Responsibility for tackling bullying within healthcare lies with the organisation, not with victims. The NHS needs to get better at this.
In previous posts, I have written about how to identify bullying in the workplace and how to cope with it when you are at the receiving end. However, I also want to emphasise that the responsibility for dealing with bullying does not lie with the victims of this harmful and corrosive behaviour. Responsibility for action lies with the organisations accountable for employee welfare, and in the context of healthcare professionals in the UK, the NHS. Three things NHS organisations can do to tackle bullying are listen up, follow up, and wise up.
Listen up
We need to stop trying to ‘fix the silenced’ and rather ‘fix the system’
Reitz & Higgins, 2020
It is not enough to encourage employees to “speak up”. Organisations and leaders need to be willing and able to listen up. This requires acknowledgement of the impact of power on the ability to speak up. Research has shown that healthcare leaders in the UK lack awareness of how their power silences others and how unskilled they are at listening. They are also overly optimistic about how often junior staff do speak up. Tackling bullying in the NHS requires its leaders to have the self-awareness to understand the barriers that power dynamics create, and the willingness to overcome these in the service of staff wellbeing. Reitz and Higgins (2020) recommend that leaders need to assume they are scarier than they think; question their ‘little list’ of whose opinion counts; and check the nonverbal “shut-up” signals they send.
Senior managers often appear defended behind management speak, processes and policies when all they need to do is take time to speak with and listen to junior staff about issues they raise – and take them seriously without minimisation and deflection. One health professional, Sam*, described a positive experience of being listened to, by people who wanted to hear:
“When I was on the receiving end of control, coercion and intimidating behaviours I sat several times with a blank word document just thinking ‘where on earth do I start?’. I was in the fortunate position of having a very supportive manager and an occupational psychologist within our trust. What helped was being able to tell the full story, with all the different strands, and my ‘formulation’ of the behaviours and the different agendas driving them. I was listened to with empathy and was asked questions like, “Have you got an example of that?”. This was helpful for me.”
Freedom to Speak Up Guardians can be an important asset and ally in helping organisations to listen up. Supported by the National Guardians’ Office, Freedom to Speak Up Guardians were established following the Francis report to enable health workers to speak up about issues affecting patient and staff safety, including bullying. Their role is to support workers to speak up, but also to proactively identify and tackle barriers to speaking up.
Dr Henrietta Hughes, OBE, National Guardian for the NHS offers this advice: “Silence can also be a signifier of a bullying culture. Take a look at where there are pockets of silence within your organisation (for example, who you are not hearing from, who isn’t filling in the staff survey). Guardians work proactively to encourage those whose voices may not be heard”.
Follow up
Sam continued…
“But despite the support and evidence I had, my concerns weren’t taken seriously. No one from senior management spoke to me other than to ask me if I would consider mediation and to ask if I would consider keeping on some of my duties when I had requested redeployment (I also had support from an employment lawyer, so they ‘had’ to move me on). So, an empathic and open conversation with senior management would have been helpful, rather than sweeping everything under the carpet because it was too much to deal with.”
Listening to people who have experienced bullying is not enough. Meaningful action needs to be taken, not only to support victims and hold those doing the bullying to account, but also to examine the organisational cultures and systems that enable and maintain this behaviour.
Reitz and Higgins (2020) surveyed thousands of UK healthcare workers about speaking up. When junior staff were asked what they thought would happen if they spoke up about a problem at work, only 13% expected a positive outcome. Nearly half (48%) expected to be ignored, and 33% thought they’d be actively suppressed and prevented from speaking up. Given these statistics, it is no surprise that people are suffering in silence.
Following up means taking meaningful action so that people who are guilty of emotionally abusing their colleagues are held accountable (as opposed to simply “moved on” or even promoted). Those who are accused of bullying need to have access to fair, open and transparent processes so that they and the organisation can learn and implement meaningful change.
But most importantly, those who have been victim to bullying need better options than having to choose between going through a gruelling disciplinary process that can re-enact the abuse they have suffered, or leaving their jobs. Too often, the best option for victims of bullying is to leave because the follow-up is non-existent or makes things worse.
Wise up
Prevention is always better than cure. Leadership and management appointments need to be considered with greater wisdom if real culture change is going to happen. Recruitment processes for leadership positions in the NHS need to actively seek out those with personal qualities that promote psychologically safe working cultures, including high levels of self-awareness, compassion and courage. This requires more than the standard interview process.
Dr John Marshall, Consultant Clinical Forensic Psychologist, with management and senior management experience, writes about how this needs to start at board/executive levels: “Some people who thrive in this arena often have Machiavellian narcissistic traits: they can be a self-selecting group who then set the tone in organisations. We need organisational psychologists who actively advise on screening out managers who have dark triad traits which can lend themselves to bullying and incivility. Selecting compassionate leaders, who enable their staff to take decisions, ensure staff have genuine autonomy (people mostly come to work to do good!) or even take risky decisions (within safe parameters), in a culture of acceptance and support, will generate innovation.”
Incivility in the workplace is a fertile breeding ground for bullying and a serious patient safety concern. Incivility should be addressed as a conduct issue, and politeness and kindness modelled in all parts of an organisation. This is not rocket science, but can make a world of difference:
Say hello, please, thank-you and I’m sorry.
Next Steps:
If you want to get in touch with your Freedom to Speak Up Guardian you can find their details on the NGO website.
Further reading: Reitz M, Higgins J. Speaking truth to power: why leaders cannot hear what they need to hear. BMJ Leader Published Online First: 29 October 2020. doi: 10.1136/leader-2020-000394
*Names and details changed to preserve anonymity
