An entrenched culture of workplace bullying and harassment within the healthcare sector is taking a toll on the wellbeing of employees and is having a serious impact on the effectiveness of health services.

An entrenched culture of workplace bullying and harassment within the healthcare sector is taking a toll on the wellbeing of employees and is having a serious impact on the effectiveness of health services. The clamour for more concerted action to tackle unacceptable behaviour is growing

Bullying within the workplace can take many forms, including verbal, non-verbal, psychological or even physical abuse. It can involve rudeness and constant arguments as well as unacceptable criticism and situations where people are overloaded with work, ignored or isolated from others. It not only has a detrimental effect on people’s wellbeing but on their work performance as well. And that’s when it becomes a major issue for both healthcare services and patient care.

In recent years the focus of bullying has moved beyond the schoolyard and internet into the workplace, with particular emphasis on people working in healthcare settings. Although there are, as yet, no studies of bullying in the dental sector specifically, the issue is highlighted in a number of healthcare-related studies and surveys in the UK and Republic of Ireland, which include feedback from dentists.

The issue of bullying was described as ‘endemic’ in the Health Service Executive (HSE) by the Medical Council, which published the results of a survey in 2017 that showed one-third of trainee doctors at all levels said they were bullied or undermined. What was surprising about the research was that the most junior doctor had a greater risk of being the victim of another trainee medic compared to a senior consultant, although this did occur.

The doctors’ union, the Irish Medical Organisation, the Irish Postgraduate Training Forum and the HSE signed a new Respect Charter in 2017 in a bid to deal with the problem of bullying and undermining behaviour being experienced by young doctors. 

Following the 2018 Health Sector National Staff Survey, which showed that 42 per cent of staff said they had experienced bullying and/or harassment in their organisation in the past two years, the HSE launched an anti-bullying task force to develop a range of measures to root out bullying, including the launch of an Anti-Bullying Awareness Day in February. In this staff survey, 29 per cent said they had experienced bullying and/or harassment from colleagues while 24 per cent said they had experienced it from service users.

This concern is mirrored across the Irish Sea, where the British Medical Association (BMA) said that bullying and harassment are causing lasting harm to doctors and have a detrimental impact on patient care and safety.

The results of the 2017 National Health Service (NHS) England staff survey showed no substantial movement from the previous year in the measures of bullying, harassment and abuse against staff, whether by patients and relatives (28 per cent) or by managers and other staff (24 per cent). 

Of the 30,000 doctors and dentists who responded to the NHS England staff survey in 2016, 24 per cent reported that they experienced some form of bullying or harassment in the preceding year: 13 per cent of doctors and dentists said they had been bullied or harassed by their manager, while 16 per cent said they had been bullied or harassed by another colleague.

In Northern Ireland, the 2015 health and social care staff survey showed that 12 per cent of employees had experienced harassment, bullying or abuse from their manager, while 16 per cent say that they had experienced it from other colleagues.

Despite the serious impact on healthcare services there is no law specifically against bullying. However, under the UK’s Health and Safety at Work Act 1974, and the Republic of Ireland’s Employment Equality Acts 1998-2008 and the Safety, Health and Welfare at Work Act 2005, employers do have a duty to ensure the health, safety and welfare of their employees, which can be compromised bullying and harassment.

Bullying may be characterised as offensive, intimidating, malicious or insulting behaviour, an abuse or misuse of power through means intended to undermine, humiliate, denigrate or injure the recipient. Harassment relates to unwanted conduct affecting the dignity of men and women in the workplace. It may be related to age, sex, race, disability, religion, sexual orientation, nationality or any personal characteristic of the individual, and may be persistent or an isolated incident. The key is that the actions or comments are viewed as demeaning and unacceptable to the recipient.

In the workplace, bullying and harassment can come from managers to their subordinates or from individual colleagues or groups of people, but patients can also present bullying behaviours, particularly if their expectations have not been managed and they threaten legal action. 

The various healthcare surveys show that very few people subjected to bullying and harassment formally report it. In its recent report on workplace bullying and harassment of doctors, the BMA highlights factors identified as likely to lead to a bullying culture, such as autocratic, target-driven management styles, poor job design, work intensification, and pressures arising from restructuring or organisational change, especially when radical and top-down. 

Another factor they raise that can lead to a bullying culture is the hierarchical nature of the medical profession which, along with workload pressure, can increase the likelihood of ‘silent bystanding’ – a failure of colleagues to speak out – which allows bullying behaviour to continue unchallenged.

It must be recognised that some people, particularly managers, may not realise or perceive that they are behaving like bullies and that their conduct is seen by others as unacceptable. They are often highly competitive and successful people who thrive in a different work value system and may not be conscious of the sensitivities of the people they work with.

The stresses at work can also cause people to behave differently, and that behaviour becomes reinforced until it becomes ‘acceptable’ and part of the culture in the healthcare setting. That is why it is important for people to respectfully challenge these behaviours and make it clear to the ‘bully’ that their behaviour is unacceptable.

On its website, the NHS advises people who believe they are being bullied at work to first seek informal advice from a trusted colleague in order to discuss how they might deal with the problem – by sharing experiences with others they may discover that it is happening to other people too.

Other people to consider raising the issue of bullying with include a manager or supervisor (if that is suitable), someone in the organisation’s human resources department or an employee representative, such as a trade union official. If the bullying is affecting someone’s health, then they need to visit their GP.  

A checklist to help you think about how your behaviour might impact on others

Source: www.rcsed.ac.uk

• Do you listen to the other members of your team or do you do all the talking?
• Do members of your team come to you with ideas or suggestions?
• Does your sense of humour involve jokes that could be racist, homophobic or sexist?
• Do you feel that ‘you had it tough so they should too?’
• If you are senior, do you use your position to offer mentorship or do people go to others for this?
• Do you always apologise to someone if you lose your temper?
• Have you written derogatory comments about someone on WhatsApp, Facebook or Twitter?
• Do your colleagues look you in the eye?
• Do you ignore any of your colleagues?
• Do you blame others for problems that occur?
• Do people speak freely in your theatre/clinic or do you dictate how people behave?
• Does banter form a big part of your interactions with others?
• Have you ever fired off an angry email?
• Do you prefer to email colleagues about difficult situations, rather than discuss things face to face?

Examples of bullying behaviour

Source: www.rcn.org.uk

• Sadistic or aggressive behaviour over a period of time
• Excluding people from meetings for no good reason
• Humiliating or ridiculing others or criticising others in public
• Persistent, unwarranted criticism of others in private
• Treating colleagues as if they were incompetent
• Changing work responsibilities or academic assignments unreasonably or without justification
• Regularly changing work deadlines or work guidelines without warning
• Deliberately withholding information to affect a colleague’s performance
• Withholding support in the academic environment or workplace
• Cyber bullying conducted via social networking channels.

This list is not exhaustive: remember, bullying is any behaviour that is unacceptable to you or makes you distressed.

NHS Advice on dealing with a bullying situation:

Be strong

Recognise that criticism or personal remarks are not connected to your abilities. They reflect the bully’s own weaknesses, and are meant to intimidate and control you. Stay calm and don’t be tempted to explain your behaviour. Ask them to explain theirs.

Talk to the bully

The bullying may not be deliberate. If you can, talk to the person in question, as they may not realise how their behaviour has affected you. Work out what to say beforehand. Describe what’s been happening and why you object to it. Stay calm and be polite. If you don’t want to talk to them yourself, ask someone else to do it for you.

Keep a diary

This is known as a contemporaneous record. It will be very useful if you decide to take action at a later stage. Try to talk calmly to the person
who’s bullying you and tell them that you find their behaviour unacceptable. Often, bullies retreat from people who stand up to them. If necessary, have an ally with you when you do this.

Make a formal complaint

Making a formal complaint is the next step if you can’t solve the problem informally. To do this, you must follow your employer’s grievance procedure.

What about legal action?

Sometimes the problem continues even after you’ve followed your employer’s grievance procedure. If nothing is done to put things right, you can consider legal action, which may mean going to an employment tribunal. Get professional advice before taking this step.

Other resources

• GOV.UK: workplace bullying and harassment
• NHS.uk: Bullying at work
• Acas helpline: 0300 123 1100
• Citizens Advice: problems at work
• Equality and Human Rights Commission (EHRC)

Tags: Bullying, dignity, Mental health, Workplace bullying