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Civility, Respect, and Engagement in the Workplace (CREW)

Rationale / Objectives

Bullying behaviours can originate from anyone at work (e.g., coworkers, supervisors, or subordinates); however, these behaviours have clear significant and adverse consequences not only for employees but also for organizations and society more broadly. Targets of workplace bullying report increased psychological distress and adverse physiological outcomes. Due to these impairments, targets are more likely to be absent due to sickness. Primary interventions are necessary in focusing on preventing the occurrence of bullying in the workplace. 

Project/Program Description & Major Achievements

CREW is a Veterans Affairs-wide culture change initiative. First launched in 2005 by the Veterans Health Administration (VHA) National Center for Organization Development (NCOD) in response to employee feedback that low levels of civility affected their level of job satisfaction, it has since been utilized by over 1,200 VA workgroups to establish a culture of respect and civility in their organization.

Lessons Learned

Research concerning situational characteristics that contribute to the occurrence of bullying may also provide fruitful avenues for future interventions. Factors such as role ambiguity, high demands, poor leadership, and perceived injustice influence the likelihood of bullying. As such, creating systems that can: ensure role clarity and reasonable workloads; offer leadership training that encourages supportive leadership styles; and generate policies to ensure fair and just treatment, decisions, and outcomes may all help to reduce the prevalence of workplace aggression and bullying. 

Further Description

Workplace bullying is detrimental to employees and organizations, yet in a meta analytic review of studies representing North America, Scandinavian, and other European countries, approximately 15% of employees report being victimized at work. Workplace bullying is defined as repeated exposure, over a period of time, to negative acts such as abuse, teasing, ridicule, and social exclusion.

CREW began in 2005 in the US Department of Veteran Affairs and involves a series of participatory exercises (e.g.,discussions, role plays), which are designed to cultivate awareness of one’s interpersonal impact in the workplace. A randomized control trial design of studies have reported significant improvements in the civility of workplace behavior, sustained across 12 months, and additional gains for job satisfaction, organizational commitment, trust in management, and job burnout.

  • Civility is an essential behavior of all employees in all organizations. These are the interpersonal behaviours demonstrated by valuing and being valued by others.These are guidelines for interaction among each other, our customers, and our stakeholders; established by the fundamentals of courtesy, politeness, and consideration. 
  • Respect ties in the personal, more intimate level of CREW. It reflects an attitude developed from deep listening and understanding, cultural and personal sensitivity, and compassion. It honors all the participants in an interaction by creating a safe place to have difficult conversations and leads to an environment of honesty and mutual trust.
  • Engagement is the result of respectful relationships within an atmosphere of trust. It provides all staff with the charge, parameters, training and the support to make prompt decisions in the best interest of the veteran being taken care of.

The objective of CREW is to improve the work climate through more civil and respectful interactions. In this intervention, trained facilitators meet regularly with identified groups for approximately six months with the intent to give the group the necessary time to focus on creating a respectful and civil work environment. Facilitators attend meetings with the employees prepared to facilitate discussions, encourage problem-solving efforts, and conduct exercises and activities that can help improve how the group participants relate to one another. The recurrent meetings provide a forum for discussions of how to improve the work environment as well as provide a place to practice the new standard of behaviors and ways of interacting in the work environment. The facility leadership, the workgroup’s manager, as well as the group members themselves, must be committed to and willing to engage in the process.  Civility levels at the participating sites were measured by an 8-item civility  scale. The scale measures aspects of workplace civility through employee ratings of personal interest and respect from coworkers, cooperation or teamwork in the workgroup, fair conflict resolution, and valuing of individual differences by coworkers and supervisor. The civility scale is a group of items originating from the voluntary, anonymous VHA All Employee Surveys (AES), administered in 2004 and 2006 and yearly thereafter.

Major Achievements

The purpose of CREW was to increase employee-rated workplace civility at the participating sites. The main conclusion of this study is that this purpose was achieved, as is demonstrated by significant improvement of employee civility ratings from preintervention to postintervention surveys at sites that had the CREW intervention.


Table 1. Relationship between Civility and Patient Satisfaction in Inpatient Care

Metric Result
Patient satisfaction percentage for high civility workplace 79.94%
Patient satisfaction percentage for high-moderate civility workplace 79.02%
Patient satisfaction percentage for low-moderate civility workplace 74.88%
Patient satisfaction percentage for low civility workplace 71.30%

The by-products of CREW-targeted culture change were: (a) employees’ conscious awareness of the importance of civility at the workplace and (b) employees’ understanding of a connection between acting civilly and effectively carrying through the VHA mission (to provide excellent health services to the nation’s veterans).