Protecting civility in healthcare

Posted Jul 10, 2018

Andrew Neuner, Chief Executive Officer, HQCA

I recently posted a piece about the ideal conditions to pursue improved healthcare quality, which included ‘protecting civility’ as one of those essential conditions.

Civility describes an interaction that is respectful, transparent and inclusive. In the healthcare context, Don Berwick from the Institute for Healthcare Improvement (IHI)said (1), “everything possible begins in civility” and in the absence of civility, dialogue is eroded. He suggests approaching conversations about healthcare improvement as if we are at the dinner table, not in the boxing ring.

Adding further clarity to this dinner table analogy, I read a recent piece (2) that stated, “Fundamental to, and governing the practice of, civility is the principle of reciprocity: your place at my table implies my place at yours.

This analogy resonates for me and after thinking further on the idea, protecting civility in a discussion or debate about how to improve quality in healthcare in Alberta means:

  • Inviting and welcoming diverse perspectives and opinions to the table,
  • Checking egos at the door,
  • Making sure everyone has an opportunity to speak and to be heard,
  • Creating a safe place for differing opinions to be shared and considered, and
  • Listening with openness and a willingness to reshape perspective or position.

I highly value these five principles when I engage with others, however have to challenge myself to keep them top of mind and apply them consistently. It can be particularly hard when the topic of discussion is one I’m passionate about or consider it an area where I have expertise. I also find it difficult if everyone at the table and especially the “host” does not apply these principles, because it risks making decisions with incomplete information or leaves participants feeling their voices were not heard.

Deliberately engaging in and leading conversations with civility encourages broader expertise and views to be voiced and leadership and followership responsibilities to be shared; creating a flexible or, in some cases, non-existent hierarchy. All of this ultimately fuels innovation and helps a team or system pursue change with more confidence and strength because all perspectives, risks and opportunities have been tabled and considered.

It is also important to clarify that civility benefits all “tables” in healthcare; whether a governance or leadership table, care team huddle, design sprint, project team, etc. Any time people, including those we serve, are brought together to talk about improving how care is delivered is an opportunity to apply these principles.

So, as we continue to protect civility to advance healthcare quality in Alberta, I challenge our health system to:

  • Take a look at your table and invite others you may have overlooked or omitted to pull up a chair;
  • Find opportunities to let your table mates lead, and hone your expertise as follower; and
  • When followers or the most vulnerable among us are brave enough to ask for a seat or opportunity to lead, find a way to say ‘YES’ and make sure their voices are heard.


(1) On this page (, under ‘Related Information,’ there is a link to watch Berwick’s complete keynote speech (recommended). This requires you to register for an Institute for Healthcare Improvement login, which is free.


Follow Andrew on Twitter @HighNeun

HQCA Matters is published monthly and presents HQCA representative perspectives on topics or issues relevant to healthcare in Alberta.