Why bullying happens in health care and how to stop it

Brendan Murphy , Senior News Writer

Poor staffing levels, excessive workloads, subpar management skills, stress and lack of autonomy are some of the factors that contribute to bullying in the workplace—including in medicine—according to a recent AMA report on the problem that pervades health care and how to stop it.

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AMA policy defines workplace bullying as “repeated, emotionally or physically abusive, disrespectful, disruptive, inappropriate, insulting, intimidating or threatening behavior targeted at a specific individual or a group of individuals that manifests from a real or perceived power imbalance and is often, but not always, intended to control, embarrass, undermine, threaten or otherwise harm the target. Individual, organizational and health system factors may contribute to the overall workplace climate or culture that allows unprofessional behavior, such as bullying, to persist.”

Bullying behaviors are common across workplaces. A report from the Joint Commission indicates that bullying in the health care workplace is more common than sexual harassment and is initiated by both men and women.

The hierarchical nature of health care has made it a field that is susceptible to workplace bullying.

“Bullying and mistreatment of students and residents are commonplace,” said Audiey C. Kao, MD, PhD, vice president of ethics standards at the AMA. “Few of us have gone through medical education and training who have not either witnessed or been the subject of bullying by individuals in greater power and authority. It’s something that was long overlooked, but it is harmful to the learning environment and needs to be eradicated.”

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Bullying in the health care workplace: A guide to prevention & mitigation

As Dr. Kao highlighted, bullying can be particularly common toward physician trainees. A 14-minute module from the AMA takes a point-by-point approach to explaining intimidation and mistreatment in training, and offers step-by-step advice on how to deal with it.

“Resident Intimidation” is one of the AMA GME Competency Education Program offerings, which include dozens of courses that residents can access online, on their own schedule. The modules are available to residency institutions that have subscribed to the AMA’s program.

The reasons to address and eliminate bullying are multifold, chief among them: Bullying behaviors among workers can adversely affect patient care, according to the report.

“Patient care is delivered not by a single individual but by a team of individuals,” Dr. Kao said. “If you work in a health care environment where bullying is prevalent or even accepted or not dealt with, you’ll create an unhealthy team dynamic ... where individuals are hesitant to raise patient care issues over concerns that they will not be taken seriously because they have been bullied in the past.”

Addressing workplace bullying can and must be done at an organizational level, the AMA report says. That means implementing or improving anti-bullying policies that show management’s commitment to a safe and healthy workplace. It also means creating an environment in which all workers feel comfortable speaking up, Dr. Kao said.

“When you witness bullying, silence and avoidance is never an effective strategy,” he said.

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Workplace bullying must have absolutely no place in medicine

The AMA’s report details advice on an effective workplace policy on bullying and tactics to improve organizational culture.

In addition, the report says, there are two key steps for management to take:

  • Make the administration aware that unprofessional behavior is a threat. If the team doesn’t recognize that there is a problem, they won’t have a plan to do something about it, nor recognize the threats to quality care.
  • Educate the entire staff about why unprofessional or hostile behavior is a problem. If the staff recognizes that the leaders are concerned about bullying, they are more likely to come forward when they feel that bullying has occurred, or better yet, tell their co-worker that their behavior is inappropriate.

Read the AMA report, “Bullying in the Health Care Workplace: A guide to prevention and mitigation.”

Also, learn how to stop microaggressions in medical school.