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…. EFS Supervision Strategies, LLC 2021 © 2 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. EFS Supervision Strategies, LLC 2021 © 3 EFS Supervision Strategies, LLC 2021© 1 5/10/21 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. EFS Supervision Strategies, LLC 2021 © 4 Workplace Bullying is an interprofessional sport that no discipline gets to sit out.. -E.Fink-Samnick EFS Supervision Strategies, LLC 2021 © 5 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) EFS Supervision Strategies, LLC 2021 © 6 EFS Supervision Strategies, LLC 2021© 2 5/10/21 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) EFS Supervision Strategies, LLC 2021 © 7 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 © 8 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) EFS Supervision Strategies, LLC 2021 © 9 EFS Supervision Strategies, LLC 2021© 3 5/10/21 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). EFS Supervision Strategies, LLC 2021 © 10 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) EFS Supervision Strategies, LLC 2021 © 11 Workplace Bullying: Data, Definitions & Demographics The costs? $200 B (Lamberth, 2015) $$$$$$$ EFS Supervision Strategies, LLC 2021 © 12 EFS Supervision Strategies, LLC 2021© 4 5/10/21 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) EFS Supervision Strategies, LLC 2021 © 13 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. EFS Supervision Strategies, LLC 2021 © 14 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 EFS Supervision Strategies, LLC 2021 © 15 EFS Supervision Strategies, LLC 2021© 5 5/10/21 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 © 16 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 © 17 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% EFS Supervision Strategies, LLC 2021 © 18 EFS Supervision Strategies, LLC 2021© 6 5/10/21 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) EFS Supervision Strategies, LLC 2021 © 19 The COVID-19 Impact N=7411 Higher incidence of: • Lateral violence • Hostility (e.g., racism, discrimination) • Harassment and Violence (Dye, et al., 2020) EFS Supervision Strategies, LLC 2021 © 20 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 © 21 EFS Supervision Strategies, LLC 2021© 7 5/10/21 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. EFS Supervision Strategies, LLC 2021 © 22 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. EFS Supervision Strategies, LLC 2021 © 23 The Bottom Line… The clinical director may be a ‘credit hog’, but not a bully. EFS Supervision Strategies, LLC 2021 © 24 EFS Supervision Strategies, LLC 2021© 8 5/10/21 Let’s be Clear: Bullying is not…. (Fink-Samnick, 2019) EFS Supervision Strategies, LLC 2021 © 25 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’. EFS Supervision Strategies, LLC 2021 © 26 Which Strikes a Chord? Dictatorial Culture Disjointed Culture Stable Culture (Faas,2017) EFS Supervision Strategies, LLC 2021 © 27 EFS Supervision Strategies, LLC 2021© 9 5/10/21 Toxic Boss Behaviors (Lipman-Blumen, 2006; Weinstein, 2007) Toxic bosses are charismatic successful, tough to accomplished, identify genius EFS Supervision Strategies, LLC 2021 © 28 Bullying Involves Power (Forsythe, 2010; Giang, 2013) Coercive Connection Expert Legitimate (aka Informational Reward Positional) EFS Supervision Strategies, LLC 2021 © 29 Consider This… EFS Supervision Strategies, LLC 2021 © 30 EFS Supervision Strategies, LLC 2021© 10 5/10/21 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. EFS Supervision Strategies, LLC 2021 © 31 • 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. EFS Supervision Strategies, LLC 2021 © 32 There’s Light at the End of the Tunnel EFS Supervision Strategies, LLC 2021 © 33 EFS Supervision Strategies, LLC 2021© 11