Workplace Bullying in Healthcare: Part 1 By Becky Lamberth, MJ, MS, CRA, FAHRA The credit earned from the Quick CreditTM test accompanying this article may be applied to the CRA human resources (HR) domain. According to the Workplace rapidly changing environment, the con- EXECUTIVE SUMMARY Bullying Institute (WBI), approxi- cept of “doing more with less resources,” • Bullying is a repetitive and abusive mately 35% of American workers have the hierarchal structure and the learning behavior in which the victim suffers experienced some form of workplace setting.3 As one physician stated, “the from abuse, humiliation, or intimida- bullying firsthand. This represents culture that perpetuates bullying goes tion to such an extent that it interferes roughly 53.5 million Americans. An back as far as medical school, when as with job performance. additional 15% of workers have been students, future doctors are trained in a • Victims of bullying have three possible witness to acts of bullying.1 pecking order not unlike the military.”4 legal solutions: harassment, hostile In 2013, millions of viewers watched Professions within the medical field work environment, and intentional/ footage on social media outlets of former tend to attract individuals who have a negligent infliction of emotional dis- Rutgers coach, Mike Rice, as he screamed, very high self-confidence level but then tress. However, the elements necessary pushed, kicked, and threw items at his expose them to an environment charac- to fulfill the legal definitions are subjec- players during basketball practice. These terized by great uncertainty.5 tive and difficult at best to satisfy. actions are unquestionably character- The word bully has Dutch origins • Hospitals are hesitant to terminate any istic of a bully. Rice describes his own dating as far back as the 1530s, in which employee, which would result in open behavior as passionate, emotional, and the term meant “lovers” or “friends.” It staff positions that are difficult to fill. intense, but does not consider himself to wasn’t until much later that the term Replacing staff with specific skills, be abusive or a bully.2 This was not an bully morphed into a more callous including physicians, is daunting and isolated event for Rice but his behavior meaning. By 1909, the mistreatment of costly. This makes recruitment cost a significant factor in retaining staff was never formally addressed or chal- nursing staff was already being docu- members who demonstrate poor lenged because he was able to achieve mented and by the 1980s British jour- behavior. desired results from the team. It wasn’t nalist, Andrea Adams, popularized the until there was public outcry that he was term “workplace bullying.”2 The concept • Part 1 will focus on terminology and concerns related to bullying. Part 2 will terminated from the university. was finally introduced and accepted in discuss the legal protection afforded Although workplace bullying occurs the American workplace in the 1990s. the bully and possible organizational in many varying professions, from Bullying abuse can be verbal, emotional, solutions. Part 3 will address managers blue-collar jobs to academia, it is most or even physical, but typically takes the who have been accused of bullying by prevalent in the medical profession.3 form of emotional-verbal abuse.6 Com- disgruntled employees and what to do The reasons for such high levels of bul- mon examples of bullying include threat- about it. lying in medicine are not fully known ening or abusive language, demeaning or understood, but are thought to stem comments, repeated criticism, humili- from the high stress work atmosphere, a ation, refusing to assist, intimidation, 12 JANUARY/FEBRUARY 2015 RADIOLOGY MANAGEMENT malevolent emails, and throwing items.6 It is estimated that workplace bullying costs Translated into workplace actions, bul- lying can take the form of unreason- an organization roughly 10% of their profits. able work demands, blaming the victim for errors, insults, deliberately denying access to critical information, denying opportunities for training or promotion, but are impatient and easily frustrated clinical depression, high blood pres- stealing credit for work successes or dis- when something does not go according sure, cardiovascular disease, impaired counting accomplishments.7 Although to plan.7 Fifty-eight percent of the time, immune systems, increased staff turn- physicians are often considered to be the victims are females who are highly over, increased absenteeism, decreased the primary culprit of bullying, the fact competent and well accomplished.11 productivity, and symptoms consistent is that healthcare bullies can be any one Victims are typically chosen because they with post-traumatic stress disorder.7 of the many professionals who work in pose some sort of threat to the bully, such Studies suggest that workplace bullying the organization including physicians, as being well liked by peers or are con- costs organizations an estimated $200 nurses, radiology technologists, pharma- sidered a resource to the department or billion annually resulting from a 40% cists, ancillary staff personnel, adminis- organization.11 Victims refuse to be sub- decline in productivity, increased sick trators, or other non-physician staff servient and often demonstrate ethical days, increased medical claims by the members. The Society and College of and honest work behaviors. Victims are victims, potential legal costs, and staff Radiographers (SCoR), a trade union in non-confrontational and could poten- turnover.7 the United Kingdom, conducted a survey tially be a whistle blower exposing uneth- Stanford University professor, Bob of its members in 2013 in which 1,463 ical or fraudulent actions.1 In situations Sutton, suggests that up to 82% of vic- members responded. Forty percent of where females are the bullies, 80% of the tims resign, transfer, or are terminated.7 the respondents indicated that they had time their victims are other females.7 Replacing employees costs two to three been subjected to bullying or harassment Bullying can also occur among work times their annual salaries.7 This is a in the past two years and 21% identified peers of the same status. This type of concern especially with the potential cri- bullying as a serious issue.8 bullying is referred to as horizontal hos- sis in the US with the looming shortage Because this behavior is often a mis- tility.12 Behaviors consistent with hori- of healthcare providers. A 2013 survey use of power, studies indicate that pri- zontal hostility (among others) can range indicated that the current average age of mary culprits are typically department from infighting, sabotage, demeaning a registered nurse was 50 years and that managers, supervisors, or organization remarks, and passive-aggressive behav- by the year 2020 over half of those nurses executives.7 A survey commissioned ior.12 The phrase “eating their young” will reach traditional retirement age.14 In by the WBI with Zogby International regarding the behavior of more senior 2007, a study indicated that one quarter in 2007 found that in 72% of the cases, nurses with newly hired nurses has been of physicians were age 60 or older.14 Of the perpetrators are supervisors (the used for decades and is now being rec- those bedside physicians, approximately survey included online interviews of ognized as a form of bullying. In a study 209,000 were primary care. It is esti- 7,740 adults between 8/10/07 through conducted in the United Kingdom, it mated that an additional 52,000 primary 8/13/07. The margin of error was +/– 1.1 was determined that 86% of nurses face care physicians will be needed by 2025; percentage points). 9,10 Of those perpe- bullying during a 12 month period and and by 2030 the US will need an extra 3.5 trations, executive members supported at some point in their careers 97% of all million healthcare providers to maintain the behavior 43% of the time.1 Leaders nurses will be exposed to verbal abuse.2 the existing provider to patient ratio.14 do nothing 43.6% of the time when bul- For the patient, bullying in the health- lying occurs, offenders are punished in care workplace compromises job perfor- only 6.2% of the cases, and in 18.4% of Effects of Bullying mance of the provider and contributes to the cases, the victim felt that employer Regardless of the bully’s identity (and increased adverse events and near misses, intervention actually made the situation position), or the reasons behind bully- increased medical and medication errors, worse.9 Employees reported that bully- ing, there are severe consequences result- decreased patient satisfaction, decreased ing stopped 40% of the time because the ing from the behavior. It is estimated that safety and quality care, and a decrease in victim quit, 24% of the time because the workplace bullying costs an organization positive patient outcomes. This negative victim was terminated, and 13% of the roughly 10% of their profits.13 Approxi- impact on patients is often blamed on a time because the victim transferred.1 mately 40% of victims never report being decrease or lack of communication and Characteristically, 62% of bullies are bullied and for those that do report, 62% collaboration between patient provid- male.11 They crave power and control. of them are ignored.7 For the victim, this ers.6 The phenomenon has become so They are competitive and appear driven, can lead to increased stress and burnout, concerning, that regulatory agencies such RADIOLOGY MANAGEMENT JANUARY/FEBRUARY 2015 13 Workplace Bullying in Healthcare: Part 1 Bullying is four times more prevalent than harassment and when it is so egregious that it creates a hostile work environment.18 Federal laws there are some key differences that distinguish the two. that address harassment include Title VII of the Civil Rights Act of 1964, the Age Discrimination in Employment Act of 1967 (ADEA), and the American with as The Joint Commission issued a senti- Legal Remedies for Victims Disabilities Act of 1990 (ADA).19 Con- nel event alert in 2008 and implemented gress enacted Title VII of the Civil Rights two additional leadership standards in There is slow movement as some health- Act of 1964, (42 U.S.C.