What is the impact of bullying and harassment?
Bullying and harassment harms doctors and patients. The effects of bullying and harassment are wide-ranging. Research shows negative impacts on patient care and safety.
For example, a trainee who is bullied by a senior colleague is likely to avoid seeking help or clarification from them to avoid future incidents, which can compromise patient safety.
Researchers have also found an association between high employee engagement and high in-patient satisfaction and lower mortality rates. Employee engagement is dependent on there being a positive working environment in which staff feel valued and respected.
Trainee doctors who are bullied report lower overall satisfaction with their placements according to the GMC’s National Training Survey. Studies also show demotivation, loss of confidence, anxiety and self-doubt among doctors who experience bullying.
Bullying increases the risk of psychological distress and mental health problems among doctors. Women doctors who have experienced sexual harassment report that it has undermined their confidence in themselves as professionals and negatively affected their careers.
The high cost of bullying for organisations
There are significant costs for organisations from bullying and harassment, mainly arising from higher turnover and increased sickness absence. Lower productivity, potential costs of litigation and compensation, and loss of public goodwill and reputational damage also need to be considered.
In recent years, there has been growing recognition of the role of organisational culture in encouraging and permitting bullying, which explains why some workplaces have higher levels than others.
Among the factors identified as likely to lead to a bullying culture are: autocratic, target-driven management styles; poor job design; work intensification; and pressures arising from restructuring or organisational change, especially when radical and top-down.
NHS-based research has identified workload pressure and stress as contributory factors. Another factor that has been found to contribute to bullying in the medical profession is hierarchy. Both the hierarchical nature of the profession and workload pressure increase the likelihood of ‘silent bystanding’ – a failure of colleagues to speak out – which allows bullying behaviour to continue unchallenged.
Formal anti-bullying policies and procedures may not work
There have been very few formal evaluations of current interventions to stop bullying and harassment in the NHS or other healthcare settings. However, a recent evidence-based review of interventions to address workplace bullying and harassment for ACAS, identified the limited effectiveness of the traditional approach of relying solely on formal anti-bullying policies and procedures.
The barriers to this succeeding include:
- placing the onus on the bullied individual to formally report the problem when surveys and research show an unwillingness to
- a reliance on formal complaints mechanisms prevents early resolution
- a reluctance to impose formal sanctions on ‘high value’ individuals
- a desire to avoid litigation or protracted formal proceedings which can result in pressure to find against the complainant or force them out.
Calls for a more comprehensive approach
There is a call for more comprehensive organisational approaches that focus on ensuring worker well-being and good workplace relations so that behaviours like bullying do not arise.
Good practice recommendations include:
- developing behavioural standards in collaboration with employees and role-modelling good behaviours by senior managers and staff
- early identification of bullying behaviours (e.g. through staff surveys, exit interviews) and acting on risk factors like poor management practices and excessive workloads
- empowering people to talk more openly about what is acceptable and unacceptable behaviour
- strong support structures for employees and managers (e.g. union representatives, bullying or fair treatment officers, occupational health)
- encouraging informal resolution where appropriate, backed up by clear and accessible formal procedures for when early resolution does not work.
What is the BMA doing about it?
We are committed to tackling bullying and harassment and over the coming months, we will be developing new resources to support members in dealing with the issues.
We will also be looking at what we can learn from dignity at work cases in which we’ve supported members, in order to press for employers to improve policies, procedures and resolution within the workplace.
We will continue to work at national level with other trade unions and NHS organisations to help drive culture change to prevent bullying and harassment arising and to endorse a collective call to action to tackle bullying in the NHS and to create a more supportive workplace culture.
BMA Scotland is part of a short-life working group set up by the Scottish government following the review led by John Sturrock QC into allegations of a bullying culture at NHS Highland.
In 2016, BMA Cymru along with other trade unions, NHS employers, and the Welsh government, agreed core principles setting out the values of NHS Wales, including commitments around dignity and respect at work and zero tolerance to bullying and harassment.
In Northern Ireland, the Department of Health has recently established a Zero Tolerance Task and Finish Group to discuss how bullying, harassment and violence, impact on the workforce.
The BMA is a member of this group. The objective is to develop a regional strategy and recommendations that are focused on making staff feel safe, respected, supported and confident at work.