Dr Malcolm Lewis, Senior Lectuerer in Health Service Management at UCLAN, gives his opinion on the issue of workplace bullying within the NHS and reflects on the ‘depressing picture’ his research reveals (DAWN, 2010).
Despite what appears to be an increasing workplace problem for large scale organisations NHS bullying presents a persistent problem for managers; and one which is all too frequently poorly handled.
Bullying, although not defined legally, is described as offensive, intimidating, malicious or insulting behaviour, an abuse or misuse of power through means intended to undermine, humiliate, denigrate or injure the recipient (Unison, 1997). Of course, one issue is the problem of subjectivity and the debate about how to distinguish true ‘bullying from that of effective and reasonable‘ management. I shall return to this shortly.
While there would appear to be increasing interest and research in the area of workplace bullying causation is multi-faceted. Various commentators have also pointed to the impact of an increasingly competitive and consumer led society, along with continued pressure for organisational change as a particular focus for our attention on the problem. Indeed, as such this acts as a pressure on the individual to perform and my own research on UK nurses within the NHS in many ways confirms this (Lewis, 2006).
Human resource management departments within trusts often have a plethora of initiatives and ‘anti-bullying’ policies which appear to have a varying impact on the problem. Research by Morgan (1997) shows that there is a gap between managerial rhetoric and the reality in relationship to organisational action on bullying, particularly where managerial demands are increasing. Far from being a simple problem with simple solutions, Lewis (2006) presents bullying as a highly complex social phenomena and one which is poorly understood by managers at all levels.
Managers reveal an overall reluctance to deal with the phenomena, partly due to its difficulty of definition and its nebulous nature as it is very rarely ‘on show’. Most health service managers are aware of the use of formal procedures in dealing with bullying incidents, but many themselves saw going to a higher authority (senior management) as often making things ‘worse’. In particular the use of formal grievance procedures (which do not often cater towards the complex issues in bullying events) are often found wanting. In particular, the processing of such procedures is usually through the line manager and in my experience a large percentage of cases workplace bullying originates from an individual’s immediate line manager. There are also highly variable responses from unions and those representing the bullied, which ultimately can put the target of bullying at a distinct disadvantage should they attempt to pursue redress for trauma caused.
Bullying has high organisational and personal costs to the NHS, with potentially serious consequences for management. While the UK has no specific anti-bullying law at present legal redress can be obtained via a number of different avenues.
In the case of Majrowski vs. Guy’s and St Thomas’s NHS Trust courts were asked for the first time if an employer could be vicariously liable for their protection of their employee under the Protection from Harassment Act (1997). This is legislation which classes any behaviour occurring on more than two occasions as amounting to harassment and can be punishable by a criminal offence or with civil remedies.
William Majrowski claimed that his manager bullied and harassed him, which was upheld under the trust’s harassment policy. Four years later he started proceedings against the trust under the PHA, claiming damages. Majrowski made claim against the trust and not the individual manager for breach of PHA, which was at first rejected, but when the claim was heard in the House of Lords the trust was found liable, with the trust having a responsibility to protect the employer. It is such that claimants under the PHA do not have to prove negligence or that they have suffered physical or psychological injury. Anxiety and distress are alone sufficient, and employees cannot use the defence that they took ‘all reasonable steps’.
It was as recently as 2009 that Healthcare Commission chair Sir Ian Kennedy called for a renewed focus on leadership and issued a warning about the ‘corrosive’ nature of bullying in the NHS; to quote: “One thing that worries me more than anything else in the NHS is bullying. We’re talking about something that is permeating the delivery of care in the NHS.”
Healthcare organisations need to know that anti-harassment policy is not enough if it fails to protect employees. Managers need to be aware that such policy exists and that harassment is not taking place. Other issues, such as Infringements of the NHS Managerial Code of Conduct (2002), Zero Tolerance (2002), Psychological Contract and the Improving Working Lives Standard (2000), may all have implications when redress is sought for acts of bullying.
Over 10 years ago, Field (1996) indicated, in calls to the ‘Bullying OnLine’ support group that health professionals are the second largest group reporting bullying problems; and the problem, far from reducing, appears to me to be as prominent as ever.
Research on nurses - the largest employee group - indicates many are severely traumatised by bullying and reveals a change in their demeanour as they attempt to move away from bullying conflict, and from being demeaned on a personal level. In my experience, Adams’ (1992) indication of their subsequent reaction is often correct; they either leave their job, attempt to fight back to gain redress, or become ill.
Cooper (1999) indicated the changing nature of the psychological work contract, increasing pressures in the workplace and the high cost of bullying activity to trusts which for me, raised a number of serious concerns. These included poor reputation, loss of staff, possible litigation costs, skill loss, and low morale. Likewise, there was often increased staff turnover; the research indicated that not only those central to the bullying episode are affected as often those who are observers and bystanders are more likely to leave the organisation. This can also lead to further increases in staff costs, in recruiting and in increasing rates of sickness and absenteeism; an average target takes an extra seven days sick leave per annum due to bullying according to Cooper’s findings.
Within bullying situations, managers within the NHS and other public sector organisations often act with a limited knowledge, which is not so much a criticism but a fact of life when one considers the increasing demands upon them. However, managers need to know where to seek advice should problems occur and also that they need to act promptly when they do occur.
By its very nature, bullying is often a subversive and hidden activity and it is all too easy to dismiss such cases as a ‘clash of personality’. Within this scenario it is often the target that is ‘moved away’ from the bullying situation - sent to a new work area or re-assigned to a new role. It is sometimes the case that personality plays a role, but in the majority of cases this action (and it is commonly seen with in healthcare) totally fails to deal with the issue. In my experience, bullying may indeed stop for a period of time, but invariably the situation re-emerges. My research has led me to make the following and for me, more important comparison: where a person is accused of bullying and they genuinely are unaware that their actions are causing distress - known as ‘unwitting bullying’ - the actions do seem to stop. However, if serial, long-term bullying is taking place, they appear not to.
Managers need to realise that bullying is abuse and while rarely it is not physical in nature, its impact can be equally as traumatic, if not more so. In all investigations it is important to consider the history of bullying events. I have found that often staff are too traumatised and even afraid, for fear of their own positions or being bullied themselves, of either reporting this abuse or acting as a witness if they see bullying in practise. In my experience, the vast majority of bullying acts often have a history of abuse behind them. Bullies are often well known in the organisation, but often little is done. They are frequently organisationally astute and well-aware of their actions and on investigation I have found that there will usually be a previous history of bullying. There is invariably a power imbalance and it is often, although not exclusively that bullying indeed starts at the level of an employee’s line manager.
The problem of long-term bullying presents difficult and demanding problems and not infrequently, a good deal of diplomacy. There is often a need to reformulate policy which existing policies are unable to tackle. It is not sufficient for managers to ignore such problems in the workplace in the hope that they will go away, or to see them as just a feature of a stressful job. Such attitudes contribute to the idea that the organisation is supporting a bullying culture, which only contributes to a climate of anxiety and fear. It should be clear now that bullying may give rise to a variety of legal challenges, not least criminal liability (Porteous 2000) and violation of Health and Safety legislation. Managers should realise bullying is incompatible with a ‘no blame’ culture and undermines professional accountability. It needs to be a prominent ‘zero tolerance’ issue.
Adams, A. et al (1992) Bullying at Work. London, Virago Press.
Cooper, C. L. (1999) The Changing Psychological Contract at Work. European Business Journal. 11. 115-18.
DAWN (2010) Dignity at Work Now. AGM Lecture.( Nurses and Bullying: Awareness, Manipulation and Deceit within the UK National Health Service) Lewis, M. Birmingham.
Field, T. (1996) Bully in Sight. London, Success Unlimited.
Lewis, M. (2006) Nurse Bullying: Organisational Considerations in the Maintenance and Perpetration of Health Care Bullying Cultures. Journal of Nursing Management 14, 52-58. Blackwell Publishing.
Morgan, D. E. (1997) The World According to Karpin: a critique of enterprising nation. Journal of Industrial Relations. 39. 4. 457-77.
Porteous, J. (2002) Bullying at Work – The Legal Position. Managerial Law. 44. 4. pp77-88.
UNISON (1997) Public Service Union Bullying Survey. Summary by Raynor, S (1998) Staffordshire University Business School, UK.
Dr Malcolm Lewis is a senior lecturer in health service management at UCLAN