The following are key points to remember from the 2022 American College of Cardiology (ACC) health policy statement on building respect, civility, and inclusion in the cardiovascular workplace:

1. Civil behavior and respect are essential to the ACC’s mission of transforming cardiovascular care and heart health and are inherent to its core values of teamwork and collaboration. The spectrum of uncivil behavior, including bias, discrimination, bullying, and harassment (BDBH), is ubiquitous in our society and institutions, and cardiovascular organizations must work to ensure freedom from BDBH in their policies, procedures, and programs.
2. BDBH in medicine may be perpetuated by institutional factors (e.g., hierarchy, financial incentives), individual traits (e.g., manipulative tendencies, poor impulse control), and patient/family behaviors (often related to race and gender biases and directed at trainees and nonphysician staff).
3. BDBH has been linked to mental and physical health problems, reduced work productivity, and burnout, and may impact trainees’ choice of specialty (for instance, female cardiology fellows may be discouraged from pursuing subspecialty training in interventional cardiology or electrophysiology). BDBH may hinder safe and effective patient care and lead to disintegration of team trust and productivity.
4. A 2019 survey of 5,931 cardiologists worldwide (23% women, 54% White) revealed that 44% experienced a hostile work environment. Gender was the most frequent cause of discrimination, followed by age, race, religion, and sexual orientation (5%). Early-career cardiologists were most likely to report a hostile work environment.
5. Organizational efforts to improve employee well-being and prevent BDBH should include: a) creating a culture of safety and support, b) providing education and skills training to help employees recognize BDBH and act as upstanders (bystanders who actively intervene), c) developing guidelines and procedures that prohibit BDBH and define consequences, d) providing data-driven longitudinal assessments of BDBH prevalence and reporting rates, and e) monitoring effectiveness of interventions. It is useful to view an anti-BDBH program as a quality-improvement initiative, incorporating continuing improvement cycles (i.e., plan-do-check-act).
6. An effective anti-BDBH policy may contain some or all of the following: a) definitions and scope, including illustrative examples as to what behaviors do and do not constitute BDBH; b) roles and responsibilities for policy enforcement; c) procedures for addressing harassment by patients, family members, and visitors; d) prohibition of retaliation against reporting individuals; and e) possibility of sanctions, up to and including termination.
7. Clinical, educational, and research programs that fail to address BDBH may be at risk for losing accreditation from the Joint Commission, Accreditation Council for Graduate Medical Education, US Department of Education, and National Institutes of Health.
8. The ACTION framework may help upstanders respond to microaggressions and racist or sexist comments: Ask clarifying questions, Curiosity instead of judgement, Tell the facts you observed, Intention versus impact, Own your thoughts and share your reactions, Next steps.
9. The cycle of improvement in hiring and promotions includes elements such as formal implicit bias training; improved learning and work environments; increased diversity of learners, workforce, and leadership; and equity in hiring and promotions among diverse people.
10. Within a “just culture” framework for responding to BDBH, there is a balance among enforcement, safety, and fairness, recognizing the potential for individual growth and learning. The level of consequences for BDBH behaviors should match the severity of the behaviors. For instance, a first-time minor offense may be addressed with informal coaching, whereas repeated egregious transgressions should prompt mandated review and disciplinary intervention.

Clinical Topics: Arrhythmias and Clinical EP, Cardiovascular Care Team, Prevention, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Stress

Keywords: Accreditation, Bias, Bullying, Burnout, Psychological, Cardiologists, Career Choice, Education, Medical, Graduate, Electrophysiology, Exploratory Behavior, Family, Freedom, Health Policy, Incivility, Leadership, Mentoring, Motivation, Patient Care, Quality Improvement, Racism, Religion, Respect, Secondary Prevention, Sexual Behavior, Trust, Workforce, Workplace

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