Creating an atmosphere of civility in the workplace, besides simply being the right thing to do, has a huge impact on patient safety and staff retention. Here are seven steps to consider.

Increase awareness. All members of your facility need to understand the importance of maintaining a civil workplace and must support a call to action to change toxic environments. Formally survey the staff. Do they encounter a lack of civility in their work relationships? How do your nurse managers treat the staff? After collecting the results, present the data to your entire facility in an open forum. Remember, this is just the awareness phase and not the solution phase. Consider bringing in a national expert to present the data and to offer solutions. An outside voice often packs more punch.

Set expectations. Bad behaviors won't improve unless a departmental framework for change is established. Make sure your mission statement includes verbiage about creating a healthy environment for patients and staff. Use the staff survey to determine their top priorities for maintaining a healthy work environment, list the top 10 concepts and commit your staff to following them.

Create a framework for change. Designate a committee to establish a reporting and response system for breaches in your facility's code of conduct. The response system should include support measures for the perceived victim. Enact measures to avoid these common barriers to change: the perception that surgeons who bring cases to the facility won't be punished, fear of retribution and apathy because of a "nothing ever changes" attitude.

Build trust. Even the best codes of civility on paper need to be proven in practice. To gain your staff's trust, approach what appear to be less egregious offenses to your conduct policy as earnestly as you would those you consider the most serious events and apply all policies consistently.

Provide education and opportunities. Give your staff the time and means to develop skills relating to civility. Refer your staff to appropriate employee assistance programs — anger management or assertiveness training, for example — and consider using commercially produced products that teach civility skills.

Be patient. Generating a tangible change in your facility's work culture takes at least two years, so don't expect difficult situations to turn around within two months. To maintain the momentum of your efforts, recognize all exemplary behavior and successes, no matter how small. The nurse who cuts her typical 20 weekly outbursts to 10? Let it be known. Celebrate it.

Secure outside help. Work with national professional organizations that have published statements on civility in the workplace, like the American Nurses Association and American Medical Association. Those types of organizations will lend credibility to your own efforts. Belligerent surgeons may not listen to you, but they may consider more seriously the recommendations of the AMA, their own organization.