Bullying It’S Not Normal — It’S Unreasonable

Stop workplace bullying It’s not normal — it’s unreasonable.

Workplace Bullying and Disruptive Behavior: What Everyone Needs to Know

What is workplace bullying and who is Some bullying situations involve employees affected? bullying their peers, rather than a supervisor bullying an employee. The term mobbing refers Workplace bullying refers to repeated, unreasonable to a group of coworkers targeting another worker. actions of individuals (or a group) directed towards Supervisors should intervene immediately to an employee (or a group of employees), which address and stop mobbing behaviors. are intended to intimidate, degrade, humiliate, or undermine; or which create a risk to the health or In a prevalence study of U.S. workers, 41.4% of safety of the employee(s). respondents reported experiencing psychological aggression at work in the past year representing Workplace bullying often involves an abuse or 47 million U.S. workers (Schat, Frone & Kelloway, misuse of power. Bullying behavior creates feelings 2006). The research found that 13%, or nearly of defenselessness and injustice in the target and 15 million workers, reported experiencing undermines an individual’s right to dignity at work. psychological aggression on a weekly basis. Bullying is different from aggression. Whereas Examples of bullying: aggression may involve a single act, bullying involves repeated attacks against the target, n Unwarranted or invalid criticism creating an on-going pattern of behavior. “Tough” n Blame without factual justification or “demanding” bosses are not necessarily n Being treated differently than the rest bullies as long as they are respectful and fair of your work group and their primary motivation is to obtain the n Being sworn at best performance by setting high yet reasonable n Exclusion or social isolation expectations for working safely. Workplace bullying n can be instigated by coworkers, supervisors, contract Being shouted at or being humiliated workers, or labor representatives. n Excessive monitoring or micro-managing n Being given work unrealistic deadlines

Learn more: www.NoBullying.Lni.wa.gov What is corporate/institutional bullying? n Work systems (e.g., lack of policies about behavior, high rate and intensity of work, staff Corporate/institutional bullying occurs when shortages, interpersonal conflict, organizational bullying is entrenched in an organization and constraints, role ambiguity, and role conflict. becomes accepted as part of the workplace culture. Corporate/institutional bullying can manifest itself How bullying affects people: in different ways: Targets of bullying experience significant physical and mental health problems: n Placing unreasonable expectations on employees, where failure to meet those expectations means n Reduced self-esteem making life unpleasant (or dismissing) anyone n Musculoskeletal problems who objects. n Work withdrawal and sickness absence n Dismissing employees suffering from stress as n Sleep and digestive disturbances “weak” while completely ignoring or denying n Increased depression/self-blame potential work-related causes of the stress. n Family tension and stress n Encouraging employees to fabricate complaints n High stress, post-traumatic stress about colleagues with promises of promotion or disorder (PTSD) threats of discipline. n Financial problems due to absence Signs of corporate and institutional bullying include: How bullying affects organizations: n Failure to meet organizational goals. Each of the individual consequences listed above n Increased frequencies of grievances, resignations, can be very costly for the organization. Costs of and requests for transfers. bullying generally fall into three categories: n Increased absence due to sickness. 1. Replacing staff members that leave as a result of n Increased disciplinary actions. being bullied, cost of training new employees. If you are aware of bullying in the workplace 2. Work effort being displaced as staff cope with and do not take action, then you are accepting bullying incidents (i.e., effort being directed away a share of the responsibility for any future from work productivity and towards coping). abuses. This means that witnesses of bullying behavior should be encouraged to report any such 3. Costs associated with investigations of ill incidences. Individuals are less likely to engage in treatment, potential legal action and loss of antisocial behavior when it is understood that the company reputation. organization does not tolerate such behavior and that the aggressor is likely to be punished. Bullies do not run good organizations; staff turnover and sick leave will be high while morale Factors that Increase the Risk for Bullying and productivity will be low. Stress, depression Behavior: and physical health problems result in time away from work that is costly in terms of workers’ n Significant organizational change (i.e., major compensation and lost productivity. internal restructuring, technological change). The health problems experienced by targets of n Worker characteristics (e.g., age, gender, parental bullying result in a sense of helplessness and status, apprentice or trainee). negative emotional states. Low self-esteem and a n Workplace relationships (e.g., inadequate negative organizational climate suppress creativity information flow between organizational levels, and hamper employees’ abilities to respond to lack of employee participation in decisions. difficult situations or challenging goals.

2 The breakdown of trust in a bullying environment slurs, and after a complaint, the employer does may mean that employees will fail to contribute nothing to stop the behavior. Another example of their best work, do not give extra ideas for harassment could be a male manager who makes improvement, do not provide feedback on failures unwelcome sexual suggestions to a female employee and may be less honest about performance. and touches her inappropriately.

Bullying is different from harassment Bullying also differs from retaliation, which occurs after a person makes a complaint of illegal Harassment is one type of illegal discrimination discrimination, and is then the subject of an adverse and is defined as offensive and unwelcome conduct, employment action or subjected to harassment serious enough to adversely affect the terms and because he or she made the complaint. conditions of a person’s employment, which occurs because of the person’s protected class, and can If you believe that you are being harassed or be imputed to the employer. Protected classes in retaliated against for making a discrimination employment are race/color, creed (religion), national complaint, you should immediately contact the origin, sex, marital status, disability, HIV/AIDS Washington State Human Rights Commission or Hepatitis C status, sexual orientation/gender (1-800-233-3247, www.hum.wa.gov). identity, and honorably discharged veteran and Bullying, on the other hand, is often directed at military status. someone a bully feels threatened by. The target An example of harassment could be when an often doesn’t even realize when they are being employee tells racist jokes and refers to a particular bullied because the behavior is covert, through co-worker or group of co-workers by using racial trivial criticisms and isolating actions that occur behind closed doors. While harassment is illegal, bullying in the workplace is not.

What can be done about bullying? At the first sign of conflict check if your company has a workplace violence program or a code of conduct that addresses psychological intimidation and aggression that is not based on a protected characteristic. It can be useful to talk to the aggressor if you are comfortable with that. The person may deny the aggression, but you have let them know that you are aware and consider it unprofessional. Or talk with someone you absolutely trust in the workplace that can advise you and advocate for you while keeping your situation confidential. What can you do about bullying? Employees — regain control: ƒƒRecognize that you are being bullied. ƒƒRealize that you are NOT the source of the problem. ƒƒRecognize that bullying is about control, and therefore has nothing to do with your performance.

3 Take action: See the Example Workplace Bullying Policy at the ƒƒKeep a diary detailing the nature of the bullying end of this document. (e.g., dates, times, places, what was said or done and who was present). ƒƒObtain copies of harassing / bullying paper trails; Disruptive behavior in healthcare: hold onto copies of documents that contradict the Disruptive behavior is described as interactions bully’s accusations against you (e.g., time sheets, among physicians, nurses, hospital staff, audit reports, etc.). administrators, patients, guests, vendors that Other actions: interfere with patient care. Healthcare employees such as nurses and doctors behave professionally Expect the bully to deny and perhaps misconstrue ƒƒ as the norm. However, there are benefits to your accusations; have a witness with you during acknowledging and addressing unprofessional any meetings with the bully; report the behavior behavior when it occurs: to an appropriate person. ƒƒ Contact the Washington State Employee 1. The organization can identify, quantify, and Assistance Program, (www.hr.wa.gov/EAP) for monitor the impact of disruptive behavior. guidance on dealing with the issue. 2. The behavior can be addressed and resolved. Employers: Some examples of disruptive behaviors are: ƒ Create a zero tolerance anti-bullying policy. This ƒ Profane or disrespectful language. policy should be part of the wider commitment ƒƒ to a safe and healthful working environment and ƒƒSexual comments, racial, ethnic, or socioeconomic should have the full support of top management. slurs. ƒƒWhen witnessed or reported, the bullying ƒƒInappropriate touching or assault, angry behavior should be addressed IMMEDIATELY. outbursts or yelling, name calling. ƒƒIf bullying is entrenched in the organization, ƒƒThrowing charts or instruments. complaints need to be taken seriously and ƒƒDisrupting meetings. investigated promptly. Reassignment of the bully Comments that undermine a patient’s trust and may be necessary. ƒƒ confidence. Structure the work environment to incorporate a ƒƒ Refusal to complete a task or carry out duties. sense of autonomy, individual challenge/mastery, ƒƒ and clarity of task expectations for employees. ƒƒIntentional failure to follow organizational Include employees in decision-making processes. policies. ƒƒHold awareness campaigns for EVERYONE on ƒƒRetaliation against any person who has reported what bullying is. Encourage reporting. disruptive behavior. ƒƒEnsure management has an active part in the staff The costs of disruptive behavior are significant: they supervise, rather than being far removed ƒƒTends to cause distress among other staff. from them. ƒƒUndermines productivity. ƒ Encourage open door policies. ƒ ƒƒLeads to low morale and high staff turnover. Investigate the extent and nature of the problem. ƒƒ Results in ineffective, substandard patient care. Conduct employee attitude surveys. ƒƒ ƒƒPoor adherence to practice guidelines. ƒƒImprove management’s ability and sensitivity towards dealing with and responding to conflicts. ƒƒMedical errors and adverse outcomes. ƒƒEstablish an independent contact for employees ƒƒLoss of patients. (e.g., Human Resources contact). ƒƒMalpractice suits.

4 Some examples of disruptive behaviors are: • Employees sign a statement of commitment to abide by the Code of Conduct; • Profane or disrespectful language; • Encourage reporting - conduct regular surveys and focus groups; • Sexual comments, racial, ethnic, or socioeconomic slurs; • Follow-up – analyze and respond to data; • Inappropriate touching or assault, angry • Provide training for leaders, managers and all outbursts or yelling, name calling; hospital staff on how to respond; and • Throwing charts or instruments; • Form an interdisciplinary committee to oversee and modify the Code of Conduct as • Disrupting meetings; needed; and • Comments that undermine a patient’s trust • and confidence; Define a framework for understanding and addressing disruptive behavior. • Refusal to complete a task or carry out duties; The framework below was developed by Dr. • Intentional failure to follow organizational Gerald Hickson and colleagues at the Vanderbilt policies; and University School of Medicine and represents a • Retaliation against any person who has graduated level, peer involved intervention. This reported disruptive behavior. intervention has strong potential for changing the safety culture because many individuals in the The costs of disruptive behavior are significant: organization are actively involved in carrying out the intervention. The approach to intervening at • Tends to cause distress among other staff; each level should be supportive rather than • Undermines productivity; punitive. What can be• doneLeads aboutto low moraledisruptive and high behavior? staff turnover; DisruptiveDISRUPTIVE behavior BEHAVIOR pyramid: P YRAMID: Organizations• canResults intervene in ineffective, to build substandard a collaborative patient safety culture bycare directing; attention to safety and creating• contextsPoor adherence where peopleto practice speak guidelines up and; No Level 3: Disciplinary problem solve together. Change Intervention • Medical errors and adverse outcomes; Ch Create a Code of Conduct that defines Pattern Level 2: Authority ƒƒ • Loss of patients; and Persists Intervention professional behaviors and unacceptable • behaviors andMalpractice includes suitspolicies. and procedures Apparent Level 1: Awareness Pattern Intervention for response. WHAT CAN BE DONE ABOUT DISRUPTIVE ƒ Employees sign a statement of commitment to Single “Informal ƒ BEHAVIOR? “Unprofessional Incidents” Intervention” abide by the Code of Conduct. Mandated EncourageO rganizationsreporting - canconduct intervene regular to build surveys a Issues ƒƒ Vast Majority: No Issues and focuscollaborative groups. safety culture by directing attention to safety and creating contexts where people can Many are models of professionalism ƒƒFollow-upspeak – analyze up and andproblem respond solve totogether. data. Provide training for leaders, managers and all ƒƒ • Create a Code of Conduct that defines Hickson, G.B., Pichert, J.W., Webb, L.E., & Gabbe, S.G. (2007). hospital staff on how to respond. A complementary approach to promoting professionalism: professional behaviors and unacceptable Identifying, measuring, and addressing unprofessional behaviors. ƒƒForm an interdisciplinarybehaviors and includes committee policies to overseeand Academic Medicine, 82, 1040-1048. and modify theprocedures Code of for Conduct response; as needed. ƒƒDefine a framework for understanding and addressing disruptive behavior. Description of Intervention Levels: 5 The framework to the right was developed by Dr. There is specific training in place for each level. Gerald Hickson and colleagues at the Vanderbilt Informal Intervention is “a cup of coffee University School of Medicine and represents a conversation” for single “unprofessional” incidents. graduated-level, peer-involved intervention. This A peer or supervisor selects a private setting for intervention has strong potential for changing the a brief review of the event with the disruptive safety culture because many individuals in the person, pauses for a response, listens and invites organization are actively involved in carrying out the perspective of the person who behaved the intervention. The approach to intervening at unprofessionally. The person may be defensive, each level should be supportive rather than punitive. minimizing or rationalizing. The response to this is, “Despite the situation, there are professional and unprofessional ways to respond and we expect a professional response.” Conclude with discussing options for professional responses. Level 1: Awareness Intervention

Takes place after an apparent pattern develops and is identified by the surveillance system or reporting, when there is a threat to quality and safety. An authority figure or peer shares a compilation of patient complaint data or report data from staff in a supportive manner. Most individuals respond professionally and adjust behavior, reducing patient and staff complaints.

5 Level 2: Authority Intervention ƒƒReduced liability exposure & risk management. When the pattern persists and the person is ƒƒA more civil, productive, and desirable workplace. unable or unwilling to respond to the awareness Conclusion: intervention and change their behavior, the authority intervention is implemented. At this level, Successful healthcare organizations promote leaders develop an improvement and evaluation professionalism, address disruptive behaviors plan with accountability built in. Leaders specify quickly, and adopt a framework for understanding what behaviors need to improve, what support and approaches for taking action. They also develop or services are needed, a timeline, and what the strong policies that clearly define issues and provide outcome will be if the improvement and evaluation guidelines for action to address disruptive behaviors plan is not successful. This intervention should be among healthcare providers and employees. Success supportive rather than punitive. Most individuals is measured by achieving high levels of patient want to improve but may be hindered by work or safety and quality of care. family stress, substance abuse problems, or mental health issues. Resources and contacts: The Washington State Employee Assistance Level 3: Disciplinary Intervention Program (www.hr.wa.gov/EAP) has representatives A lack of response to the authority intervention that are available to help state workers with personal leads to the disciplinary intervention which includes or work-related problems that may be impacting restriction or termination of privileges, reporting your work performance. EAP services are only to government entities and other actions related available to state employees and are confidential, to the Code of Conduct policies and procedures as voluntary, free of charge, and accessible. EAP do all levels of the Disruptive Behavior Pyramid representatives can be reached at these offices: Intervention framework. Surveillance systems are Olympia 360-407-9490 required to provide information and data related to The following websites/organizations have put the disruptive behavior. For further details about together valuable information that includes these interventions and the pyramid framework, definitions and facts about bullying and disruptive see: www.studergroup.com/DB behavior in the workplace: Provide Support Services: ƒƒBullying in the Workplace Healthcare organizations can provide support www.docep.wa.gov.au/WorkSafe/PDF/ services to the individual including use of an Guidance_notes/Dealing_with%20bullying_ Employee Assistance Program or Wellness Program, english.pdf a medical evaluation and treatment planning, ƒƒEuropean Agency for Safety and Health at Work and group classes on professional behavior. The Facts: Bullying at Work (osha.europa.eu/en/ organization can also provide service recovery for publications/factsheets/23/view) staff, patients and others who have experienced or The Studer Group and the Center for Patient witnessed disruptive behavior in the workplace. ƒƒ and Professional Advocacy at Vanderbilt Benefits of addressing disruptive behavior: University. Workshops on Disruptive Behaviors in Healthcare. www.studergroup.com/DB ƒ Improved staff satisfaction and retention. ƒ ƒƒWorkplace Bullying and Trauma Institute, ƒƒEnhanced reputation for the organization. Bellingham, Washington: ƒƒCreates a culture of professionals. www.workplacebullying.org ƒƒImportant role models for all others. ƒƒImproves patient safety and quality of care. ƒƒGreater staff willingness to speak up on patient care problems.

6 Research References: ƒƒ Salin, D. & Hoel, H. (2011). Organisational causes of workplace bullying. In Einarsen, S., Hoel, H., Fox, S. & Stallworth, L. E. (2009). Building a ƒƒ Zapf, D., & Cooper, C. (Eds). Workplace bullying: framework for two internal organizational Development in theory, research and practice. approaches to resolving and preventing London. Taylor & Francis, 227-243. workplace bullying: Alternative dispute resolution and training. Consulting Psychology ƒƒSchat, A. C. H., Frone, M. R., & Kelloway, E. K. Journal: Practice and Research, 61(3), 220-241. (2006). Prevalence of workplace aggression in the U.S. workforce: Findings from a national study. Hickson, G.B., Pichert, J.W., Webb, L.E., & ƒƒ In E. K. Kelloway, J. Barling, and J. Hurrell (Eds.), Gabbe, S.G. (2007). A complementary approach Handbook of workplace violence (pp. 47-89). to promoting professionalism: Identifying, Thousand Oaks, CA: Sage. measuring, and addressing unprofessional behaviors. Academic Medicine, 82, 1040-1048. ƒƒVartia, M. (2001). Consequences of workplace bullying with respect to the well-being of Rosenstein, A. H. & O’Daniel, M. (2005). ƒƒ its targets and the observers of bullying. Disruptive behavior & clinical outcomes: Scandinavian Journal of Work Environment and Perceptions of nurses and physicians. American Health, 27, 63-69. Journal of Nursing, 105, 54-64.

SHARP – Research for Safe Work

This document was produced by the Safety & Health Assessment and Research for Prevention (SHARP) Program, a research program within the Washington State Department of Labor & Industries. SHARP’s researchers and scientists partner with business and labor to identify industry- wide hazards and then develop sensible, effective solutions to eliminate those hazards. If you have questions about this report or the SHARP program, please contact us at: SHARP Washington State Department of Labor & Industries P.O. Box 44330 Olympia, WA 98504-4330 Tel. 1-888-66-SHARP (toll-free) Fax 360-902-5672 Email [email protected] Check out our website at: www.SHARP.Lni.wa.gov

7 EXAMPLE WORKPLACE BULLYING POLICY Adapted from The Commission of Occupational Safety and Health, Government of Western Australia

Company X considers workplace bullying unacceptable and will not tolerate it under any circumstances. Workplace bullying is behavior that harms, intimidates, offends, degrades or humiliates an employee, possibly in front of other employees, clients, or customers. Workplace bullying may cause the loss of trained and talented employees, reduce productivity and morale and create legal risks. Company X believes all employees should be able to work in an environment free of bullying. Managers and supervisors must ensure employees are not bullied. Company X has grievance and investigation procedures to deal with workplace bullying. Any reports of workplace bullying will be treated seriously and investigated promptly, confidentially and impartially. Company X encourages all employees to report workplace bullying. Managers and supervisors must ensure employees who make complaints, or witnesses, are not victimized. Disciplinary action will be taken against anyone who bullies a coworker. Discipline may involve a warning, transfer, counseling, demotion or dismissal, depending on the circumstances. The contact person for bullying at this workplace is:

Name:

Phone Number:

April 2011 Report # 87-2-2011 8 FY13-205 [03-2013]