Getting Rid Of The Bullies With Renee Thompson
Various reports claim that bullying is rampant within the healthcare industry, especially among nurses, and this leads to instability and incivility. Renee Thompson has experienced this problem herself, and now she is taking a stand to get rid of the bullies once and for all. Joining Sean Olson, the author and owner of Healthy Workforce Institute discusses how to properly address bullying within the healthcare sector to provide better quality care and build positive workplace cultures. Renee also explains how to handle uncomfortable conversations that lead to better teamwork, the importance of taking small steps when making big decisions, and how beneficial it is to hire your own business coach.
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Getting Rid Of The Bullies With Renee Thompson
Welcome to the newest episode of the show. I’m glad that you are here with us. Be sure to hit that subscribe button so you know every time a new episode comes out. The show is where you read about the real stories of normal people like you who become extraordinary leaders. You’ll learn some valuable lessons from their lives, lessons you can apply to become the best leader you were created to be. When you become an intentional leader, lives are changed.
I’m glad to have you here. We have a wonderful guest, Dr. Renee Thompson. She is a nurse who got a good taste of the industry and realized that she wanted to really tackle the issue of bullying and incivility in the healthcare industry. As a result of that, she’s a Business Owner of the Healthy Workforce Institute and an author. You’re going to love her and her story, and the impact that she’s having. This goes way beyond healthcare, which is where her focus is. This is in life in general no matter where your job is and even in your families.
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Dr. Renee Thompson, welcome to the show.
Thank you so much. I’ve been looking forward to our conversation. I always think about the reader who really needs to know this at that moment. I can’t wait for our conversation to talk about my journey and trying to tackle this age-old problem that we’ve seen in healthcare. I appreciate that you said even if you don’t work in healthcare. These same principles apply outside of healthcare. It’s the same principles.
Looking Back
Readers, you know that life is about relationships and networks. Renee and I met a couple of years ago. Ironically, when we both wrote our first books, we had the same book coach. That’s how I became aware of who Renee was. My company does work in healthcare. Her company does all the work in healthcare. We have crossed paths over some conferences and saw one another a few months ago down in New Orleans, Louisiana, at a great conference. You’re familiar with our show. We open up with the same open-ended question. We want to get to know Renee and your professional path, but with that professional path, the leadership lessons learned along the way. Tell us about Renee.
I have been a nurse for 32 years. I always say I’ve done everything you can do as a nurse. You started out at the bedside as most nurses do. I always got to a point where I wanted more or I thought, “What else could I do?: I’m one of these people that as soon as I master something, it’s not to say that I get bored. You work in healthcare. There’s no boredom there. There’s always something, but I thought, “What else could I do?” I started working in home care. I thought, “Let me try that.”
I was a home care nurse for a while, and then I got lured over to a managed care company. I moved over to the dark side. I started working for a managed care company. I learned more about the delivery of healthcare in that role. I was a quality manager. I did case management and comprehensive disease case management. I did a lot. I learned more about how healthcare is delivered from that managed care company than any other role that I had in healthcare. It really helped me to see things from that 360 perspective.
After I was in that role for a while and mastered that, I really missed patient care. I missed being in that patient environment. What I wanted to do was become an educator. I was in a Master’s program to get my Master’s in education. I remember I heard about these education positions at this one hospital near where I lived and I applied. They said, “You don’t have your Master’s yet so you can’t be in education, but we had this great unit director role.” It was being a nurse manager of a department. I thought, “Being a leader in the department? Sure. I’ll do it.”
I became the manager of a 35-bed unit and found out very quickly that I was responsible for a department that had the worst reputation in the entire 700-bed hospital. I was the 6th leader in 6 years. I had never seen such horrific behaviors from adult professionals in my entire life. I lasted fourteen months. I became manager number seven. From there, I left. I went back to the bedside and did that for a little while. I then became an educator. I got my Master’s and did some education. I ended up in a corporate position. I was in a leadership role.
When I left that frontline manager role, for years, I felt like a failure. I was like, “I’m not good at leading people because I was not successful.” I then got older and wiser as we all do and realized, “I’m not a failure. I’m smart. I can learn. I wasn’t equipped.” I decided that I never wanted another leader to feel like a failure like I did.
After I was in a corporate role for a while, I decided to quit a job that I love to start my own company with the intention to really eradicate bad behavior by equipping leaders and their teams with the skills and tools that they needed to address it. I started this company. Here I am almost thirteen years later, the CEO and founder of an institute. If I take a look back, I’m like, “How did I get here?”
Leadership Lessons
I want to jump backward for a second on some of this because there are some good leadership lessons in here. The first thing I heard that stuck out to me was you went to that organization looking to be an educator. They said, “Not yet,” because you didn’t have a credential, but they opened up another door and you stepped through it. That is so crucial for leaders, especially aspiring ones. You were early in your career, right?
That’s right.
We think, “This is what I want to do. I’m going to go after this. If this job isn’t exactly what I want, I’m going to walk.” You didn’t. That took some humility and vulnerability. Can you talk to us about your mindset when you decided to take that role?
I remember sitting there talking to someone else I knew who worked in that organization as a frontline manager. I will never forget this. We had dinner together. I said to her, “I want you to talk me into taking this position, and I want you to talk me out of it,” because I really wanted to hear both sides. Even though 1 might think it was a mistake having that role because I failed, I was not successful, and I quit, there are 2 considerations here.
First of all, especially for all of you who are reading, it takes a little bit of humility. Maybe you’re like, “They want me to do this. I hadn’t even considered that.” One of the things that has helped me to go from being that brand-new bedside nurse to being the CEO of a company is that I’ve always been a risk taker. I’ve always thought, “Other people do this? Why can’t I?”
Even if a position is not the right fit for you, try to learn what you can. It will help you perform better in your next role.
I also know that even if it’s not the right fit, I’m going to learn something that’s going to help me with that next role. That was how I looked at it. If I would not have been in that role, I would not be doing the work that I’m doing now. It was a gift to me to have that experience so that I can be more credible to the leaders who I’m working with to say, “I know how you feel.”
I didn’t know what to say to these people at 2:00 in the morning when I was getting a call that they were huffing, puffing, stomping down the hallway, or threatening each other. I didn’t know how to handle it either. Now, I do because I had that experience. If you are considering a leadership role, and you said I wanted to go through this door and it wasn’t open, so they opened a different door, it’s about taking a calculated risk. Know that even if it’s not the right fit for you, what can you learn that’s going to help you and apply that learning to another role?
One of the things that we talk about in our coaching all the time is we will make mistakes. We’re human. It’s going to happen. If we learn from them, it’s just a mistake. If we don’t learn from them, it becomes a failure. I’m going to challenge you for a second. I don’t think you failed in those fourteen months. There may have been some mistakes in there and things. Those fourteen months, I love how you said those were instrumental in bringing you where you are. What were the two leadership lessons you received in those fourteen months? Whether from good news or bad news, mistakes or otherwise, what were your two leadership lessons?
There were clinical issues. Some of my nurses were not competent. It was clear that we were not providing high-quality care. It was clear that the way they treated each other was awful. The unit itself was ugly there. The walls were drab. It was dirty. It never looked clean. There were no pictures on the walls. It looked like gloom and doom when you walked in.
The mistake I made was I tried to tackle everything at the same time. I tried to make the department pretty. I had somebody come in and paint. We got pictures. I had the housekeeping. This has not been cleaned in ten years. You could tell. I tried to do that. I tried to work on the clinical issues. I tried to work on the behavioral issues, but because I wasn’t equipped, I didn’t even know how to do that. I did not prioritize.
A leadership lesson learned is when you step into a role in a department, a company, or whatever that is, give yourself some time to really assess all of the issues and then prioritize them. I should have been focusing on my clinical outcomes and quality care and starting to tackle some of those behavioral issues. Worry about making the department pretty later. That was certainly not above some of the other issues. That’s one of the hardest lessons. I share that with a lot of people when I know they’re starting in their roles. Take some time. Don’t make any quick decisions. Assess.
The second lesson that I learned is that it's important for the leader to have uncomfortable conversations with their team. I was so afraid of telling my nurses or my PCTs, Patient Care Technicians, and giving them constructive feedback. I didn’t know how to do that. I didn’t know how to do it. It was during the last nursing crisis that we had. I was afraid if I said anything to them, they would quit on me.
I did what was comfortable for me. I used silence as a strategy. I did not address it, but then I would talk about them to my colleagues like, “I cannot believe her.” I talked to my friends like, “Can you believe this person did this?” I wasn’t willing to have honest conversations with my team when I saw or heard very negative behaviors and performances. We have to, as leaders, have to get comfortable being uncomfortable and having honest conversations with our team.
Uncomfortable Conversations
I agree. What I like in how you shared that was you articulated there were a few different things that put you in that box. You talked about the fear because of where the workforce was. It was a semi-nursing crisis. You didn’t want to perpetuate it. You talked about the fear of not knowing what to say or how to have that conversation effectively. We all have our different reasons. Some people are fearful or people-pleasers. They’re like, “I have to make everybody happy, so I’m not going to give them real feedback and such.”
To the audience, I want you to understand that no matter what the fear is because there are 15 to 20 different types of things causing you to not have these conversations, the conversations are a gift to you and a gift to them when you do it from the right place. Meaning, your heart’s got to be right. If your heart’s right, it works.
There’s a book that I highly recommend if this is something that you struggle with called Radical Candor by Kim Scott. It is about how you have to care enough about people to tell them the truth. Many of us leaders are people-pleasers. I’m one of them. However, it’s having the courage to sit down with someone and be incredibly honest with them under this umbrella of respect. It’s like, “I’m telling you this because I care about you and I care about our team.”
Bullies: Radical Candor.
It’s a psychological reality that exists in all human beings that we avoid pain. It’s part of our survival. Confronting someone, especially if you’re concerned about how they’re going to react, like, “Will they retaliate against me?” is painful, so we avoid that conversation. What I encourage anyone who’s reading to do is when you feel that uncomfortableness like I feel it in my gut, it’s to say, “This is normal that I feel this way. I’m going to have that conversation anyway because it’s an important conversation to have.”
I work with mostly leaders. I cannot tell you how many conversations I’ve had with leaders about their reluctance, to be honest with their team. If you give them the tools like, “This is how you have the conversation. This is when you say it, how you say it, and how you follow up,” they’re more willing to do that. It’s so easy.
We coach on that regularly. It’s interesting. What I’ve found is we’ll prep them for a difficult conversation, they’ll go have it, and then we’ll talk afterward in the next coaching session. The leader’s evaluation of whether it was successful is how it was received by the other person. If they were happy with what they heard, that’s not the measure. The measure is did they hear you? Do they understand what they need to do differently? Can you take them down that path? That’s a people-pleaser side of how they received it. You can’t judge it by how it’s received. You judge it by the results it brings.
I’ve had many conversations myself with leaders who finally sit down and they have an honest conversation with one of their employees. I’ll never forget this one manager. She finally sat down with an employee who was pretty tough. This employee stormed out of her office and was angry about it, but then circled back three days later and said to her, “I’ve given this a lot of thought. You were right. I apologize for how I reacted.” I was like, “That’s the win right there. Let’s circle back.”
You need to see evidence that they’re going to adapt their behavior after. It might not just be one conversation. That’s one of the common mistakes leaders make. They think one conversation changes someone’s behavior. Most of the time, it does not, so it’s the follow-up with that employee. That’s where the change will occur. It is over a series of conversations. You do have to get to a point where you’re like, “We’ve had 57 conversations about this. I haven’t seen any improvement.” That's a different conversation.
Healthy Workforce Institute
Let’s pick back up on your story. You started the Healthy Workforce Institute. What were you seeing in healthcare that was that painful driver for you, and why did you think you would be the one to begin to address it through the institute?
It was an a-ha moment. When I had this corporate position, I was responsible for the professional development of about 10,000 nurses. It was student nurse experience, new nurse residency program, preceptor program, certification, advanced degrees, and all of that. I found myself doing a lot of focus groups with nurses, students, new nurses, preceptors, all of them, and speaking to a lot of audiences. It was really taking a look at what they needed to be successful so that we could revise our programs and develop development opportunities, but all they wanted to talk about was how badly the other nurses treated them. It reminded me of my own experiences.
When I was a new nurse, I was bullied by someone and almost quit. I remember the conversation was, “That’s the way it is in nursing.” I thought to myself, “We have been saying this for a century.” At that moment, I said, “Enough is enough. We’ve been talking about it forever. Nobody’s doing anything about it. I’m going to do something about it.”
I started really speaking about it. I’ve found myself in front of large audiences. People would always come up to me after and say, “Are you a professional speaker? That was the best presentation.” I’m like, “No. I get on stage and talk.” I’ve worked in education so I know how to deliver a message. I thought, “Other people do this. Other people are speakers. Why not me?”
I took a leap of faith and quit that job to start the company with the intention of addressing bullying and incivility because I had seen my share of badness and decided to do something about it. From there, it was speaking and then people wanted more. You expand your speaking to workshops and seminars. I started hosting our own events and then developed our academy. We have a lot of online programs. Most of them are a hybrid program. We do a lot of consulting. We’ll go into an organization. We’re hip-to-hip with their leaders and their entire team. It expanded from there.
Books And Bullying
Your first book was Do No Harm. I assume that came out of the workshops you were doing and some of the content you were creating. I know that had an impact. Your newest one is Enough!, which I know has a longer subtitle. What’s the actual full title of Enough!?
It is Enough! Eradicate Bullying & Incivility in Healthcare: Strategies for Frontline Leaders. The Do No Harm book is Do No Harm Applies to Nurses Too! Strategies to Protect and Bully-Proof Yourself at Work. That was the work that I did in my doctoral program where I taught senior nursing students how to protect and bully-proof themselves before they started their first job. Also, I wanted to make sure that I was addressing the new generation of bullies coming into healthcare. I wanted to make sure they didn’t become the bullies. That was really focused on that nurse dealing with another nurse at 2:00 in the morning who was being incredibly disruptive.
When I wrote Enough!, that was the book I wish I would’ve had when I was a leader. In chapter one, I talk about the experience of being a brand-new frontline leader and how challenging it was for me. I always say If I had had that book when I was that leader, I wouldn’t have made the mistakes that I made, but then I wouldn’t be doing what I’m doing.
It’s all an evolution in how we grow and how we receive things. What I like about that title and the transition in the 2 books is how the first 1st is really focused on you and what you need to do for you. You didn’t use the word armor or shield. That’s almost what I was envisioning, to protect myself from that. The second one is you’re a leader. What are you going to do about this? If you accept it, that’s on you. Indirectly, you become that bully, don’t you?
You do by being a bystander. It’s what it is. If you don’t speak up, you're a witness to it. You’ve become a bystander. We know that there are more people who witness bullying and incivility than experience it. I always give this example. You’re walking down the hallway and all of a sudden, you overhear and see Tina screaming and yelling at Amy. What do you do? You turn and go the other way. You’re thankful that Tina’s not screaming or yelling at you.
Instead, we need to walk right up to Tina and say, “Time out. You’re screaming at Amy. You need to stop.” Especially if you’re the leader, that is your responsibility to address any incident of disruptive behaviors in your organization. Recognize that we all have a responsibility because even if you are a witness today, you could become a target tomorrow.
That’s exactly what I was going to say. It’s this thing we think about. Your Tina and Amy thing, it’s like, “At least it’s happening to Amy, not me.” If you accept it, it will come to you eventually. They’re not going to stop because they don’t care about titles, positions, and people. That’s why they’re doing it that way.
Unfortunately.
Pain Points
You’re doing a lot of consulting with the Healthy Workforce Institute. I know a majority of it’s still in healthcare, but it applies in every other realm. What are these organizations coming to you with as their pain points, and then what are some of the things you’re consulting around in that?
Healthcare organizations will reach out. The story usually is they have a department or sometimes, it’s the whole service line. Our two most popular service lines are maternal child health, which are labor and delivery, NICU, and postpartum, and the other one is surgical services. You have the PACU and OR maybe the same day where they either get some data when they’ve done some type of pulse survey, employee engagement, or do their own survey and they’re looking at things like retention, turnover, and the feedback they’re getting from their employees. The feedback is that bullying and incivility are rampant.
They’ll reach out to us and say, “Here’s our problem.” We, through a conversation with them, really try to get to, “What’s really happening? What’s the impact? Why is this important for you to address now?” Usually, what we hear is that they can’t keep people there. I remember having a conversation with somebody not too long ago who said they even brought in an experienced nurse in a specialty department. They’re hard to come by. She lasted six weeks because she said, “I cannot believe you people tolerate these behaviors. I’m not willing to tolerate this. I’m out.” She left.
Usually, by the time they reach out to us, their pain point is 10 out of 10. I often think, “I wish you would’ve come to us sooner or earlier. We could have stopped the bleeding if we could have intervened earlier.” Usually, what we hear from our clients is that they receive information that shows bullying and incivility are happening and they’re losing people because of it.
It’s huge. When I think about the non-healthcare corporate culture, the word is different. They don’t use the word bullying. They might use incivility. It’s more of that toxic person. No matter what word you use to define it, it’s there. It’s there in every workforce. It’s present in communities. It’s present in families. It still comes back to people skills of how we handle and deal with people.
An interesting thing, and I’m sure you run into this so I’d be curious to hear, is when we’re coaching organizations and coaching leaders, we hear them talking about these different pieces. They’ll talk about that person. They can identify, “This is the person that’s causing all these problems.” They always say, “I can’t do anything about it. I can’t fire them. I can’t move them.” I’ll always simply say, “Why can’t you?” They can never really define it.
Podcast
Sometimes, they’ll have something like, “With HR, we got to go through all these different steps and do all these different things.” It’s the phrase that we use, “Choose who you lose.” You can choose to do something about that bully and get rid of them, or if you don’t, like that specialist nurse, and you choose not to do anything, you’re going to lose all stars. As a leader, you choose who you lose. I know with your consulting, you’re making an impact in that. I also know that you yourself have your own podcast. What is the name of that? What’s the purpose of it? What are you doing there?
It’s called Coffee Break: Breaking the Cycle of Bullying and Incivility in Healthcare One Cup at a Time. What we focus on is how to address workplace bullying and incivility so that you can cultivate a healthy, respectful, professional, and kinder work culture. We focus primarily on leaders in equipping the leaders with the skills and tools that they need.
We have found that you also need to equip the people on the front line. Whether you’re in healthcare or not, your employees need to be equipped too. If they’re equipped and their leader is not, you will never cultivate a healthy work culture. You’ve got to start with the leadership team and then you equip your employees. That’s what we do on the podcast. We talk about how to address disruptive behaviors with leaders.
You will never cultivate a healthy work culture. Start with the leadership and equip your employees with the right mindset.
How frequent is that?
We release a podcast every Wednesday morning.
Is that teaching content? Do you have guests? What’s the approach to it?
75% of the time, I am interviewing another leader. We’ve had nurse executives. We’ve had a chief medical officer. We’ve had a chief wellness officer. We’ve had some physicians. We will interview executives. We’ll interview nurse managers at the front line. It’s all people who work in healthcare, at least for now. Sometimes though, I’ll do a solo. I did a solo where I talked about graduate nurses and how we’re losing them. The turnover rate for new graduate nurses is through the roof. I talked about this. I did an episode. I was like, “I need to get this message out.” I’ll mix it up and do a solo act every now and then.
Business Coaching
I want to transition for one second because I know a lot of our readers are entrepreneurs and solopreneurs. Building a business is huge. You’ve been building the institute. Talk to us for a few minutes about how the institute has grown, what your reach is with your work, how big your team is, and the business owner side for a little bit.
It’s been an interesting journey. I’m a good nurse. I’ve done cardiac and neuro. I’m a good educator. I’m a good speaker. I then decided that I wanted to start a company, and that’s completely different. I’ve had to learn how to become the CEO of a company. It started with me. I hired a graphic designer to help me with my logo and branding. She’s still with us. It will be thirteen years at the end of May 2024 that we’ve had this company.
My husband was in law enforcement. He retired to help me because he was coming home from work and helping me with the business. We’re at twelve people. We have a core team. We have two 2-time employees, and then we have 4 consultants who speak and do the consulting work with me. We’re a team of 12, soon to be 13. We’re hiring a program manager. It has really grown organically.
One of the key strategies for me that I would encourage anyone who’s reading and is either starting their own business, has their own business, or aspiring is that I’ve always had a business coach. I’ve always sought coaching because I’ve never done this before. I wanted to not make all the mistakes and then learn from them. I wanted to learn from other people’s mistakes. I’ve had different coaches because as I’ve evolved, my coaches have evolved.
I’ll give you an example. I had a call with my business coach and we talked about finances. I’m learning how to forecast the next twelve months to see, “Can I hire someone else? What will that do to my bottom line revenue?” We talked all about that. How do I not look in the rearview mirror and say, “Accounting and bookkeeping, this is the revenue we brought in,” but look ahead to say, “Are we healthy 6 months from now and 1 year from now?” I wouldn’t have been able to figure that out on my own. I could have, but having a business coach helps decrease the learning curve.
It does. That’s the aspect of leaders are learners. We always have to be learning, listening to podcasts, and talking to coaches. As an executive coach, I’m big on coaching and you coaching your realm and things like that. I also want the audience to understand that there are different coaches for different things even though it may sound the same.
For instance, somebody may say, “We are a business coach at Recognize Professional Coaching.” We talk to people in businesses, but we’re there truly about their leadership. Who are they as a person? How are they gifted? How are they leading? How can they lead more effectively? We’re zeroed in on that for their personal leadership leading themselves as well as their people, their teams, their families, and their lives.
You’re in there and you’re coaching people around how to create a certain culture and how to deal with bullies and things like that. The business coach you talked about who is on the finance side, they have them around strategy, marketing, and all these different things. There are so many people out there who can really share their wisdom and save us from making all the mistakes, but we have to be open and say, “I’m willing to learn. I’m willing to invest in myself for the good of our organization.”
One of the healthiest strategies that you can make is finding someone who you can hire as a coach. I love how you said you have different coaches for different things. To start a business is one thing, but to grow and scale that business and still have a life is another thing. This is one of the commitments that I’ve made to my coach for 2024. I’m getting a little nervous about it. I committed, so there’s no going back. He encouraged this. I am going on vacation in July 2024 and I’ve committed to not working on vacation.
Bullies: Hiring a business coach is one of the healthiest strategies you can make. It will allow you not just to start a business but scale it while still having a life.
I’ve had this business for almost thirteen years and I’ve never not worked on vacation. I use that, “I’ll work for a couple of hours in the morning before everybody else gets up or before my husband gets up.” I am not working on this vacation. He’s holding me accountable for that. I highly recommend finding a business coach or any coach depending on what you’re looking for as an outcome. It has really been instrumental in my growth.
That’s great. Part of that is putting good people around you. It’s going to be easier than you think. You’ve been there, done that a few years ago for the first time.
I’m nervous. What am I going to do?
It’s going to be good, and here’s why. I’ve met a couple of people on your team at the conferences, but I don’t know your team. You have full faith and confidence in them. It’s going to be okay. For most businesses, there’s not any emergency that can happen. I’m saying this to entrepreneurs. My wife and I, in the same vein when we started our business, said, “We will own it. It will not own us.” We’ve stuck to that. I’m fortunate with the executive coaching work and corporations, we’re a “business week.” You’re 8:00 to 5:00 from Monday through Friday. Maybe one weekend a month, I open my computer.
I want to be you in the near future. That’s what I’m working on.
Stuff is always there. We’ve got to pick it up. I’m glad your business has been growing.
Thank you.
We always finish with the same question at the show because we like those quick, intentional tips. What is something our audience can do intentionally to lead more effectively?
It’s one of my simple and practical but powerful strategies. I call it my bookends. As a leader, you only have control over two times during your workday. It’s what you do when you first walk into work and what you do on your way out. Anything in between is a crapshoot. You never know what you’re going to get. You may think your day’s going to go this way but it goes another way.
Connect with one of your employees in a meaningful way on your way to work. As you’re walking through your department, or if you’re not in a department like I’m thinking in a hospital or an ambulatory care center, connect with 1 of your employees at the start of your day and 1 of your employees at the end of your day. Have a 30-second or 1-minute conversation like, “How are you? How’s your mom?” Bring in something for that personal connection. Everything we do is about the relationships that we have with each other. That helps you to build a relationship with your team. It also helps you to put your team first. Do it on your way in and on your way out. That’s it. That’s my tip.
Episode Wrap-Up
I love the tip. To the audience, put that into action. Renee, thank you so much for joining us on the show. We hope that everything keeps growing for you at the Healthy Workforce Institute because it’s having results that are cutting the bullying out. Readers, thanks for tuning in. We’ll catch you in the next episode.
Thanks.
Important Links:
Enough! Eradicate Bullying & Incivility in Healthcare: Strategies for Frontline Leaders
Do No Harm Applies to Nurses Too! Strategies to Protect and Bully-Proof Yourself at Work
Coffee Break: Breaking the Cycle of Bullying and Incivility in Healthcare One Cup at a Time