Retired hospital chief executive Kate Grimes reflects on recognising bullying in her own behaviour, and on three aspects of bullying in the NHS

I’m a bully. The thought shocked me, causing my heart to beat heavily in my chest and colour to rise on my face. I was reviewing our updated “Bullying and Harassment Policy” and, as the trust’s chief executive, recognised myself amongst the behaviours given as examples of bullying. What could be seen as the normal give and take of professional debate among a team of peers became something very different for my staff in the context of my positional power. Particularly among a roomful of their colleagues, my robust challenge could easily become an experience of being bullied. How could I credibly lead the implementation of the policy if I didn’t first change my behaviour? In this article I want to make three points about bullying.

When the powerful feel powerless

Firstly, we should acknowledge that bullying is an entirely normal human behaviour. There is abundant research demonstrating that when people feel powerful, they tend to misuse it – the work of Robert Fuller, for example. Some recent research in the Harvard Business Review found that when managers were feeling powerful, perhaps attending a management meeting or making a hiring or firing decision, they reported having more negative interactions with others. Additionally, the work of Julie Diamond suggests that when people with power feel powerless, implementing an order from above for example, they are more likely to abuse others. If every member of staff who has power over others, from the supervisor in the canteen to the very top of the NHS, experiences these entirely normal and human responses to their power, then of course there is a bullying problem in the very hierarchical NHS.

We should stop portraying the bully as “a bad person” and therefore “not me”. Most people working in the NHS care about other people and want to do a good job. By acknowledging that everyone with power engages in bullying behaviour to some extent, even if they don’t intend it, and helping organisations to support every one of their supervisors, clinical leaders and managers to be aware of and minimise this natural human behaviour, we may help to reduce bullying.

Watching your ‘F’s and ‘T’s 

Secondly, research demonstrates that more managers have a “T” preference on the Myers-Briggs indicator than those with an “F” preference. For those not familiar with this psychometric test it measures, amongst other things, the process each individual prefers to use to make a decision. Those with a “T” preference are guided by objective logic, focus on cause and effect and look for flaws in logic. Those with an “F” preference are guided by personal values, focus on harmony and look for common ground. The downside of having a “T” preference is that we can inadvertently forget about other people’s feelings when making decisions and are often surprised (and upset) to find we have left a trail of hurt people in our wake. The decision-making of someone in a more powerful position who has a “T” preference can appear cold and brutal, contributing to an overall impression of bullying.

When under pressure, I can become extremely task focused and appear uncaring towards others

As you will have guessed, I have a “T” preference and, especially when under pressure, can become extremely task-focused and appear uncaring towards others. One way of managing the negative impact of a “T” preference is to ensure that those with an “F” preference are included in teams and decision making fora and that they are listened to. We only had one person with an “F” preference in our executive team. It was not always easy for her to add her perspective and not always easy for us to listen, but we all appreciated how important is was and so worked hard to value her input. She helped us to stay thoughtful of others’ feelings in our decision-making.

The anxiety of power

Finally, there is the contribution of anxiety. Much has been written about the impact of anxiety in the NHS. The very nature of caring for the sick is anxiety-inducing, and this is further exacerbated by the highly political nature of the environment we work in. Particularly at the more senior levels, mistakes and failure can have a very public, catastrophic affect. Often, those held accountable for delivery have very little ability to influence that delivery personally other than to hold those below them in the hierarchy to account. The entire system is driven by anxiety, and anxiety makes us feel powerless, meaning the abuse of power is more likely.

Anxiety is rarely talked about and is not a feeling I had ever fully come to terms with in myself. I saw anxiety as a weakness. However, I did regularly get frustrated, annoyed and irritated. These feelings, even if not verbalised, would tend to show on my face. From someone in a position of power, a frown can be experienced as a severe admonishment. A key breakthrough came for me when I acknowledged that my frustration arose because of my anxiety. I found by owning the anxiety and verbalising it whenever I got the feeling in my chest that had previously signalled frustration, I immediately deflated the tension. By saying “I feel anxious…” I made myself vulnerable and ameliorated the impact of my power.

We must tackle the anxiety apparent in the performance management systems desperately trying to drive the delivery of national targets

In conclusion, it is hard to see how anyone in a position of power could avoid bullying others on occasion, especially if unconscious actions like a change in facial expression can be experienced by someone in a less powerful position as bullying. Acknowledging that fact and then taking action at both the organisational and individual level could make a big difference. However, to truly change the culture of bullying across the NHS, we must tackle the anxiety apparent in the performance management systems desperately trying to drive the delivery of national targets.

Reducing anxiety may have a bigger impact on staff retention, productivity, patient safety and performance, by reducing the conditions that promote bullying, than all the current anxiety-inducing systems introduced to try to manage them. Now there’s a paradox.

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