Bullying and workplace violence, in any setting, are unacceptable. These behaviors are of particular concern in the health care setting, as they pose a risk not only to our colleagues and peers, but also to patient safety.
Too common a problem
According to an article in The International Journal of Environmental Research and Public Health, “Workplace bullying among healthcare workers” by Antonio Ariza-Montes and co-authors, the most frequent victims of violent events in the health care sector are 40 years old or younger. The article also states that women physicians and unmarried women employees with less education and with children at home are more likely to endure bullying.1
In addition, a recent Occupational Safety and Health Administration (OSHA) report indicates that 21 percent of registered nurses or nursing students said they have been physically assaulted, and more than 50 percent said they have been verbally abused—a form of workplace violence that includes bullying.2 Meanwhile, 12 percent of emergency nurses reported physical violence and 59 percent experienced verbal abuse during a one-week period.
The Workplace Bullying Institute defines workplace bullying as “repeated, health-harming mistreatment of one or more persons by one or more perpetrators.”3 This bullying may manifest as verbal abuse, threats, intimidation, humiliation, or even work interference.
The institute estimates 65.6 million workers in the U.S. either have been bullied in the workplace or have witnessed bullying. A 2014 survey showed that 69 percent of bullies were men, and 57 percent of targets were women; it also showed that 68 percent of women bullies targeted other women.3
Effects on patient care
In the health care arena, bullying occurs most frequently in behavioral health units, emergency departments, and intensive care units. Bullying also is fairly common in perioperative areas, including the pre-anesthesia room, the operating room, and the recovery room. Whether it is exercising the power of authority or misusing the hierarchical structure, some surgeons have been known to intimidate other coworkers, sometimes with the excuse of doing so “on behalf of their patients.” Circumstances that are particularly suited to spurring this type of behavior include emergencies, which are common in surgery; difficult situations faced during the course of an operation that require prompt attention; new instrumentation; and changes in the patient care plan.
Bullying under these circumstances poses an immediate and direct threat to the safety of the patient, as those who are bullied are nervous and will most likely underperform because of their anxiety. In the long term, the impact on bullied employees can include lower morale, productivity, and attendance. This, in turn, can lead to more organizational turnover, causing talented workers to leave the profession—which can directly affect patient safety.
The Journal of Community & Applied Social Psychology categorizes workplace violence as the following:4
- Threat to professional status
- Threat to personal standing
Workplace bullying—which is more common than sexual harassment—tends to happen to employees who don’t have good support systems or who are unable to defend themselves from their aggressors. Factors that contribute to workplace bullying include the following:
- A bullying culture
- Poor staffing levels
- Excessive workloads
- Power imbalances
- Poor management skills
- Role conflict or ambiguity
- Lack of autonomy
Gerry Hickson, MD, and colleagues at Vanderbilt University Medical Center, Nashville, TN, determined that a common barrier in the fight against bullying was underreporting of the issue. In response, they created a Co-Worker Observation Reporting System to encourage accountability and respect among coworkers.5 This reporting system allows coworkers to document observed acts of bullying, which provides an inventory of such events and an opportunity for administrators to address these issues through education and compliance-related initiatives.
Health care organization leaders also can play a role in battling bullying by creating a safety culture that doesn’t tolerate bullying behaviors, confronts bullies, and supports their victims.
The Joint Commission also highlighted some safety actions to consider in Sentinel Event Alert, Issue 40, which include the following:6
- Educating team members on appropriate behaviors
- Holding team members accountable
- Developing anti-bullying policies
Surgeons must lead
I believe that surgeons can play a substantial role in the fight against bullying in the health care field. Not only do I believe that we should always self-monitor to ensure that our statements, our actions, and our attitudes are not interpreted as bullying, but that we also have an obligation to observe and counsel our colleagues who may exhibit those behaviors.
Surgeons should leverage their visibility, their position in the hierarchy of an organization, the way that other health care providers perceive the role of surgeons, and their capacity to influence institutional policies and procedures to create and maintain an environment that is positive—for the health care workers, the surgeons and, most importantly, the patients.
For more, read a Quick Safety report on workplace bullying.
The thoughts and opinions expressed in this column are solely those of Dr. Pellegrini and do not necessarily represent those of The Joint Commission or the American College of Surgeons.
- Ariza-Montes A, Muniz NM, Montero-Simo MJ, Araque-Padilla RA. Workplace bullying among healthcare workers. Int J Environ Res Public Health. 2013;10(8):3121-3139.
- Occupational Safety and Health Administration. Workplace violence in health care: Understanding the challenge. OSHA 3826, 12/2105. Available at: www.osha.gov/Publications/OSHA3826.pdf. Accessed May 18, 2016.
- Workplace Bullying Institute. The Healthy Workplace Campaign. Healthy Workplace Bill website. Available at: healthyworkplacebill.org/problem/. Accessed May 14, 2016.
- Rayner C, Hoel H. A summary review of literature relating to workplace bullying. J Comm Applied Social Psych. 1997;7:181-191.
- Webb LE, Dmochowski RR, Moore IN, et al. Using coworker observations to promote accountability for disrespectful and unsafe behaviors by physicians and advanced practice professionals. Jt Comm J Qual Patient Saf. 2016;42(4):149-161.
- The Joint Commission. Issue 40: Behaviors that undermine a culture of safety. Sentinel Event Alert. July 9, 2008. Available at: www.jointcommission.org/sentinel_event_alert_issue_40_behaviors_that_undermine_a_culture_of_safety/. Accessed August 24, 2016.