Accountable Healthcare - Frontline Work When Everyone Is Angry
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November 11, 2022

Frontline Work When Everyone Is Angry

Today’s public-facing employees deal with insults, rants, and rudeness — and leaders must better protect them. Here’s how. by Christine Porath at

In October 2020 Dr. Adrienne Boissy, then the chief patient experience officer at Cleveland Clinic, had a big problem, and it wasn’t just Covid-19. Caregivers at the hospital, already stretched thin by the pandemic, were coming to her with alarming reports of abusive behavior from patients and visitors: mean comments, screaming tirades, even racist insults. “It’s never been so bad!” she told me.

I’ve studied incivility — defined as rudeness, disrespect, or insensitive behavior — in workplaces for more than 20 years, polling hundreds of thousands of people worldwide about their experiences. But after that conversation with Dr. Boissy, who is now the chief medical officer at Qualtrics and a neurologist at Cleveland Clinic, I wondered whether incivility is getting worse over time, particularly for frontline workers, who labor in person and often interact directly with customers and patients. These workers’ industries include health care, protective services (think police officers), retail, food production and processing, maintenance, agriculture, transportation (including airlines), hospitality, and education.

My research has found that reports of incivility are indeed on the rise — as evidenced not just by viral videos of airline passengers refusing to wear masks or café patrons hurling racial epithets but also by my recent survey that asked more than 2,000 people around the world how they have experienced rudeness lately. Even amid a global health crisis in which frontline workers were heralded as essential and heroic, these employees still became punching bags on whom weary, stressed-out, often irrational customers (and sometimes fellow employees) took out their anxieties and frustrations.

This kind of incivility leads to negative outcomes not only for the workers who experience it directly but also those who witness it — all of which harms businesses and society. In this article, we’ll explore those consequences and discuss how leaders can help to improve things.

Note that incivility takes many forms, from ignoring people to intentionally undermining them to mocking, teasing, and belittling them. For this article, it does not refer to physical aggression or violence, although incivility can spiral into aggressive behaviors.

Where We Are

Identifying and studying incivility can be difficult, because bad behavior is often in the eye of the recipient. Behavior you consider uncivil may not be regarded the same way by a customer — but if you feel disrespected, whether your counterpart intended it or not, your work will suffer. In addition, what’s considered uncivil varies by culture, generation, gender, industry, and organization.

Regardless of how individuals define incivility, they’re reporting more of it — and have been for a while now. In 2005 nearly half of the workers I surveyed across the globe said they were treated rudely at work at least once a month. In 2011 it was up to 55%, and by 2016 it had climbed to 62%.

In August of this year, I designed a new survey to further track incivility trends and glean more insight into what’s happening on the front lines of business and society today. It drew on customer-focused studies I previously conducted with marketing professors Deborah MacInnis and Valerie Folkes at USC Marshall School of Business, as well as on insights from people in a range of consumer-facing industries.

In the new survey, the data I collected came from more than 2,000 people in more than 25 industries in various roles across the globe (representing every major region except Antarctica). They included both frontline employees and people who had observed them at work. Here’s what I found:

  • 76% of respondents experience incivility at least once a month.
  • 78% witness incivility at work at least once a month, and 70% witness it at least two to three times a month.
  • 73% report that it’s not unusual for customers to behave badly.
  • 78% believe that bad behavior from customers toward employees is more common than it was five years ago.
  • 66% believe bad behavior from customers toward other customers is more common than it was five years ago.

These numbers have risen steadily and sharply since my 2012 survey about customer incivility. In that survey, 61% of respondents reported that it was not unusual for customers to behave badly, 49% believed that bad behavior from customers toward employees was more common than it was five years before, and 35% believed bad behavior from customers toward other customers was also more common.

In addition to this year’s survey, I conducted many interviews with employees, managers, and organizational leaders to learn more about how they’re experiencing incivility from customers and patients.

A pediatric emergency medicine physician shared:

Daily, families disparage, yell at, and belittle us while we provide care for their children. A few months ago, I asked a father to put his mask back on, per hospital policy. He stormed out of the room and said he was leaving because he did not believe in masks. I came back in and his six-year-old child told me, “Daddy spit on the ground.” Sure enough, there was a big spit wad on the hospital floor.

One retail employee related a customer’s response to her saying “Good morning”:

I do not need you for anything. Leave me alone. If I need you, I will call you. You are here to serve, not to talk with me.

A restaurant patron described her sister’s bad behavior:

She berated a waitress to the point of making her cry. Why? Because the waitress didn’t bring her salad just the way she ordered it.

A traveler shared their experience of watching a fellow passenger yell at a car service driver:

He yelled, “What are you waiting for?! Get your act together!” He shoved his luggage at the driver and stormed out. The driver stood blinking for a minute before following.

A former school principal explained what educators and staff must often shield themselves from:

Parents approach school staff with claws out, ready for blood. They’re unwilling to listen and are rude, mean, and threatening.

Then there are the reports of online behavior, exemplified by the emails received by the customer support team of a video game company:

In one interaction, a customer was upset about some experience they had in the game, and they sent long paragraphs of complaints that included comments such as telling the support representatives that they hope their wives and daughters will be raped.

Needless to say, it’s gotten pretty ugly out there. Some uncivil behavior may be too extreme to fix, and some people are unmotivated or unwilling to change; in my research, 4% of people report being rude because it’s fun and they can get away with it. But research shows that much of incivility can be reined in. To do that, we need to understand its drivers.

How We Got Here

So, why does it feel like incivility is getting worse? My research suggests that several compounding factors and pressures have brought us to this point:


Over the years, I’ve found that stress is the number one driver of incivility. In my most recent data, 73% of respondents who had been rude to a coworker blamed it on stress, and 61% pointed to being overloaded with work.

The pandemic, the economy, war, divisive politics, the changing nature of work, and continued uncertainty are all taking a toll. Any (or all) of these factors may contribute to our stress and burnout, which have risen to unprecedented levels recently. And considering our reduced levels of self-care, exercise, and sleep, it’s no surprise that we have a tougher time regulating our emotions.

Negative emotions.

In October 2020 my brother Mike Porath and I reported data from The Mighty, a supportive community Mike founded for people facing health challenges and those who care for them. A survey of over 70,000 readers and community members found that the number of respondents who chose anger as one of their top emotions more than doubled from March to September — rising from 20% to 45%.

Naturally, as negative emotions swell in us, we may lash out or take them out on others, often without realizing it. Even if we muster restraint, when we’re not feeling well we’re less mindful and less capable of interacting positively and respectfully.

Weakened ties.

We can also attribute the epidemic of rudeness to a general fraying of community and workplace relationships. I define “community” as a group of individuals who share a mutual concern for one another’s welfare. In a 2014 study of 20,000 people for my book Mastering Community, I found that 65% didn’t feel any sense of community. In July of this year a colleague and I surveyed more than 1,500 Conference for Women participants, finding that their sense of community has decreased 37% since the beginning of the pandemic.

The feeling of lacking community is exacerbated when people don’t feel valued, appreciated, or heard — which applies to the vast majority of employees. Sometimes subtle (or not-so-subtle) behaviors are what sting most. A European participant in my recent survey explained:

Nothing happened — and that was the rudest part itself: A junior colleague got completely blanked by a more senior figure. He said good morning and the senior staff member just continued walking.…Not surprisingly, the junior person left after about six months.


For all its benefits, technology can lead to greater disconnection and rudeness. It can also distract us from the humans in front of us, as countless frontline employees and cashiers have reported. Often we’re too busy scrolling through Instagram or listening to music on our headphones to interact with those serving us or ringing up our groceries — much less to utter a simple “Hello,” “Please,” or “Thank you.”

This heavy use of technology, and of social media in particular, may come with a price: We’re taking in a whole lot of negativity (consciously or unconsciously) on a daily basis. The content we consume affects not only us but others too. What we ingest from online sources can harm our mood and mental health, and we can pass our anxiety, depression, and stress on to others.

Finally, in the digital age messages are often subject to communication gaps and misunderstanding — and, unfortunately, putdowns are more easily delivered when it doesn’t happen face-to-face. While electronic communication can bring us together in remarkable ways, it also liberates us to voice our frustrations, hurl insults, and take people down a notch from a safe distance.

Lack of self-awareness.

One of the biggest takeaways from my decades of research is that incivility usually arises from ignorance — not malice. People lack self-awareness. According to research by Tasha Eurich, an organizational psychologist and a collaborator of mine, a whopping 95% of people think they’re self-aware but only 10%–15% actually are. That means 80%–85% of people misunderstand how they’re perceived and how they affect others. We may have good intentions and work hard to be patient and tolerant, but our tones, nonverbal signals, or actions may come across differently to the people we interact with and those who witness the interactions.

The Costs of Incivility

Research shows that rudeness is like the common cold: It’s contagious, it spreads quickly, anyone can be a carrier — at work, at home, online, or in our communities — and getting infected doesn’t take much.

When incivility does spread, it affects people and organizations in several ways.

Incivility’s mental and physical toll.

My research has shown over and over that incivility’s effects are both mental and physical. This tracks with sociologist Charles Horton Cooley’s 1902 notion of the “looking-glass self,” which explains that we use others’ expressions (e.g., smiles or snarls), behaviors (e.g., ignoring or paying attention to us), and reactions (e.g., listening or belittling) to define ourselves. How we believe others see us shapes who we are and how we behave. Brief interactions signal respect or disrespect. People feel valued when we acknowledge and thank them. When we cut people down, we make them feel smaller and uglier.

Ryan Snook

These dynamics help to explain why the effects of incivility are so damaging. Merely being exposed to rude words reduces our ability to process and recall information. Dysfunctional and aggressive thoughts (and sometimes actions) can skyrocket. Witnessing rudeness and triggers of incivility — such as reading a nasty comment on social media or listening to an argumentative interview — takes a cognitive toll, interfering with our working memory and decreasing our performance. And these disruptions can be catastrophic. For example, exposure to rudeness has been shown to negatively impact medical teams’ diagnoses and procedural performance.

Incivility’s toll on business.

In my recent research, I found that when people witness rude treatment of employees or frontline workers, 85% report being annoyed, 80% are upset, and 75% are angry. Additionally, 61% report being distressed and 43% feel threatened.

When customers witness other customers being uncivil to employees, they have a few responses. Their attitudes toward the employees improve, but their feelings toward the workers’ organization shift in costly ways: 42% report that the rude behavior changes their perception of the company, 40% question whether they want to do business there again, 65% think the organization should better protect its employees, 45% question its values — and, overall, people’s willingness to use the company’s products and services drops 35%. MacInnis, Folkes, and I found that these feelings are tied to concerns for human dignity and whether others are being treated respectfully.

How Organizations Can Address Incivility

Business leaders have a responsibility not only to support their employees in dealing with incivility, both in the moment and afterward, but also to try to mitigate it in the first place. I’ve used the following four-part Cycle to Civility© framework, outlined in my book Mastering Civility, in dozens of organizations. It covers the entire employee experience: recruiting, coaching, scoring, and practicing. While executives and HR leaders may take the lead on implementing the framework, anyone can benefit from being familiar with it. And although focusing on any of these steps individually will help move your organization’s culture toward civility, change will happen faster if you work on more than one at a time.


Fostering a feeling of community begins with who you hire — so choose wisely. During the hiring process, use techniques that will help reveal whether a candidate is well equipped to handle incivility on the front lines. Rely on structured behavioral interviews and ask questions like, “Tell me about a time when you’ve had to deal with stress or conflict at work. What did you do?” Use follow-up questions to probe deeper, and pay attention to the person’s tone, demeanor, and pace of speaking, which may provide useful indicators of their attitude. In addition, look for candidates who can be trained to respond well to incivility, including those who are self-aware and motivated to improve and who embrace learning. Talk about your organization’s values, and ask questions to understand how the person’s past behavior aligns with them.

Recruiting applies to clients and customers too, since managers can spend an extraordinary amount of time, energy, and focus dealing with the fallout of uncivil actions. If you’re in a position to choose the clients you serve, it’s worth asking, “Are they really worth it?” Why not investigate their reputations and how their people are likely to treat yours? One founder I know charged some clients a “high-maintenance tax” that took into account how challenging they were to deal with, sometimes amounting to 1.5x the normal price of the company’s services.


Training your employees to handle bad behavior from customers is a critical component of creating a more civil workplace. Just as important is determining how you expect those customers and patients to treat your employees and steering them toward that desired behavior. Taking a few steps can help.

First, set expectations and establish norms for how people interact with one another, and for what they should do when others don’t adhere to the norms.

UMass Memorial Health, a health care network in Massachusetts, has introduced a patient and visitor code of conduct. At kiosks on campuses and in offices, visitors are asked to sign an agreement to adhere to the code of conduct, which formalizes the parameters and expectations of their behavior. UMass Memorial has also established a verbal template that employees can use to respond to someone’s incivility, which includes: Either you stop [the problematic behavior], or [the result of the behavior]. For example, “Either you stop yelling at me, or it’s going to make it harder for me to give your mother her meds.”

The goal, says Laura Flynn, senior director of performance, learning, and education, is to create a respectful, safe environment. When UMass Memorial Health piloted the new program, it collected and analyzed feedback and experimented with options to improve outcomes. In just over a month, it had more than 56,000 signed agreements for the code of conduct — and only four visitors were asked to leave during that time.

Second, encourage and train employees to show empathy. Being empathetic in interactions with others can require skills in negotiation, stress management, difficult conversations, and mindfulness. Organizations need to coach employees in these skills, as well as in listening fully, giving and receiving feedback (both positive and corrective), working across differences, and dealing with difficult people. People who possess these skills are better equipped to deal with incivility.

When Dr. Adrienne Boissy was the chief patient experience officer at Cleveland Clinic, she rolled out an eight-hour course where physicians role-played scenarios about how to have better conversations with patients to express their intention of care. In a study of 1,500 physicians who participated, there was a statistically significant and positive impact on their capacity for empathy, which had a positive effect on patient experience. The training also reduced burnout and emotional exhaustion among physicians, an effect that persisted for three months after the completion of the course — suggesting that the payoff for coaching employees who interact with patients or customers is significant.

Also helpful for empathy is considering why someone is being uncivil. Many people are struggling with ongoing stress and challenging circumstances, for example. Adriene McCoy, senior vice president and chief people officer of Baptist Health, a health care organization in Florida, told me that its leaders are coaching employees to take a beat before responding to uncivil colleagues, patients, and families. “People are so stressed that we often just react instead of thinking about why,” McCoy said.

My research shows the value of this approach. When you encounter rude behavior at work, pause and try to put yourself in the uncivil person’s position. “Someone’s behavior could be due to dementia, intense pain, behavioral challenges, addiction.…People come to the hospital when they’re really challenged — not on their best day,” Flynn notes. So when someone is uncivil, ask yourself: Do I have the whole argument? And, importantly: What’s the most generous interpretation of their behavior? This question is especially valuable when you’re stressed or feeling burned out. Before shutting down, saying no, or displaying frustration, try to appreciate where the other person is. You might even go one step further and ask, How can I help them?

Finally, nudge customers and patients toward empathy. Nudges — short, personalized recommendations with a clear call to action — have proven useful in a variety of settings, including retail and health care.

McCoy recalls going into a Starbucks during the pandemic and feeling annoyed when her drink wasn’t made as she’d asked it to be. Then she saw a sign on the wall that read “People who are here chose to be here.” “This stuck with me,” she says. The employees were just human beings doing their best during a difficult time. “So they didn’t put drizzle on my drink. I moved on.”

In addition to its code-of-conduct agreements, UMass Memorial Health has begun displaying signage to nudge patients and visitors toward respectful behavior. Upon arrival, they see a welcome sign that says “Help us keep this a safe space of healing, kindness, and respect.” In a small font at the bottom are the hospital’s standards of respect. A second sign, placed in units and the emergency department, has the patient and visitor code of conduct, which spells out unacceptable behavior such as yelling, swearing, spitting, and making offensive remarks about race, ethnicity, or religion. Laura Flynn told me that trying to protect employees with signs and nudges is a delicate balance “because you have to be sensitive to each patient and visitor’s circumstance, and it can’t feel like a hammer [to them].”


One of the most compelling ways to show how much civility matters to your organization is to recognize and reward it. Gestures of appreciation, for example, can help reduce burnout, promote retention, and aid mental health and well-being. When reviewing performance, don’t just focus on the results; also consider the how of the work by expressing gratitude for the full contributions people make, which includes handling uncivil behavior. Recognition may not make up for the abuse they’re weathering, but it helps people feel like their community is backing them and appreciates the care they’re delivering — or simply the fact that they’re showing up.

Peers are an underutilized source of appreciation. Consider using a peer-to-peer recognition program, like the Fool’s Gold program at stock adviser The Motley Fool. Each employee is given an allotment of “gold” that they can dole out to their coworkers to recognize them for any action they feel is worthy. Employees can redeem the gold for gift cards and other rewards. There’s also a recognition live feed that allows employees to read all posted compliments. It’s a way to share information and celebrate accomplishments related to both results and the how of work.


Make sure your employees have the tools they need to protect themselves from uncivil behavior — both in the moment and over time.