We must address bullying at every level in healthcare

The risks to patients are well documented, with bullying linked to poor teamwork, practice errors and communication failures

Bullying can also take the cruel form of exclusion, where a person is deliberately cut off from interactions with others.

Chatting with my teenage daughter about the latest episode of US presidential bullying and hubris, it became clear that she believed that Donald Trump’s conduct is rare in adult life. Once schooldays are finished, a bully-free nirvana appears, as adults don’t commonly bully each other.

Unfortunately, this is not true.

Workplace bullying goes on at every level. No job is free of it: teaching, law, finance, media, technology, nursing and medicine. I have met seasoned medical consultants counting every day until retirement to escape a ‘colleague’ who had bullied them for decades.

Bullying is about power. The bully cares nothing about the oppressed, except for the surge in power that they feel after undermining their work or denigrating them in front of colleagues. Bullying can also take the cruel form of exclusion, where a person is deliberately cut off from interactions with others. Belonging is such a fundamental human need that organised exclusion bites deep into a person’s self-esteem but gives them little to point at.

Unpleasant interactions

When we were just qualified as interns, we had to book x-rays for our patients. One person in the radiology department took immense pleasure in ripping up completed booking forms, telling us we were idiots and sending us away to do it again. And again. They held the power, knowing we would get in trouble if the x-rays were not carried out. Everyone knew about this person’s conduct. The bruising experience was considered by some more senior doctors to be ‘good training’. This rationalisation of unpleasant interactions is where the game is lost. If recognition that someone has behaved badly is set aside in favour of a warped view of learning, or the status quo, nothing will change.

Research published by Dr Margaret Hodgins and Dr John Cullinane from the University of Galway in 2020 suggests that one in ten employees have experienced bullying. 

The cost of this corrosive conduct is enormous in terms of productivity, commitment, errors, and absence from the workplace 

It is not a surprise that people being bullied do not perform well. It is a particular concern when patient care is involved.

Internationally, bullying in healthcare settings is well described. A Greek study looking at neonatal intensive care found that being female, young, and relatively inexperienced greatly increased the risk of becoming a victim of harassment by a colleague. Even more concerning are the risks to patients that are also well documented, with bullying linked to poor teamwork, practice errors and communication failures.

An organisation which fails to tackle bullying inevitably suffers reputational damage, low morale and repeated recruitment costs. Most employers have endeavored to tackle bullying by instituting measures to promote dignity in the workplace and a positive culture. There may be HR disciplinary processes to manage reprehensive behavior, but the truth is that they are limited by the fact that it is the person being bullied who must shout stop. 

If the employer will not or cannot immediately pull around and protect them, they will suffer more

Already experiencing sleepless nights, loss of confidence and crippling anxiety about the next attack, it makes no sense to expect the victim to launch an industrial relations exercise. Sharing the responsibility for showing a bully that their conduct is intolerable makes more sense.

Bystander awareness training has been found to be effective in tackling poor behavior. Intervening as a bystander reduces the harm experienced by the target of the bullying, shows everyone that the behavior is out of line, and gradually chips away at a negative culture. Most universities and employers now provide bystander training to give people the language and actions they need to call out bullying. Actions range from distraction, enlisting help from other witnesses, and focusing empathy on the person who has been made to feel inferior.

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Wider safety campaigns raising awareness of the effects of a poor working culture have also been shown to be effective. ‘Incivility Kills,’ was the memorable title of a recent project run across several Australian hospitals which galvanised healthcare staff to tackle unpleasant conduct in the interest of improving patient safety. ‘Civility Saves Lives,’ is a similar project in Britain. As we learn more about the impact of human behavior on patient safety, we must address bullying at every level in healthcare. It is a silent, shameful influence on our well-being and how we do our work.

When I look back at the early years of my training, I see that as young doctors and nurses we were already grappling with workload, assessments, night shifts, death, and grieving families. We had enough learning experiences.

Our capacity to learn more was never going to be enhanced by being humiliated and reduced. Such Trumpian thinking is profoundly wrongheaded.

Dr Suzanne Crowe, consultant in pediatric intensive care, President of the Medical Council