Organisations tend to wait for individuals to raise concerns rather than proactively tackle the bullying culture, notes Roger Kline

Almost one in four NHS staff report being bullied in the previous 12 months whilst the proportion of staff reporting bullying that they have experienced or witnessed has steadily fallen to well below 50 per cent. We know why this matters.

Costs of bullying

Firstly, bullying undermines the mental and physical health of staff and can trigger low self esteem, anxiety, depression and disengagement in affected individuals.

Bullied staff are less likely to raise concerns, less likely to admit mistakes and are less likely to work in effective teams.

Secondly, bullying adversely impacts on organisational effectiveness. A decade ago, NHS Employers reported that “the costs of bullying and harassment include increased sickness absence, low productivity, high staff turnover, costs of potential litigation and damage to the reputation of the organisation.” 

Thirdly, bullying impacts adversely on patient care and safety. Bullied staff are less likely to raise concerns, less likely to admit mistakes and are less likely to work in effective teams.

There is a strong negative correlation between NHS staff reporting harassment, bullying or abuse from managers and colleagues, and whether patients reported being treated with dignity and respect. 

Why tackle bullying?

Research shows that “managing staff with respect and compassion (is important) since doing so correlates with improved patient satisfaction, infection and mortality rates, Care Quality Commission ratings and trust financial performance.” 

This is not just a UK problem.

Australian research confirmed that health sector organisations with strong staff safety cultures have fewer patient safety incidents, and the incidents that do occur are of shorter duration. 

Australian research confirmed that health sector organisations with strong staff safety cultures have fewer patient safety incidents

American research reported a strong correlation between disruptive behaviours and the occurrence of adverse events and compromises in patient safety. The US Institute for Safe Medication Practices found that 40 percent of clinicians have kept quiet or remained passive during patient care events rather than question a known intimidator. 

So why we have not successfully tackled this toxic phenomenon? 

Failure to adress bullying

A key explanation is that many approaches to the bullying of healthcare staff have, until very recently, tended to address the impact on individuals and the cost to organisations but have not tackled the impact on patient care and safety.

Responses have often relied on individuals raising concerns, rather than using the research evidence that it is “organisational climate” which makes bullying possible. The key NHS guidance (now changed) for many years stated “employers can only address cases of bullying and harassment that are brought to their attention.”

Research emphasises the need to improve “organisational climate”, to be proactive and preventive rather than wait for individuals to raise grievances

Major inquiries into healthcare scandals have repeatedly highlighted bullying cultures as key causes of poor care. Robert Francis’ 2015 report on whistleblowing found bullying was a deterrent to staff raising concerns, particularly for black and minority ethnic staff.

The good news is that some trusts are ending their reliance on “policies, procedures and training” whose limitations were highlighted in a recent Advisory, Conciliation and Arbitration Service review of bullying research.

“In sum, while policies and training are doubtless essential components of effective strategies for addressing bullying in the workplace, there are significant obstacles to resolution at every stage of the process that such policies typically provide. It is perhaps not surprising, then, that research has generated no evidence that, in isolation, this approach can work to reduce the overall incidence of bullying in Britain’s workplaces”. 

Research instead emphasises the need to improve “organisational climate”, to be proactive and preventive rather than wait for individuals to raise grievances, and to make clear that leaders within each organisation must model the behaviours they expect of others. That is what the new NHS national guidance on leadership development stresses as does the new national Tackling Bullying Call to Action, launched in December 2016. 

Call to Action

The Call to Action helpfully summarises some of the crucial interventions that include:

  • Building a culture in which staff have a heightened awareness of workplace bullying, negative behaviours are challenged and positive behaviours endorsed
  • A focus on preventive interventions 
  • The need for leaders and managers to model the behaviours they expect of others
  • The importance of proactive monitoring of organisational data to identify patterns and outliers to help target interventions
  • Training to a critical mass of appropriate staff (especially managers).

These steps do go well beyond the failed traditional reliance on policies and procedures. I’ve met those leading this work. They are serious.

Evidence suggests the Call to Action should also 

  • Emphasise the importance of speedy intervention once concerns are raised
  • Make clear that victimisation of staff raising concerns about bullying is serious misconduct. 

Way forward

The unprecedented pressures on resources and very significant structural changes within NHS organisations are precisely the circumstances in which, unchecked, bullying will increase. Good employers already try to tackle bullying. Some trusts have undertaken interventions we should all learn from. Too many others will not, given all the other pressures, unless they are required to. 

The Call to Action is voluntary and whilst the CQC is increasingly questioning trusts where bullying is off the scale, too few trusts address the issue until they become a complete outlier.

Given the evidence on the cost to patients and staff, surely the NHS should learn from the Workforce Race Equality Standard which has shown how a mandatory requirement driven by metrics, a powerful narrative and accountable leadership, without national targets but with local ones, can drive change. 

Should we not adapt the Call to Action in just the same way?