eight units across five hospitals participating and another 33 units as a waiting list control. The major research report from that project (Leiter et al. 2011) reported a clear effect for CREW. Using Hierarchical Linear Modeling with intervention (CREW vs. Control) and Time (Before vs. After) as independent variables, the analysis found interaction effects for coworker civility, supervisor incivility, respect, cynicism, job satisfaction, management trust, and absences. Improvements in civility mediated improvements in attitudes.
This research program provided support for key elements of the Risk Management Model. The research examined the quality of social exchanges among members of workgroups in five hospital settings. It assessed both ends of the social continuum: civility among colleagues as well as instances of incivility. It inquired about interactions with colleagues as well as interactions with supervisors. To balance these assessments of received social behavior, it also assessed participants’ self-reports of incivility towards their colleagues. Together, the assessment produced an informative profile of each workgroup’s social climate. Through a series of analyses we examined the connections of these social variables with employees’ attitudes and perceptions about work.
Initially we established that incivility at work was a stressor in itself. Workplace mistreatment makes social contact among people at work an additional demand sapping employees’ energy and enthusiasm rather than a resource for addressing the legitimate demands of a job. Following this logic an analysis established that nurses’ perceptions of empowerment, supervisor incivility, and cynicism were strongly related to job satisfaction, organizational commitment, and turnover intentions (Laschinger et al. 2009). Incivility combined with burnout to be the most powerful predictors of turnover intention. Motivation to escape a workplace is consistent with nurses viewing it as a more risky environment in terms of their career aspirations as well as their well-being. Exhaustion augments employees’ motivation to escape in that they lack the necessary energy resources to cope effectively with a more risky environment. Without effective coping resources, the environment appears even more hazardous. Cynicism aggravates the relationship with turnover in that it reflects a weaker attachment of employees to their job. The distancing reflected in the cynicism aspect of burnout describes psychological escape that often precedes the physical escape of absences and turnover.
The playing field for incivility at work is not level. GenX nurses report more incivility from colleagues than do their Baby Boomer colleagues (Leiter et al. 2010). Incivility occurs more readily across group boundaries. An in-group/out-group bias increases the probability of both intentional and unintentional incivility. This study found that the more junior and therefore lower status members of the workforce were more often recipients of incivility from their coworkers, adding to their demand level at work.
A structural equation analysis (Leiter et al. 2012) supported a job demand resources model of burnout and engagement in finding that incivility was related to the core burnout scales of exhaustion and cynicism while resources (i.e., civility) was related to professional efficacy and work engagement. This analysis reinforced the conception of working relationships residing on both sides of the demand and resource balance with the level of civility or incivility as a decisive indicator. The experience of incivility was related to later increases in exhaustion and cynicism. The analysis found that instigated incivility—employees’ acknowledging that they behaved uncivilly towards their coworkers—was better predicted by low civility than by high levels of incivility. It appeared that the lack of a civil work environment reflecting a core value of respect was a more salient factor in employees behaving in an uncivil manner than was receiving incivility from others. This finding suggests that the core values of a workgroup are a more important issue than revenge or reciprocity in employees’ social behavior.
A further analysis (Gilin-Oore et al. 2010) established that in addition to being a stressor in itself, incivility aggravates the relationships of other stressors on employee wellbeing. This analysis identified supervisor incivility as a moderator of the relationship of worklife qualities with employee well-being. First, the relationship of work overload with mental health was stronger for employees who encounter higher levels of coworker incivility. Similarly, the relationship of control with mental health was also stronger for employees who encounter more coworker incivility. This relationship was striking in that the difference was evident for employees who had experienced any coworker incivility at all in contrast to colleagues who reported no coworker incivility. A similar pattern was found for supervisor incivility: for employees who had encountered any supervisor incivility in the past year there was a stronger relationship of work overload with stress symptoms than for those who had experienced none. The pattern was once again evident for respect: those who experienced less respect at work had a stronger relationship of work overload and of control with mental health than did those who had a positive experience of respect at work.
Coworker and supervisor incivility reflect the negative end of workplace relationships while respect reflects the positive, constructive end of the continuum. The moderation demonstrated in this study suggests that relationship qualities are more than a unit of resource that is added or subtracted from the resource balance depending on whether they are on the negative or positive side of social exchange. Positive relationships, in addition to being resources, provide a means of making effective use of other resources that are available and to apply those resources to managing the demands that arise. For example, employees with good working relationships can develop shared strategies for managing workload. They can cover for one another, allowing individuals to rest or to manage child care during the working day. Those without respectful working relationships would lack important tactics for controlling the demands and time flows of their work days. Incivility creates barriers among colleagues, depriving them of the capacity to access one another’s knowledge, emotional support, or energy to address demands. Overall, the workgroup becomes less effective because it lacks the means to coordinate its inherent resources to the best effect to provide treatment or to create products. In summary, a major message from this study is that collegial relationships function as an enabler for workgroups, allowing them to perform effectively with the demand/resource balance they experience.
One of the dynamics that perpetuate incivility among members of workgroups is the use of cognitive rationales. Although few people openly acknowledge a desire to treat their colleagues with disrespect, people readily generate excuses for their bad behavior. Leiter et al. (2010, August) identified three rationales that are used within workplaces. (1) The Pressure rationale acknowledges one’s behavior was wrong and out of character, but blames incivility on the environment (in terms of feeling stressed or pressured by too much work, pressing deadlines or demands from other people. (2) The Toughness rationale reflects arguments that one’s behavior is tough, but necessary, in that work context. For example, one must speak bluntly to inspire action from colleagues at work. By doing so, this toughness rationale may even make a virtue of uncivil behavior. (3) The Sensitivity rationale contends the behavior is not uncivil, but other people erroneously describe it to be so because these people are overly sensitive. This rationale denies incivility and puts the blame on other people over-reacting. In a sample of Canadian health care providers the sensitive rationale was endorsed most frequently, while the toughness rationale was endorsed less often, and the pressure rationale was reported least frequently. Despite differences in the use of each rationale, all three rationales moderated the relationship between experienced incivility and instigated incivility: those who used the rationales more frequently instigated incivility more readily in response to experienced incivility.
In hospitals, the working relationship of physicians and nurses has a compelling quality in defining the social environment. Galletta et al. (2012) found that nurses’ evaluation of their working relationships with physicians moderated the association of affective commitment with turnover intentions. The moderating effect operated at the work unit level. The analysis defined for each hospital unit an average rating for nurse/physician relationship. In units with a positive rating, affective commitment—the enthusiasm nurses expressed towards their hospital—was more strongly related to their intention to stay than was the case in units with a poor rating of nurse/physician relationship. This pattern suggests that nurses’ enthusiasm for their work has less consequence when they encounter incivility from physicians. By using hierarchical linear modeling (HLM) the analysis confirmed that the quality of the workgroup community had an impact distinct from that of individual encounters.
Bringing About Change
The Risk Management Model proposes (Proposition 4) that improvements in civility occur through a reflective process. Without reflection, the emotional tone of a workplace perpetuates itself through reciprocity and social contagion. Secondly, consistent with the Model’s proposition that workgroup climate is self-perpetuating, we expected that interventions that target the workgroup level would have a more enduring impact. The overall respect and civility among members of a workgroup does not arise from a mass of independent individual decisions but from a network of inter-dependent events that build upon one another. One individual diligently attending to etiquette has the potential to improve that person’s encounters. These efforts can make a worthy but limited improvement when taking the whole workgroup into consideration. These exchanges are unlikely to have a broad impact on the overall quality of the workplace environment.
A group of individuals working to conduct their interactions is more powerful. First, a group has a larger number of encounters with others within the workgroup. Through these encounters they have more opportunities to promote a more positive mode of social interaction. Second, group members can use their encounters with one another to develop both ends of a dialogue. For example, one individual assists another in a task; the assisted person expresses appreciation for the assistance; the assisting person receives the appreciation graciously. This exchange establishes more momentum than does an individual behaving well in the hope that someone may notice and respond accordingly. The cooperation occurring between the parties in the dialogue results in the exchange proceeding in an ideal fashion. Without cooperation, the exchange could break down: the assistance could be taken for granted with no expression of appreciation or the appreciation could be dismissed as improperly expressed. Instead, the cooperative exchange among group members aspiring to improve the civility in their workgroup reaffirms their efforts while producing a model for other workgroup members to follow.
As noted in Chap. 5, the active involvement of participants in defining the parameters of the intervention is an integral aspect of the intervention. Active participation engages the participants in (1) defining civility as it relates to their workgroup (2) adapting the intervention process to fit within their schedules and work area, and (3) make consequential decisions about specific activities and their timing within the overall intervention process. This level of participation would be much less intense in a highly structured intervention following a ballistic trajectory defined prior to implementation. These qualities help the developing standards for civility and respect to pervade the workgroup.
As with most workplace interventions, employees have some discretion about participation. Often this prerogative results in those who appear most in need of improving their behavior to avoid attending sessions. An intervention process that continues for six months in an active organization will fail to show perfect attendance of even the willing participants in light of travel commitments, absences, and vacations. As such, an effective intervention cannot rely entirely on the sessions alone to have an impact. Instead, the sessions provide a psychologically safe environment in which attendees can reflect on their behavior with the aim of exploring more fulfilling and respectful ways of interacting.
The CREW Process [In a Box to highlight this text]
What is CREW?
CREW is a series of structured gatherings among people who work together designed to enhance participants’ sensitivity to the quality of their working relationship. CREW stands for Civility, Respect and Engagement at Work; the foundations to constructive and productive interactions amongst colleagues.
Participants become more sensitive to the impact of their social behavior on others.
Participants develop effective strategies for responding to incivility and disrespect at work.
Participants develop a deeper repertoire of supportive interactions with colleagues.
How Does It Work?
Organizational leaders, often with help from consultants, introduce CREW to the organization through town hall meetings, print media, and other formats. Through a series of discussions, leaders identify one or two work units to participate in the initial wave of the CREW process. A questionnaire survey assessing areas of worklife and workgroup social climate establishes a baseline assessment for participating units. Soon afterwards, CREW sessions are started. Once the sessions are finished a follow up assessment is done to measure the units’ progress.
develop a plan for each session;
gather any needed materials;
inform participants of the session;
communicate with the unit managers to ensure optimum participation with minimum disruption of the unit’s work, and
maintain ongoing updates with a member of senior management with a commitment to the initiative.
Unit Managers are integral to CREW’s success. They work with Facilitators to ensure that the CREW sessions occur and that they fit within the life of the work of the unit without excessive disruption. They lead by example, by participating in the CREW sessions, and ensuring that the staff has an opportunity to attend. With help from the organization, the Unit Manager integrates the CREW process and philosophies into the everyday life of the unit, thereby ensuring sustainability.
Champion CREW within the organization;
Keep senior leadership informed of the CREW progress;
Participate in the monthly CREW Community Conference Calls;
Attend CREW Community meetings.
The CREW Process
Senior leadership endorses the CREW process as a strategy for realizing the organization’s values regarding collegiality, respect, and teamwork
The in-house expert or the consultant provides information sessions regarding CREW to stakeholders (board members, managers, EAP providers, leaders of labor or professional organizations).
Senior leadership tells the organization about CREW and its staged implementation and selects the initial units.
The in-house expert or the consultant provides information sessions to unit employees intending to participate in CREW.
Six Months of CREW
Assessment. A survey to establish a baseline. The survey results are compiled into a unit profile and may be used as a CREW session starting point.
Facilitator Orientation. Facilitators meet with the Champion and relevant Managers to become acquainted with matters of concern and opportunities that could help the CREW process. The Facilitator works out a process for managing the logistics of the CREW meetings.
CREW Community Orientation. The first CREW Community Events brings together Facilitators, Unit Managers, and CREW Champions. The day’s events provide CREW background and training. Facilitators receive the Profile for their unit and begin their planning process in collaboration with their Coordinator, and Unit Manager. Open image in new window
Kickoff. After the Orientation, the kickoff celebrates and launches CREW on the participating units. The kickoff is an upbeat, fun event but delivers a crucial message: it is an organizational priority, and allows potential participants to make an informed decision about their personal CREW participation.
CREW Sessions. CREW sessions occur through a six-month process of regular meetings. The baseline schedule for CREW sessions is one hour weekly. Groups adapt this standard to the pace of their work. One alternative is ten-minute meetings two or three times per week. During the sessions, facilitators introduce a topic or exercise. Initial sessions often start with icebreaker exercises from the Toolkit to get the conversation going. They to substantive exercises or discussion topics. An early substantive topic is: “How do we show support to one another in this team?” A complementary question is: “What do we do when acting rude to one another?” Facilitators strive to encourage active participation in the dialog. They also ensure that individuals feel safe to express themselves in the sessions. As sessions progress, Facilitators encourage participants to take responsibility for the quality of their social environment at work, both by comporting themselves with civility and responding effectively to incivility when it occurs. The Survey Results Profile may be used to provide direction to facilitators in selecting information and exercises from the CREW Toolkit in the initial meetings.
Second Assessment. During the final weeks of the six-month process, members of the participating workgroups complete a second survey, identical to the first, with a few additional items reflecting on their experience with CREW. A second profile is generated providing an assessment of any changes.
CREW Community Gathering. Another CREW Community Event is the Midpoint. Facilitators, Coordinators, and Unit Managers attend a gathering led by the consultant. It is an opportunity to share frustrations, victories, problems, and solutions. The Midpoint shows a learning community in action.When a Gathering occurs towards the end of the six-month process, Facilitators receive the complete Profile summarizing responses from before and from after CREW. The Profile provides a take-off point for a critical evaluation of CREW’s contribution. CREW units may present posters summarizing the history of their CREW experience. An important agenda item is identifying strategies for maintaining gains from CREW.
Conclusion and Follow-Up
Sustainability Activities. CREW never completely ends. The regular meetings and guidance from Champions draws to a close after six months, but the workgroup continues civility as a topic of reflection indefinitely. Civility and respect may become ongoing agenda items for team meetings with a member responsible for bringing a tip or lea a discussion on a related topic.
First-line Managers. The first-line manager of a work unit plays a pivotal role in sustaining the gains from the CREW process. By actively involving the manager throughout the CREW process from planning through implementation to follow-up, the process lays the groundwork for sustaining change. Ideally, the CREW process confirms the manager as a champion of a respectful work culture. Should the process identify that the manager lacks the commitment or skills to support a respectful workgroup culture, that gap requires action through coaching or other forms of professional development.
Follow-Up Assessment. A thorough process would conduct assessments annually to assess the development of the civility culture over time.
Implications of Improved Civility
The CREW process includes exercises and discussions that focus on the quality of relationships at work. For example, an initial exercise asks participants to respond to the question: What is civility for our group? How would we show civility towards one another in our workday? A companion exercise asks: How do we show disrespect toward one another? What are the actions and words that define uncivil behavior here? An honest and meaningful conversation on these topics requires a sense of psychological safety for the group and capable guidance from a facilitator. There is a risk that a group would give a superficial consideration to the questions. Participants may blame others for their problems. The finding that CREW affected employees’ attitudes through improvements in civility (Leiter et al. 2011) confirms the compelling quality of personal relationships in the connections people make with their work.
In a follow up to the CREW intervention reported in Leiter et al. (2011), the research team investigated the extent to which improvements found soon after competing CREW remain evident one year later (Leiter et al. in press). The analysis examined whether the results over time would follow one of three models: (1) Steady State in which the improvements achieved at Time 2 would remain in effect at Time 3 (2) Augmentation in which improvement would continue from Time 2 to Time 3, or (3) Lost Momentum in which the improvements at Time 2 would revert at Time 3 to Time 1 levels after the end of active intervention.
For workplace civility, incivility, and distress, the pattern followed an Augmentation model for the intervention groups in which improvements continued after the end of the intervention. For work attitudes, the pattern followed a Steady State model for the intervention group in that they sustained their gains during intervention, but did not continue to improve. For absences the pattern reflected a Lost Momentum model in that the gains from pre-intervention to post-intervention were lost, as absences returned to the pre-intervention level at follow-up.
These results are encouraging in that they provide evidence of CREW establishing fresh momentum in a positive direction. The improvement in both civility and incivility suggest that the workgroups who had participated in CREW had established social contagion in the right direction. The way that people interacted with one another was prompting positive spirals that improved the balance of civility to incivility over time. Open image in new window
The diagram summarizes the CREW process, comprising structured learning, reflective processes, empathy development, and psychological safety, as having a moderating effect on the overall civility level of a team. When CREW occurs, that level improves; when CREW does not occur, that level remains constant. This moderation was confirmed in the research of both the Osatuke et al. (2009) study and the Leiter et al. (2011) study. The second moderating effect derives from sustaining activities, comprising manager involvement, keeping civility on the agenda, and maintaining psychological safety in the team’s day-to-day operations. When these activities are present, a group is more likely to show a Steady State or even Augmentation model for its gains; when they are absent, the team is more likely to show a Lost Momentum pattern. This interaction has not yet been tested. The units involved in the Leiter et al. (in press) analysis reported engaging in the sustaining activities; they were not manipulated to test whether their absence would make a difference in their follow-up results.
The Enhancing Workplace Communities research project developed a range of ideas with a potential to improve organizations’ capacity to address civility concerns among their employees. The approach considers workgroups rather than individuals as the primary target of intervention because social behavior is a collaborative enterprise, even when the workplace culture runs contrary to everyone’s hopes. The message from the CREW intervention is that workgroups have the capacity to improve themselves when members work together. With concerted and sustained effort, they can establish positive dynamics that can sustain a civil, respectful, and engaging worklife.
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