How to deal with bullying, harassment and discrimination in the workplace?

We have all worked with or known bullies in the workplace. Often, those individuals who bully or harass others, sexually or otherwise, are in positions of power in institutions, and generally, those bullied are in positions with rather limited power. The culture of institutions contributes to a toxic environment that can then lead to situations and environments where bullying and harassment are likely to prosper. Understanding institutional cultures is important in order for us to make sense of the working environment or 'working environments where we face such challenges on a daily basis to deliver healthcare. Healthcare institutions have their own individual cultures, and in many settings, specialties and disciplines, bullying and harassment are rife. So, what should we do, especially if we feel powerless to raise these issues?

In responding to constant and rising demands, healthcare institutions are often under enormous pressures, especially if they are expected to meet certain centrally-set and often unreal and unachievable targets. These pressures can be even more elevated in certain challenging and demanding medical specialties such as surgery, emergency medicine, acute medicine where punishing and intolerable demands can put extraordinary demands on junior doctors, trainees, staff grades and other disciplines. Often, these demands and expectations fall on the most junior members of the team, who have the least power. In addition, women, international medical graduates and sexual minorities are particularly vulnerable and often face acts of discrimination, bullying and harassment.

The National Health Service (NHS) ¹ defines bullying at work as several acts, which include arguments, verbal assaults and consistent rude behaviours towards the targeted individual, making them feel inferior and uncared for. Often bullying is targeted at one or more persons who may be lower down in the hierarchy in the team or the bully may ‘appear’ to have real ‘power’ over them. The bullying comments may be made in private or in public and are often persistent, derogatory, critical and humiliating. Derogatory comments may be made on a regular basis without any basis or any reason and are often exaggerated. The actions may include targeted individuals being excluded deliberately from team activities and giving them boring tasks to perform, making them feel invisible and continually ignoring their contributions. In addition, denying promotion or training opportunities with all other things being equal can all be construed as different levels of bullying. An individual who is targeted feels humiliated, unworthy, hurt, rejected and inferior.

Harassment is defined as unacceptable behaviour that can be of an emotional, physical or psychological nature, or a combination of two or more. Targeted individuals may be attacked on the basis of one or more characteristics, such as gender, age, sexual orientation, religion, race, ethnicity and nationality. Harassment like bullying is seen as any behaviour that is unwanted, unwarranted and unwelcome, thus making the target feel vulnerable and experience a loss of dignity. It is entirely possible that in return, the target being bullied or harassed may take their frustrations on others. The Equality and Human Rights Commission (EHRC) ² suggests that protected characteristics are often the target of bullying and harassment, and the individual bully creates a hostile, degrading, humiliating or offensive environment within which the target is expected to work. It is worth acknowledging that, on occasion, these actions may be unintentional.

Patients may also bully or harass doctors, especially if the doctors are in junior positions and in training and may also belong to minority groups. This may also happen if the doctors stand up to patient demands for inappropriate medication or treatments. Harassment can also be sexual when the target is exposed to unwanted physical contact with sexual overtones.

Discrimination is described as the actions individuals face based on holding privilege and denying others of such privilege. ² Any unfair or prejudicial treatment of individuals or groups based on certain characteristics such as sex, religion, disability, gender reassignment, sexual orientation or age are probably because of fears that the bully may have against the target. ³ These behaviours often thrive in toxic environments and under toxic leaderships. Bullying, harassment and discrimination can all lead to burnout, depression, withdrawal, absenteeism, presenteeism (where the individual is physically present at work but not able to function at their full capabilities), poor sleep and exhaustion.

Toxic environment in hospitals, universities and other institutions is defined as settings where negative behaviours become embedded in the institutional culture. This makes the environment ripe for bullying, harassment and discrimination, which become rampant making the setting extremely difficult to work in.

Prevalence

In a survey, 19% of respondents described their work environment as toxic. ⁴ Prevalence of bullying and harassment across countries^5–11 as well as across specialities is being increasingly recognised.^10,12–14

Institutional responsibility

Institutions have a moral and ethical obligation to minimise and eventually eliminate bullying and harassment. ¹⁵ Within the NHS, policies exist related to equality, workplace bullying etc.^1,16–20 Making workloads manageable, reducing working long hours and improving resources can all help. An environment of openness needs to be created where concerns about bullying and harassment can be raised without fear of reprisals. Change-oriented leadership can reduce workplace aggression. ²¹

Institutions must investigate any complaints of bullying, harassment or discrimination in a timely manner, with appropriate remedial measures and support for the target. Most healthcare and other institutions will have policies for dealing with bullying, harassment and discrimination, but how these policies are put into practice is a crucial question. In some cases, external evaluation and mediation may be needed. Both formal and informal processes may be needed.

Doctors from minority groups are more likely to be referred to the General Medical Council (GMC) ²² for various reasons, some of which may be trivial, as hospitals may not want to deal with certain issues and thus pass the buck. International medical graduates and ethnic minority doctors are also more likely to face bullying and harassment from colleagues, patients as well as managers. The GMC ²³ encourages doctors to report unwanted behaviours even if they are not the target and are aware of someone else being bullied.

On an individual basis, the person who has been the target of bullying and harassment needs, in the first instance, to raise their concerns with their line manager. If the line manager is the source of bullying and harassment, then the clinical or educational supervisor must be informed. Keeping a diary can help recall the circumstances, words used, witnesses (if any) and other details, both by getting it out on paper and maintaining a proper record. If local approaches fail to elicit proper response, then legal actions may be indicated. Individuals must ensure their personal wellbeing using psychological and medical means. It is helpful to be aware of one’s legal rights and to seek clinical and supportive help early.

If any psychological symptoms such as burnout, exhaustion, anxiety, avoidance or depression appear, primary care physicians and institutional occupational health physicians should be approached promptly. Trade unions can provide support, guidance and assistance in addressing these matters. Many of these organizations also offer psychological support services that can be readily accessed.

Declarations

Competing Interests

None declared.

Funding

None declared.

Ethics approval

Not applicable.

Guarantor

DB.

Contributorship

Sole author.

Provenance

Commissioned, editorial review.