Management of Bullying-(Plenary)

5/10/21

Management of Bullying in Health Care: Tactical and Ethical Guidance for Professional Case Management

BULLYING & VIOLENCE

Ellen Fink-Samnick MSW, ACSW, LCSW, CCM, CCTP, CMHIMP, CRP, DBH-C EFS Supervision Strategies, LLC [email protected] 1

Once Upon a Time….

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Objectives • Explore the incidence, scope, and organizational impact of bullying in the healthcare workplace. • Identify implications for the industry’s emerging interprofessional practice culture. • Review initiatives and strategies to empower professionals.

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Disclaimer

There are no potential conflicts of interest contained in the information provided in this presentation. All material is the opinion of this presenter or cited to source and/or authority Any products referred to during this presentation are for the sole purpose of example only and should not be taken as product endorsement.

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Workplace Bullying is an interprofessional sport that no discipline gets to sit out.. -E.Fink-Samnick

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Workplace Bullying: Data, Definitions & Demographics

• 37% of American workers are impacted54… . Million people

• Include50% the all bystanders of those bullied employees in the United States (Mental Health America, 2021)

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Workplace Bullying: Data, Definitions & Demographics Repeated, health-harming mistreatment of one or more persons (targets) by one or more Overperpetrators 72% of employers deny, discount, encourage, rationalize, or defend it (Workplace Bullying Institute, 2021)

(U.S. Legal, 2021; Workplace Bullying Institute, 2015)

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Workplace Bullying: Data, Definitions & Demographics

• 4X more common than: – sexual harassment 75% – racial discrimination, affected, – though not illegal whether as witness or target

(Comaford, 2016; Workplace Bullying Institute, 2021) EFS Supervision Strategies, LLC 2021 ©

Workplace Bullying or Hostile Work Environment: Distinctions Legal requirements: • Actions or behavior must discriminate against a protected classificationActions must seriously • Behavior disruptor communication the employee’s must be work pervasive • The problem becomes significantand and pervasive. • The hostile interferebehavior, actions,with their or communication career must be severe. progress (Muller, 2020)

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Workplace Bullying: Data, Definitions & Demographics True or False? Healthcare has among the highest levels of WB?

77% by Physicians 65% by Nurses

(Farouque and Burgio, 2013; Rosenstein and O’Daniel, 2008).

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Workplace Bullying: Data, Definitions & Demographics WB as a heart disease risk factor • N=80,000 workers – Ages 18-65 – 9 % bullied at work, and – 13% experienced violence/threats in the past year.

121% (Safety + Health Journal, 2019)

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Workplace Bullying: Data, Definitions & Demographics The costs?

$200 B

(Lamberth, 2015) $$$$$$$

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Workplace Bullying: Data, Definitions & Demographics • Myth: Bullies target vulnerable employees • Fact: Targets are high performing, highly ethical employees whose competence poses a threat to lower performing, unethical bosses. (Falzoi, 2016)

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In a work atmosphere of toxic behaviors, even good employees can be drawn into negative bullying interactions; their alignment akin to following the path of least resistance.

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Workplace Bullying: Data, Definitions, & Demographics Mobbing: bullying by numerous colleagues, superiors, and, in some cases, even subordinates of the victim of the bullying. 37% of (LegalMatch,bullying 2018) incidences © Can Stock Photo / novelo

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Engages in tactics so outrageous Target Bully Bully becomes repeatedly convinces Drives the the alone & reprimands others the target to target’s report the support vulnerable more than target is to problem system average incompetent depression target doesn’t believe /suicide him/her

Suicidal ideation:>30% Suicides related to bullying: >15% Staff subjected to bullying 2X as likely to take their own life

(Falzoi, 2016; Nielsen, Neilsen,

Notalaers, and Einarsen, 2015) EFS Supervision Strategies, LLC 2021 ©

Workplace Bullying: Data, Definitions & Demographics The Joint Commission: disruptive behaviors fuel medical errors, lead to preventable adverse outcomes (TJC, 2008). • 250,000 Disruptive MDs: 14% more deaths complications annually • Disruptive behaviors led to (Cha, 2016; Brown, 2011). medical errors: >75% of the time, with 30% of deaths.

(Cooper, et al, 2017, Painter, 2013). EFS Supervision Strategies, LLC 2021 ©

The Gender Factor

• 69% of bullies: men • 57% of targets: women • 80% of case Woman bully women What percentage of women believe they were undermined by another woman in the workplace? 95%

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The ‘Queen Bee’ Syndrome “Women who rise to success in male-dominated environments and are prone to oppose the rise of other women.”

(Fink-Samnick, 2017; Drexler, 2013)

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The COVID-19 Impact N=7411 Higher incidence of:

• Lateral violence

• Hostility (e.g., racism, discrimination)

• Harassment and Violence

(Dye, et al., 2020)

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Consider this…. • The department manager does not agree with how a staff member handled a recent situation with a client at the agency. • While meeting in the agency entry hall, the boss reacts coming across more as a disciplinarian than Bullying or mentoring leader. not? • The interchange is brief and perceived to be hostile by the staff member. The manager was direct in approach, but not rude. EFS Supervision Strategies, LLC 2021 ©

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The Bottom Line….

• The staff member may perceive the interaction as bullying, but it is not.

• When the behavior becomes part of a repeated pattern (e.g. calling the staff member incompetent whether in front of staff, or private) it © Can Stock Photo / rnl crosses the bullying line.

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Consider this….

• A case management supervisor meets with the clinical director to brainstorm about strategies to Bullying manage the team. They develop a or not? strong process and tool to manage the situation. • In an organization wide management managers’ meeting, the director takes credit for the plan development and implementation of the process.

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The Bottom Line…

The clinical director may be a ‘credit hog’, but not a bully.

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Let’s be Clear: Bullying is not….

(Fink-Samnick, 2019)

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What About Organizational Culture? Sound familiar? • ‘Bullying is part of the culture; so not changing’. • ‘It’ll take someone higher up the chain to fix ’. • ‘WB goes from the top down in my organization’. • ‘If I call out the behavior, I’ll be fired’. • ‘Change involves shifting the culture; that won’t happen’. • ‘Why are you so riled up about this? It’s nothing new’.

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Which Strikes a Chord?

Dictatorial Culture

Disjointed Culture

Stable Culture

(Faas,2017) EFS Supervision Strategies, LLC 2021 ©

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Toxic Boss Behaviors (Lipman-Blumen, 2006; Weinstein, 2007)

Toxic bosses are charismatic

successful, tough to accomplished, identify genius

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Bullying Involves Power (Forsythe, 2010; Giang, 2013)

Coercive Connection Expert

Legitimate (aka Informational Reward Positional)

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Consider This…

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Ethical Tenets and Codes: Application to Bullying Commission for Case Manager • Beneficence Certification (2015) – Is Gail acting in Michael’s best interest’s? Principle 2: Board-Certified Case • Non-Malfeasance Managers (CCMs) will respect the rights – Is Gail potentially harming and inherent dignity of all of their Michael’s recovery? clients. • Autonomy – What does Michael want? Principle 3: Board-Certified Case • Justice Managers (CCMs) will always maintain – Is Michael being treated fairly by objectivity in their relationships with Gail ? clients. • Fidelity – Is Gail subject to reprimand? Principle 4: Board-Certified Case (CMSA, 2016) Managers (CCMs) will act with integrity and fidelity with clients and others.

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• Workplace bullies thrive on opportunities to make targets feel less than they are. • Nobody wants to be the villain in their own story. • Nobody wants to view themselves from a place of weakness • Vulnerability is NOT fuel for someone else’s strength. • Nobody should be forced to travel on someone else’s power trip.

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There’s Light at the End of the Tunnel

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Advocacy Toward Action

The Healthy Workplace Bill (HWB)-Template of a bill that – Defines an "abusive work environment” – Requires proof of health harm by licensed health or mental health professionals – Protects employers from vicarious liability risk when internal correction and prevention mechanisms are in effect – Gives employers the reason to terminate or sanction offenders – Requires plaintiffs to use private attorneys – Plugs gaps in current state and federal civil rights protections – Supports those in “at will’ situations who fear retribution (Healthy Workplace Bill, 2021)

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Advocacy Toward Action

• January 1, 2009 The Joint Commission (TJC) created a standard in the Leadership chapter, LD.03.01.01. – It calls for organizational leaders to create and maintain a culture of safety and quality

(TJC, 2008)

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Advocacy Toward Action

The U.S. Department of Veterans Affairs the Equal Employment Opportunity, Diversity and Inclusion, No FEAR, and Whistleblower Rights and Protection Policy Statement

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Advocacy Toward Action

Incivility, Bullying & Workplace Violence: Position Statement (2015)

“ the nursing profession will no longer tolerate violence of any kind from any source. All registered nurses and employers in all settings, including practice, academia, and research must collaborate to create a culture of respect, free of incivility, bullying, and workplace violence.”

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Advocacy Toward Action

2.01 Respect Social workers should: a) Treat colleagues with respect and represent accurately and fairly the qualifications, views, and obligations of colleagues. b) Avoid unwarranted negative criticism of colleagues

(NASW, 2017)

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Advocacy Toward Action

Social Dominance Orientation Scale (Ho, et. al., 2015, Moss, 2016) • High SDO: – Reinforce inequality between groups – Evoke an autocratic leadership style, • Low SDO: – Emphasize cooperation, egalitarianism, and humanitarianism. – Subscribe to more interprofessional team approaches.

Instructions: Show how much you favor or oppose each idea by selecting a number from 1 to 7 on the scale below. Work quickly as your first instinct is generally best.

1 2 3 4 5 6 7 Strongly Somewhat Slightly Neutral Slightly Somewhat Strongly Oppose Oppose Oppose Favor Favor Favor Protrait dominance: • An ideal society requires some groups to be on top & others on the bottom. • Some groups of people are simply inferior to other groups. Contrait dominance: • No one group should dominate in society. • Groups at the bottom are as deserving as groups at the top. Protrait anti-egalitarianism: • Group equality should not be our primary goal. • It is unjust to try to make groups equal. Contrait anti-egalitarianism: • We should do what we can to equalize conditions for different groups. • We should work to give all EFSgroups Supervision an Strategies, equal LLC chance 2021 © to succeed.

Advocacy Toward Action

Standard K: Ethics Professional case managers should behave and practice ethically, and adhere to the tenets of the code of ethics that underlie her/his professional credentials. • Demonstrated: – Awareness of: • Beneficence (CMSA, 2016) • Nonmaleficence • Autonomy • Justice • Fidelity • Recognition of: – A primary obligation to the client – A secondary obligation: engagement in and maintenance of respectful relationships with coworkers, employers, and other professionals EFS Supervision Strategies, LLC 2021 ©

Advocacy Toward Action Accountability: • Recognizes and demonstrates shared accountability, both at the patient and the team levels. • Contributes to decision-making and decision support as a member of the interdisciplinary team.

• Professionalism • Emulates the standards of practice for both Case Management and their professional discipline. • Demonstrates commitment, initiative, integrity and flexibility

(ACMA, 2020)

Confront • via direct bullying discussions with behavior involved parties When Events Occur

Seek • use all available resolution employer routes (e.g. leadership, human resolution resources, EAPs)

File complaint with requisite • only if no other credentialing resolution can be reached body Seek • *use experts in human independent resources, EEOC legal policies & regulations consultation Obtain • *assure independent documentation/ mental health assessment of consultation occurance(s)

Promote Your Workplace Resilience!

Document, Intervene early! Don’t get isolated! Document, Document

Set limits on what Promote your Don’t react to the negative behavior is professional self! acceptable! bully!

Approach bullying Take time to heal and Protect your personal like a work project, recharge. information. including financial costs!

Costs of Workplace Bullying (Workplace Bullying Institute, 2017b) • Employee turnover: – multiply combined salaries of departed workers by 1.5. (e.g. for a person earning a $80,000 salary, recruit and replace expenses are $120,000)

Costs of Workplace Bullying (Workplace Bullying Institute, 2017b) Absenteeism and Presenteeism: Estimate # & hours per day targets miss work to avoid the bully. • For Absenteeism, multiply hours away from the employer by the hourly rate. For salaried exempt workers, divide the annual salary by 2020 to find the hourly pay rate. • Presenteeism are employees coming to work sick – Is considered the trend of bullied workers not being able to find another job elsewhere with equivalent pay. – As a result they stay, show up daily, but are present in body, not spirit. They are disgruntled, disgusted, and desperate (the "3-D"'s) to be somewhere else. – The Presenteeism cost estimate method counts the number of "3-D" employees, their hourly wage, & # of hours worked during the entire bullying episode, then halve that value. That # represents paid wages lost to the employer by paying workers rendered unproductive by bullying.

Costs of Workplace Bullying (Workplace Bullying Institute (2017b) Absenteeism and Presenteeism: Estimate # & hours per day targets miss work to avoid the bully. • Absenteeism: Hours away from the employer – $80,000 an hour equal $39.60 per hour

• Presenteeism: Lost wages due to workers who come but are not able to work • two employees are bullied over one year; each earns $39.60 an hour, or $79.20 combined. • Each employee worked a 40-hour work week over the year they endured bullying; 52 weeks=2,080 hours worked • multiply $79.20 x 2,080=$164,736, and halve that total: • TOTAL: $82,368 in paid wages lost to the employer

Costs of Workplace Bullying (Workplace Bullying Institute, 2017b) • Litigation and settlements: – Safe estimate-approximately $30,000 per lawsuit. – If the case is filed in court, increase to $60,000. • Workers Comp and Disability Insurance Claims: – Tough to know this exact number – Call a firm who manages disability claims

Don’t Forget To…

Provide relevant Take opportunities to resources (e.g. EAP educate and support programs, local colleagues therapy support)

Engage with local and Advocate for change national initiatives to in your profession, move relevant and organization legislation forward.

Resources Empowerwork Healthy Workplace Bill Interprofessional Education Collaborative Mental Health America Overcome Bullying Times Up Now Workplace Bullying Institute

Ellen’s

Workplace Mantras 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 WB without fear of retribution.

‘No one can make you feel inferior CM without your consent’ -Eleanor Roosevelt

Thank Contact Information you

#mustdobetter #interprofessionalimpact

Ellen Fink-Samnick MSW, ACSW, LCSW, CCM, CCTP, CMHIMP, CRP, DBH(c) Principal, EFS Supervision Strategies, LLC www.efssupervisionstrategies.com [email protected]

References • American Case Management Association (ACMA) (2020). Standards of Practice and Scope of Services: Author • American Psychiatric Association. (APA) (2013) Diagnostic and statistical manual of mental disorders (5th ed.): Author • American Nurses Association (ANA) (2015). Incivility, Bullying & Workplace Violence: Position Statement: Author • Ariza-Montes, A., Muniz N., Montero-Simo M. and Araque-Padilla R, (2013) Workplace Bullying Among Healthcare Workers, International Journal of Environmental Research and Public Health , 10, 3121-3139 • Cannizzo, M. (2017) New North Texas Study Highlights Bystanders in Workplace Bullying Incidents, June 8, 2017, Dallas Business Journal • Cha, A (2016) Researchers: Medical Errors Now Third Leading Cause of Death in United States,, Washington Post • Cooper, W., Guillamondegui, O., Hines, J (2017) Use of Unsolicited Patient Observations to Identify Surgeons With Increased Risk for Postoperative Complications, JAMA Surgery • Comaford, C. (2016) 75% of workers are affected by Bullying--- What to do about it, August 27, 2016, Forbes • Commission on Case Manager Certification(CCMC)(2015) Professional Code of Conduct, Guidelines, and Standards, 2015: Author • Dye TD, Alcantara L, Siddiqi S, et al (2020). Risk of COVID-19-related bullying, harassment and stigma among healthcare workers: an analytical cross-sectional global study BMJ Open 2020;10:e046620. doi: 10.1136/bmjopen-2020-046620 • Faas, A. (2017 ). From Bully to EFSBull’s Supervision Eye, Strategies,RCJ Press LLC 2021 © 55

• Farouque, K. and Burgio, E (2013) The Impact of Bullying in Health Care, The Quarterly, The Royal Australasian College of Medical Administrators • Fink-Samnick, E. (2019) Chapter 3, The Value Proposition of Ethical Case Management and Chapter 5, Workplace Bullying in, The Essential Guide to Interprofessional Ethics in Healthcare Case Management, HCPro • Giang, V. (2013) The 7 types of Power that Shape the Workplace , Business Insider • Healthy Workplace Bill (2021). Updates and FAQs • Ho, AK et. al. (2015) The nature of social dominance orientation: Theorizing and measuring preferences for intergroup equality using the new SDO Scale. Journal of Personality and Social Psychology, 109(6) pg. 1003-1028 • Lamberth, B.B (2015) Workplace Bullying, 3, Radiology Management, May/June 37(3): pp. 18-22 • LegalMatch (2018) Mobbing • Lippman-Bluman, J. (2006) The Allure of Toxic Leaders: Why We Follow Destructive Bosses and Corrupt Politicians—and How We Can Survive Them, Oxford Press, New York • Mental Health America (2021) Workplace Culture and Bullying • Moss, S. (2016, June 7). Why some bosses bully their best employees. Harvard

• Mueller, R. L. (2011) Bullying Bosses: A Survivor’s Guide; Bullying Bosses • Muller, D. (2020). How to recognize and investigate a hostile work environment, HRAcuity • National Association of Social Workers (NASW) (2016) Executive Summary: Workplace Violence, National Committee on Women’s Issues, NASW: Washington, DC: Author • Nierlsen, M. B., Nielsen, G.H., Notelaers, G., and Einarsen, S. (2015) Workplace Bullying and Suicidal Ideation: A 3 Wave Longitudinal Norwegian Study, November 2015, American Journal of Public Health, 105(11), pg. e23-e28 • The Joint Commission [TJC], (2008). Sentinel Event Alert, Issue 40: Behaviors that undermine a culture of safety, from http://www.jointcommission.org/assets/1/18/SEA_40.PDF • US LegalTM (2021) Definition of Lateral Violence • Workplace Bullying Institute (2017b) Estimate the Cost of Bullying • Workplace Bullying Institute (WBI) (2021) The WBI Definition of Workplace Bullying