Incivility in the NHS: Racially minoritised workers experiences of incivility, its consequences for them and patient care

Workplace incivilities are subtle, disrespectful behaviours that adversely affect staff wellbeing, organisational functioning and patient safety. Despite NHS commitments to equality, diversity, and inclusion, racially minoritised staff face inequities shaped by racism, racialisation and cultural dynamics that remain underexplored in safety research. Four studies explored incivility among racially minoritised hospital workers: (1) an international scoping review identified four incivility dimensions and eight behaviours, (2) a secondary analysis of NHS staff survey data, used an exploratory model to examine relationships between compassionate leadership, civility, and emotional exhaustion, finding civility (and by extension incivility) was unevenly experienced across Trusts and compassionate leadership was differentially experienced across ‘ethnic’ groups.
These findings informed (3) a multi-method qualitative critical ethnography with 16 racially minoritised staff across two NHS maternity settings, examining how incivility, enacted by colleagues, patients, and visitors, intersected with organisational cultures; and (4) ten interviews with staff in ‘listening roles explored how such dynamics are interpreted and actioned. Findings showed existing listening and reporting mechanisms often failed to recognise the racialised nature of incivility, allowing it to persist and become normalised. Staff in listening roles were aware of harms but constrained by institutional logics, conflicting responsibilities, and limited knowledge, creating psychologically unsafe environments that threaten equity and safety.
Evidence-based recommendations include:
• Mandating equity-focused, context-specific training and targets for leaders, HR, and safety teams, co-designed with minoritised staff, to recognise racialised incivilities and address their systemic roots.
• Embedding inclusive metrics in leadership appraisals, recruitment and national policy, evidencing racial literacy and accountability.
• Integrating racialised incivility into safety systems (e.g., reporting, Schwartz rounds, regulatory bodies), ensuring harms are acknowledged, recorded, and actioned with an intersectional lens.
These contributions highlight how racialised incivility is embedded within the NHS, underscore the need for systemic, equity-oriented safety reforms to promote inclusion, staff wellbeing, and equitable maternity care outcomes.