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Promoting dignity at work

a busy hospital

Everyone deserves to be treated with dignity and respect at work, bullying and harassment is not acceptable.

We have launched a programme to raise awareness of workplace bullying and harassment, improve support for doctors and to seek changes in employer practice and organisational culture. 

Chair of BMA Representative Body, Anthea Mowat explains why this work is so important.

Read her blog

 

Data and research

As part of this important work we have conducted a review of survey data and recent research, which highlights the scale of the problem and gives some insights into what is needed to address it.

Download the full research report

 

The numbers paint a stark picture

  • 22% of NHS doctors and dentists experienced bullying, harassment or abuse from other staff in the preceding 12 months, (this compares to 24% for all NHS staff) according to the NHS England Staff Survey (2016).
  • Although NHS Scotland and Wales staff survey findings suggest lower levels of workplace bullying and harassment, compared to NHS England, in Northern Ireland, the HSCNI survey suggests similar levels to England.
  • The NHS England Staff Survey found that, by grade, 23% of consultants, 20% of trainees and 24% of other doctors and dentists (including SAS grade doctors) had experienced workplace bullying, harassment or abuse in the previous year.

bullying and harassment graph

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Only a minority of doctors report incidents to their employer

  • According to the NHS England Staff Survey, only 33% of doctors and dentists who had suffered workplace bullying, harassment or abuse in the past year reported the latest incident, which is significantly below the proportion for all NHS staff (47%).
  • Only 1% of trainees were willing to submit details of incidents to the GMC NTS survey so that they could be investigated by deaneries or local education and training boards. The most common reasons for not reporting were feeling that it would not make any difference and fearing adverse consequences.

bullying and harassment graph

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Who is more vulnerable to bullying?

Staff with certain protected characteristics are more vulnerable to workplace bullying or harassment.

The results of the NHS England Staff Survey show:

  • Disabled staff in the NHS are the most likely to experience bullying or harassment (32%),
  • Followed by LGBT staff (27-30%)
  • Black staff and those from some other minority ethnic groups are more likely to be targeted than white staff (24% of BME staff as a whole compared to 22% of white staff).
  • Women are slightly more likely to be on the receiving end than men (23% compared to 21%). However, other research shows that women doctors are significantly more likely to suffer sexual harassment in their careers than men.

 

SAS doctors

In 2015 our survey of SAS doctors across the UK, found that more than a third had experienced bullying, harassment or victimisation at work over the preceding 12 months and a similar BMA survey of SAS doctors in Wales, found that half had experienced bullying, harassment or victimisation. The survey also found that only a minority reported incidents and, of those who did report, most were not satisfied with the outcome.

Read the SAS doctor survey findings

 

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 is understandable, but can compromise patient safety.

Researchers have also found an association between high employee engagement and high in-patient satisfaction with hospital care and lower mortality rates in acute NHS trusts. 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 NTS. 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.
Find out more about our work in this area

Wales

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.
Read the blog

Scotland

BMA Scotland participates in the Partnership Information Network which last agreed a revised policy on preventing bullying and harassment in NHS Scotland in 2011, which is aimed at creating a culture of dignity and respect at work.
Read the policy

Northern Ireland

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.

Do you need practical advice on how to identify and address bullying and harassment at work?

Read our latest guidance