The pandemic has reminded all of us how vulnerable human beings are to stress – there is only so much that people can handle. Pressures to work faster and achieve fiscal imperatives play out across every practice setting.

Direct, curt communications between colleagues and team members to get the job done replace respectful interactive dialogues. Workplace bullying can easily become more the norm than the exception.

Use the force

A study by the International Bar Association yielded results consistent with Dignity Matters. For over 700 British lawyers, the prevalence of workplace bullying by employers was 62% for females and 41% for males.

In the healthcare sector, workplace bullying is particularly fierce and grossly affects every aspect of patient care, as well as workforce retention and mental health. Quality patient-centred care is best rendered by a team of individuals who can effectively work together.

However, what happens when those efforts are negated by workplace bullying? Studies continue to affirm the prevalence of medical errors from poor team communication and fragmentation secondary to bullying – as many as 250,000 incidents annually are associated, with upward of 100,000 deaths.

These numbers shocked the industry upon their release.

New language was developed to address workplace bullying across established resources, from organisational accreditation standards to licensure regulations, standards of practice, and codes of ethics.

Yet, despite industry’s recent best intentions, bullying prevalence is too dependent on pressures brought to bear on the workforce. The pandemic has amplified levels of stress and burnout, if not high rates of collective occupational trauma.

Concerning levels of workplace bullying have emerged, as every member of the healthcare workforce struggles to manage unparalleled illness morbidity and mortality rates, as well as issues of diversity, equity, inclusion, and social and racial injustice.

This perfect storm of factors has advanced workplace bullying and imperilled the quality of patient care. 

Let the Wookiee win

Perhaps the following phrases sound familiar to you. They are among a list of reasons that spark hesitancy in addressing workplace bullying:

• “Workplace bullying was here long before I got here, and will still be here long after I’m gone”,
• “I have no authority to change things”,
• “The workplace bullying elevator is local – it starts at the top of my workplace, and hits every floor going down”,
• “If I call out bullying, I’ll be fired”,
• “Workplace bullying is nothing new– don’t let it get to you”, and
• “Ms S is a bully – ignore her like everyone else does!”

The last five years have seen a steady flow of actions to address workplace bullying – and there is far too much data to fight the mandate for change. For example, in the United States:

• A total of 79.3 million workers are affected by workplace bullying – in all, 75% of the workforce is affected, whether as target or witness,
• People in non-leadership roles experience workplace bullying that is double the rate of those in managerial positions, including 65% of bullying by bosses,
• A new generation of remote-working professionals is forced to contend with a rising incidence of workplace bullying – 50% during virtual meetings and 9% via email, and,
• Research in Europe indicates that people exposed to workplace bullying had a higher risk of cardiovascular disease, as well as other chronic illnesses.

The power of the dark side

To begin with, organisational commitment to manage incivility starts with acknowledging a culture that allows bullying. The following three workplace cultures influence the prevalence of bullying in organisations:

• Autocratic culture – power and control reign, with high levels of staff secrecy and jealousy. Competition is prioritised over collaboration, while positive employee relationships are viewed as a threat, since they would create cohesion rather than maintain the current state of fragmentation,
• Fragmented culture – core values are absent, with hierarchical power and bureaucratic rules the norm. Inconsistent enforcement of policies and procedures, as well as knee-jerk reactions, guide the management of staff conflict, or the lack thereof,
• Enduring culture – clear goals, rules, and values are embraced by all leadership for employees and contractors. Communications reflect mutual respect, with consistent action and consensus to address behaviours that run counter to accepted standards.

Corporate cultures play a major role in encouraging all types of workplace culture. Companies may reward assertive, if not aggressive, behaviour by promoting such individuals or providing monetary bonuses.

As far as the leadership is concerned, these people get the job done – how they achieve it doesn’t matter if a successful outcome is achieved. Simply stated, the end justifies the means.

A majority of organisations continue to dismiss, deny, or discount bullying behaviours – in the US, more than 60% have no policies in place to manage these situations.

It is particularly unfortunate when these situations reach a point of individual self-harm and/or occupational trauma before action is taken to stop the disruptive behaviours.

We know that increased workplace bullying leads to worse mental health and greater suicidal ideation and behaviour.

The droids you’re looking for

It becomes too easy for individual employees to be labelled as bad apples and blamed for bullying actions. Organisations must be held equally accountable for their role in promoting a bullying culture.

Cultural changes are tough, but possible with constant and unwavering action at the individual level:

1)  Address incivility early – everyone has rough days, but there’s a big difference between ‘one-and-done’ versus a more enduring pattern. Address the behaviours early, and directly, with the person involved. Grab a witness to the conversation whenever possible,

2)  Use human resources – most people resist involving human resources, but it’s important to do so. Should you seek legal recourse, it is vital to demonstrate that all employer channels were accessed, even if you question their usefulness,

3)  Stay engaged – bullies strive to isolate their victims. Keep connected with your colleagues and peers for support,

4)  Document everything – an old mantra exists in healthcare: ‘If it’s not written down, it never happened’. Maintain documentation of all bullying interactions and conversations that address the events, including dates and the names of those present,

5)  Show your resilience – bullies strive for reaction from their victims. Instead of immediately reacting, take ten seconds to stop, breathe, process, and restore your resilience. Only then can you effectively assess and best manage the situation.

6)  Remember: bullying victims are rock stars – bullies go after those persons who threaten them, usually their most ethical and competent employees. Let the bully know you’re on to them, and thank them for acknowledging your ‘rock star’ status. It will totally unnerve them.

7)  Behavioural health support is a must – bullying wears at your resilience, fuelling anxiety, depression, insomnia, and stress. Obtain a mental-health consultation for objective support and intervention (see the LegalMind section of the Law Society’s Wellbeing Hub at lawsociety.ie).

8)  Be part of greater change – bullying is a hot topic across professional associations and accrediting entities. Most have crafted language for standards of practice and codes of ethics, making bullying and incivility subject to reprimand. Join public-policy and advocacy initiatives to stop bullying on a macro scale. Workplace bullying legislation is advancing in the US, via the Healthy Workplace Bill, now introduced across 31 states.

9)  When the culture can’t change, move on – there are times when the bullying culture either can’t or won’t change. When you’ve done all you can to stop the incivility cycle, it’s time for a career shift. Can you afford to wait?

10) Repeat the following mantras (and keep them where you can see them):

• We deserve respect,
• We deserve to have our knowledge and expertise valued,
• We deserve to feel safe,
• We deserve not to feel trapped in a toxic workplace,
• We deserve to have confidence that all are accountable for their actions,
• We deserve to be able to confront workplace bullying without fear of retribution. 

Look it up

LITERATURE:

• ‘Bullying has no place in health care’, Quick Safety Issue 24, The Joint Commission. (www.jointcommission.org), updated June 2021
• Ellen Fink-Samnick, ‘Ten ways to tackle collective occupational trauma and restore resilience’, Paces Connection, 23 February 2021. (www.pacesconnection.com)
• Liana S Leach, Carmel Poyser, Peter Butterworth (2016), ‘Workplace bullying and the association with suicidal ideation/thoughts and behaviour: a systematic review’, Occupational and Environmental Medicine, vol 74, issue 1
• Munirah Al Omar, Mahmoud Salam and Khaled Al-Surimi (2019), ‘Workplace bullying and its impact on the quality of healthcare and patient safety’, Human Resources for Health, vol 17, article number 89
• Tianwei Xu, Linda L Magnusson Hanson, Theis Lange, et al (2019), ‘Workplace bullying and workplace violence as risk factors for cardiovascular disease: a multi-cohort study’, European Heart Journal, November 2019. (www.academic.oup.com)
• 2021 WBI US Workplace Bullying Survey (www.workplacebullying.org)
• Us Too? Bullying and Sexual Harassment in the Legal Profession (International Bar Association (2018), www.ibanet.org/bullying-and-sexual-harassment)

Ellen Fink-Samnick is principal of EFS Supervision Strategies LLC and an adjunct with the Department of Social Work at George Mason University, Virginia, USA

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