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The New Age of Bullying and Violence in Health Care: Part 4 Managing Organizational Cultures and Beyond

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The New Age of Bullying and Violence in Health Care: Part 4 Managing Organizational Cultures and Beyond 1.5 ANCC Professional Case Management CE Vol. 23, No. 6, 294-306 Contact Hours Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved. The New Age of Bullying and Violence in Health Care: Part 4 Managing Organizational Cultures and Beyond Ellen Fink-Samnick, MSW, ACSW, LCSW, CCM, CRP ABSTRACT Disrespect among the health and behavioral health workforce may have reached the point of no return. The industry is on heightened alert, as the disruptive behaviors of bullying and lateral violence, plus escalating incidents of workforce harassment and workplace violence incidents, impact every practice setting. These behaviors contribute to concerns around client and professional safety, quality-of-care processes, as well as workforce retention and mental health. Purpose/Objectives: This article: 1. Defines a hostile workplace; 2. Identifies types of toxic employees; 3. Discusses types of workplace harassment; 4. Reviews the impact of organizational culture on these disrupters; and 5. Explores strategies and legislation to manage workplace violence across practice domains. Primary Practice Setting(s): Applicable to all health and behavioral health settings where case management is practiced. Findings/Conclusions: Despite glaring improvements in how care is rendered and an enhanced focus on quality delivery of care, organizations must address cultures that support as opposed to negate disruptive workplace behaviors. The emerging regulatory and organizational initiatives to reframe the delivery of care will become meaningless without consistent attention to enforcement of regulatory, policy, and prevention actions. Implications for Case Management Practice: Professionals who hesitate to confront and address incidents of disruptive and oppressive behavior in the health care workplace potentially practice unethically. Bullying has fostered a dangerous culture of silence in the industry, one which impacts client safety, quality care delivery, plus has longer term behavioral health implications for the professionals striving to render care. Add the escalating numbers specific to workplace violence and the trends speak to an atmosphere of safety and quality in the health care workplace that puts clients and professionals at risk. Key words: bullying, earned respect, hostile work environment, mobbing, owed respect, toxic employees, sexual harassment, workplace harassment, workplace violence he final installment of “The New Age in mandate further attention by all professionals and Bullying and Violence in Health Care” series organizational leaders. Twas originally targeted to focus only on manag- However, workplace bullying and violence are ing an organizational culture of bullying, plus offer not the only disruptive behaviors to invade the health further strategies on workplace violence (WPV). care industry. A new generation of negative actions has Sixty-eight percent of executives identify bullying as a arrived on the scene, pushing where that line in the serious problem in their organizations, though, only sand marks a clear and present “no crossing” zone. about 5.5% actively do anything about it (Smith, The year of 2018 has seen the rise of the #MeToo 2013). Those persons exposed to bullying in the movement across work sectors, especially health care. workplace, whether as target or victim, are twice as likely to commit suicide (Falzoi, 2016). Workplace Address correspondence to Ellen Fink-Samnick, MSW, homicides, in tandem, have risen significantly as high ACSW, LCSW, CCM, CRP, EFS Supervision Strategies, LLC as 600% between 2015 and 2016 (Bureau of Labor ([email protected]). Statistics, 2017). Increasingly brazen acts of WPV The author reports no conflicts of interest. quickly appear over social media and then through- out the world. These are concerning numbers that DOI: 10.1097/NCM.0000000000000324 294 Professional Case Management Vol. 23/No. 6 Copyright © 2018 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited. Despite glaring improvements in how care is rendered and an enhanced focus on quality delivery of care, organizations must address cultures that support as opposed to negate disruptive workplace behaviors. The emerging regulatory and organizational initiatives to reframe the delivery of care will become meaningless without consistent attention to enforcement of regulatory, policy, and prevention actions. The literature is quickly amassing surveys and research information. It is a form of employment discrimina- that reveal no profession is immune from harassment, tion that violates Title VII of the Civil Rights Act of especially that which is sexual in nature. Other ter- 1964, the Age Discrimination in Employment Act of minology has hit the workplace radar, that of mob- 1967 (ADEA), and the Americans with Disabilities Act bing, hostile work environment, and toxic employees. of 1990 (ADA). Harassment becomes unlawful where: Understanding where bullying fi ts in the scope of these 1. enduring the offensive conduct becomes a condi- fresh framings is vital. To round out our scope, health tion of continued employment, or and behavioral health settings are balancing state laws 2. the conduct is severe or pervasive enough to cre- that secure the rights of persons to carry weapons with ate a work environment that a reasonable person WPV safety and prevention protocols. would consider intimidating, hostile, or abusive. This Part 4 article goes far beyond the original scope to focus on the current and emerging landscape Antidiscrimination laws also prohibit harassment of workplace bullying and violence. Attention is on against individuals in retaliation for fi ling a discrimi- defi ning and distinguishing between hostile environ- nation charge, testifying, or participating in any way ments and toxic employees, the increased recognition in an investigation, proceeding, or lawsuit under these and management of the types of harassment, naming laws, or opposing employment practices that they rea- organizational cultures and their relationship with sonably believe discriminate against individuals, in vio- harassment and bullying, as well as WPV and requi- lation of these laws ( U.S. Equal Employment Oppor- site legislation. Considerations for case management’s tunity Commission [EEOC], 2018a ). This legislation interprofessional workforce are also discussed. extends to whistleblowers who initiate dialogues with supervisors, leadership, and human resources about THE NEW WORKPLACE LANDSCAPE: DEFINITIONS bullying, unethical or related behaviors. AND DISTINCTIONS Under the law, employers are automatically liable for harassment by a supervisor that results in The past decade has seen the emergence of workplace a negative employment action such as termination, challenges that include bullying but are not limited to failure to promote or hire, and loss of wages. Exam- bullying behaviors. The defi nition and growth of toxic ples that come to mind include when the staff are not employees within hostile environments add fury to the promoted on the basis of their professional discipline already smoldering fi re of dysfunctional occupational alone or potentially not judged on the merits of their behaviors. Add the highlighting of sexual harassment qualifi cations for a position (e.g., degree, case man- and oppression of women across sectors and the land- agement training, certifi cation, Interqual training). scape has exponentially increased. This section defi nes and explores these newer trends to infect the industry. Types of Workplace Harassment Workplace Harassment Twenty percent of American workers fi nd the work- place hostile or threatening, which includes situations Workplace harassment is unwelcome conduct based on marked by sexual harassment and bullying ( Wiseman, race, color, religion, sex (including pregnancy), national 2017 ). Table 1 presents the two basic types of unlaw- origin, age (40 years or older), disability, or genetic ful harassment, Quid Pro Quo or Hostile Work Environment Harassment ( United States Depart- Professionals who hesitate to confront ment of Labor, 2018 ). An employer can be liable for one of the two types of harassment by nonsupervi- and address incidents of disruptive sory employees or nonemployees over whom it has and oppressive behavior in the health control (e.g., independent contractors or customers care workplace potentially practice on the premises) if it knew, or should have known, unethically. about the harassment and failed to take prompt and appropriate corrective action. When a supervisor’s Vol. 23/No. 6 Professional Case Management 295 Copyright © 2018 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited. TABLE 1 Types of Workplace Harassment Types of Workplace Harassment Definition/Explanation Quid Pro Quo— • Generally results in a tangible employment decision based upon the employee’s acceptance or rejection of unwelcome “This for That” sexual advances or requests for sexual favors but can also result from unwelcome conduct that is of a religious nature. • Generally committed by someone who can effectively make or recommend formal employment decisions (such as termination, demotion, or denial of promotion) that will affect the victim. Examples: • Supervisor who fires or denies promotion to a subordinate for refusing to be sexually cooperative • Supervisor requires a subordinate to participate in religious activities as a condition of employment • Supervisor offers preferential treatment/promotion if subordinate sexually
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