Continuing the discussion on the negative impact bullying has on patient care and teamwork
by Dennis Ernst • February 06, 2020
Bradley noticed how the new kid at school was withdrawn, quiet, and reclusive. Sensing an easy target, he set out to establish himself as a force to be reckoned with. When nobody was looking, he roughed up Preston, another fifth-grader, with menacing words and physical intimidation. Thirty years later, Bradley was roughing people up on another playground: the hospital laboratory. The new phlebotomist was quiet, withdrawn, reclusive... an easy target.
Whether it’s on the playground or at work, bullying is bullying. It’s dispiriting, demotivating, and demoralizing. It’s not just intimidation, it’s an assault against human dignity that burdens its victims whether the bully is physically present or not. Bullies intimidate even when they’re not there.
Healthcare managers and employees who recognize and eradicate bullying immediately preserve the spirit of cooperation necessary to deliver the quality of care patients deserve. Facilities that ignore bullying behaviors not only fail to deliver quality care, but expose themselves to legal action from patients and employees.1 Gerald B. Hickson, MD, director of the Center for Patient and Professional Advocacy at Vanderbilt University Medical Center in Nashville, Tennessee says any behavior that impairs the healthcare team’s ability to function well risks malpractice litigation.1
Not only that, but openly hostile and passive-aggressive actions chase away good employees. “High performers don’t thrive in hostile environments,” says Catherine Ernst, RN, PBT(ASCP) with the Center for Phlebotomy Education. “They’ll recognize it immediately and go to a competing hospital that recognizes the importance of top performers. Thoroughbreds don’t want to run with donkeys. That’s why facilities that tolerate bullying to any degree have scant hope of ever building a well-functioning team. Instead, they settle for employees who are just there for the paycheck, most of them unhappy.”
Lack of Reporting
Based on the results of a recent survey on workplace bullying conducted by the Center for Phlebotomy Education, 87 percent of participants admitted to having been bullied at work, while 85 percent have witnessed bullying. The problem is most people don’t report it for a number of reasons including:1
- Fear of revenge;
- Fear over being branded a troublemaker;
- Reluctance to confront a bully;
- The belief that bullying by powerful, profit-generating physicians is excused.
Gary Namie, PhD, Workplace Bullying Institute cofounder, reports that not only do most employees fail to report workplace bullying, when they do, their managers don’t take it seriously.2 Could it be that victims lack confidence their managers will discipline bullies effectively and consistently? Probably so. According to one study, 62 percent of cases in which employers were made aware of bullying behavior, employees thought their managers either worsened the situation or simply did nothing.
As for consistency, over one-third of those surveyed (39%) agreed that “physicians in my organization who generate high amounts of revenue are treated more leniently when it comes to behavior problems than those who bring in less revenue.”1 The article “Behaviors that Undermine a Culture of Safety” suggests facilities that fail to formally address unprofessional behavior are indirectly promoting it.1
Joint Commission Standards
The Joint Commission warns of a distressing decline in trust among hospital employees and, with it, a decline in the quality of medical outcomes.3 In 2008, TJC issued a standard on unprofessional conduct in the workplace, citing concerns about patient care:4
Intimidating and disruptive behaviors can foster medical errors, contribute to poor patient satisfaction and to preventable adverse outcomes, increase the cost of care, and cause qualified clinicians, administrators and managers to seek new positions in more professional environments. Safety and quality of patient care is dependent on teamwork, communication, and a collaborative work environment. To assure quality and to promote a culture of safety, health care organizations must address the problem of behaviors that threaten the performance of the health care team.
Addressing the Issue
So how should conscientious managers address bullying when it is brought to their attention? First and foremost, there must be a commitment to a zero-tolerance policy.
The Joint Commission provides some helpful tips on how organizations should address this issue, including:1
Promote the organization’s code of conduct and enforce it consistently and fairly at all levels. The code and education should emphasize respect.
Include training in basic business etiquette (particularly phone skills) and people skills.
Emphasize the organization’s zero tolerance for intimidating and disruptive behavior.
Establish policies and processes that encourage reporting of intimidating/disruptive behavior.
Hold team members at all levels of the organization accountable for modeling desirable behaviors regardless of seniority or clinical discipline.
Respond to patients and/or family members who are involved or witness bullying behavior. The response should include hearing and understanding their concerns, thanking them for sharing those concerns, and apologizing.
Educate staff on conflict resolution and how to respond to intimidating and/or disruptive behavior.
Encourage discussions across professional and departmental lines as way of addressing ongoing conflicts, overcoming them, and moving forward.
Document all efforts to address intimidating and disruptive behaviors.
For addressing conflict with staff one-on-one in a constructive way, Barbara Linney, vice president of career development at the American College of Physician Executives, Tampa, FL suggests the following:5
Avoid teasing the individual, as this makes you an equal in bad behavior.
Avoid emotional outbursts and defensiveness, which can escalate the problem.
Be mindful of your body language, since it constitutes 55% of what we communicate. The tone of our voice is 38% of what we impart to others, with only 7% of what we convey coming from the words we use.
Listen to what the employee has to say, restating concerns and asking questions to improve your understanding.
If you are at fault, admit it. If not, explain your point of view to help resolve the situation.
When bullying occurs, facing the bully and reporting the behavior is the first step toward fixing the problem. However, according to executive coach Robin Samora, it’s best not to react in the moment. Instead, she suggests “building a bubble around yourself” to protect your self-esteem and work performance while addressing the issue. Samora also recommends communicating by email, so that you have a documentation trail to back you up, or keeping a notebook that lists the date, time and details of the incident. Be sure to note if another employee witnessed the event. This is important in case things worsen and you have to go to your human resources department or take legal action.
If you seek help from human resources, documentation of the incident along with a description of the bully’s impact on the organization gives HR information to work with on your behalf. It’s not just a matter of the bully hurting your feelings. Their bad behavior can sabotage the reputation of your employer, staff productivity, and the health and welfare of your patients.6 In the United States, there isn’t a law against workplace bullying. However, over 20 states have introduced some form of anti-bullying legislation known as The Healthy Workplace Bill.7
Ineffective communication due to bullying among healthcare team members can be harmful on many levels. Bullying in a healthcare environment can potentially:8
contribute to medical errors
negatively impact safe and effective care
result in poor patient outcomes
impact patient satisfaction
lower productivity and morale
increase staff turnover and absenteeism
increase healthcare costs
diminish the organization’s image
increase the risk of employee retaliation and violence
Conversely, the building blocks of effective communication that contribute to team satisfaction also contribute to quality patient care. Phlebotomists and laboratory personnel are motivated to do their best work and fulfill their role in providing exceptional patient care when they feel supported both in the job and interpersonally, are respected, valued, listened to, have a clear understanding of their role, and are fairly treated in work and pay.
When nobody was looking, Bradley roughed up the new phlebotomist with words and physical intimidation. The next day Bradley was suspended, assigned to counseling sessions with the human resources department conducted by Preston, an HR professional who remembered Bradley from fifth grade. For bullies like Bradley, the Day of Reckoning may not be swift, but it is inevitable.
- The Joint Commission. Behaviors that undermine a culture of safety. Sentinel Event Alert. Issue 40, July 9, 2008. http://www.jointcommission.org/assets/1/18/SEA_40.PDF. Accessed 2/3/2020.
- Workplace Bullying Institute & Zogby International. U.S. Workplace Bullying Survey. September 2007. http://workplacebullying.org/multi/pdf/WBIsurvey2007.pdf. Accessed 2/3/2020.
- Workplace Bullying Institute. Physician, Heel Thyself. http://www.workplacebullying.org/2011/05/10/physician-heel-thyself/#more-4295. Accessed 2/3/2020.
- Yamada D. Workplace bullying in healthcare 1: The Joint Commission Standards. Minding the Workplace (blog). December 15, 2009. http://newworkplace.wordpress.com/2009/12/15/workplace-bullying-in-healthcare-i-the-joint-commission-standards/. Accessed 2/3/2020.
- Hernandez, JS. Confronting Conflict in the Lab. How Managers Can Curb the Effects of Disruptive Behavior. Clin Lab News. July, 2011; 16–17.
- Healthy Workplace Bill. http://www.healthyworkplacebill.org/. Accessed 2/3/2020.
- Workplace Bullying Institute. Yamada: Workplace Bullying Is Bad For Business. http://www.workplacebullying.org/2012/01/09/yamada-2/. Accessed 2/3/2020.
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