Angry patients, safer teams: How health care employers can respond to incivility

Rude, angry and sometimes violent patients are an everyday hazard in health care, and the strain doesn't stay at work.

The June 2026 TELUS Health Mental Health Index found 21% of U.S. workers say their mental health is hurting their productivity. Workers who believe their employer cares more about productivity than their well-being scored 60.1 out of 100, compared with 75.0 for those who believe it cares about both. Only 49% would feel comfortable telling a manager about a mental health issue.

Paula Allen, global leader of research and insights at TELUS Health, a global health and well-being company, said employers should track incivility, not just violence, and train staff to de-escalate. She spoke with Medical Economics about employee assistance programs (EAPs), support for independent physicians and why a supervisor's response after an incident matters.

This transcript has been edited for length and clarity.

Patient safety is paramount in health care, but so is workforce safety. Some encounters have escalated beyond rudeness and incivility to physical confrontation. What should employers be doing?

Paula Allen: I agree with you 100%. This is about psychological safety in the workplace, and there are many dimensions of it. The interface with the public is part of that, and it is getting more difficult.

There's also physical risk, which is another part of being a frontline health care worker: your own exposure, even with proper protocol, lifting or blocking patients who get angry or upset. If you talk to anybody in an emergency room situation, or somebody who is dealing with an elderly population, the physical [risk] is quite real on top of everything else.

One of the reasons why we publish different statistics by industry in the Mental Health Index is that one's exposure to risk is different based on your industry. That means no blame to anyone. It just is what it is. I think it is important for people to be as equipped as possible, and for employers to be as supportive as possible in helping to manage those risks.

For example, with the issue around incivility: Track not just incidents of violence, which most facilities would do, but also incidents of incivility, making sure that there's an understanding of patterns. Is there anything from a systemic or procedural point of view that might help de-escalate? But also train individuals on how to deal with those situations, and repeat that training. When somebody is feeling hostile, how do you bring that down? How do you make sure that you are protecting yourself and stepping away when you need to? Where do you go for support if you feel overwhelmed? It's quite difficult to go through a very rattling incident and then serve another patient immediately without some process change.

Very unfortunately, all of those things are becoming more and more critical in most environments, but in particular in the health care environment, given that you're often dealing with people who are not in their best frame anyway. When people are in a situation of pain and fear, you're generally not going to see the best of them.

Is that type of training and support available in health care right now, or could it be better?

Paula Allen: It's definitely available. In our organization, TELUS Health, we do this kind of training. Others do it as well. I'm not prescribing where you get it, but one of an organization's first steps might be to go to its employee assistance program to help with that.

One thing that the employee assistance industry is outstanding in is understanding crisis and how to help people deal with different levels of crisis, from incivility right up to a major incident, and how to protect themselves in terms of mental preparation. If this is an ongoing part of the job, you do need to understand that and inoculate on it. In many instances, police officers have to go through that same kind of inoculation training because of what they face. So helping people understand and start that preparation before there is an incident is really important, and that "before" could be at any point: the start of your career or, if you're long in your career, before the next one happens. But also helping you. If there is a widespread situation — somebody comes into a ward or an individual's office with a weapon, for whatever reason, somebody is trying to steal medication and is violent. There are all sorts of examples that could be traumatizing to a group, and we help with the group, as well as following up with individuals. Maybe it is something that impacts just one individual, and they have the opportunity to contact their employee assistance program for support.

If you are an independent practitioner, one of the things that I would look at is your association, because most do have member assistance programs, which are exactly the same as what I'm describing as employee assistance programs. That support can be available to you. If you're working for a health care facility, more likely than not you have an employee assistance program for yourself. And if you are a leader, there is opportunity for you to bring in support for your teams.

What role do physician leaders and other team leaders play after these incidents?

Paula Allen: We were talking about the lack of civility. Unless people feel tremendously supported and have really good tools to help them deal with, and to a healthy extent compartmentalize, what's happening to them, they're going to take that home as well, and that's going to come back into the workplace.

We find that leaders are really important. Think about a situation where you are disrespected, or there is a threat of violence from a patient or a family member. You handle it, and you move on. You tell your supervisor what happened.

Situation A: The supervisor interrogates you in a manner that makes you feel, "What did you do wrong to make this happen?" and subtly or not so subtly threatens you that you'd better not see this happen again. You're retraumatized.

On the other side, your supervisor empathizes with what you went through. They make sure, first and foremost, that they understand how you're doing and what you need from them to be supported. Maybe it's a recommendation for EAP, maybe it's not. You work together on skills, on the things you did that were helpful, because you did de-escalate it. They're focusing on you as a person, a human being, and essentially building your strength.

You're going to have two very different outcomes as a result of that supervisor's behavior. So it is really important that leaders of teams understand that part of their job is to do no harm and to make things better in difficult situations. Training it, as well.