Workplace bullying poses risks to patients
More than 54 million people are impacted by workplace bullying or incivility in the United States. Add the number of direct targets to those who are witnesses or bystanders, and the total hits 75% of employees (Cannizzo, 2017; Morgan, 2014). Whereas 68% of executives identify bullying as a serious problem in their organizations, only 5.5% actively do anything about it (Smith, 2013). Seventy-two percent of employers deny, discount, encourage, rationalize, or defend bullying occurrences (Workplace Bullying Institute, 2014). The high incidence of these distressing behaviors in healthcare poses grave risks to clients and the workforce.
Workplace bullying refers to the repeated, health-harming mistreatment of one or more persons (targets) by one or more perpetrators, marked by abusive conduct that does the following (Workplace Bullying Institute, 2018):
- Is threatening, humiliating, or intimidating
- Includes work interference or sabotage, which prevents work from getting done
- Includes verbal abuse
The terms incivility and workplace bullying are interchangeable. Several words are used to identify the various dimensions of workplace bullying, including lateral violence, harassment, hostile workplace, and mobbing. The Joint Commission (2008) identified how intimidating and bullying behaviors fuel medical errors and lead to preventable adverse outcomes. Disruptive physicians have 14% more complications in the month post surgery than patients treated by surgeons with good bedside manner (Cooper, Guillamondegui, & Hines, 2017). Fragmented communications among the interprofessional treatment team can lead to severe risk management issues, such as medical complications.
Here is a common scene that plays out. Perhaps staff members become frustrated by the loss of a critical benefit (e.g., reimbursement for professional fees or case management credentialing examinations) and project their anger onto each other. Lateral violence takes over the atmosphere, with poor morale and decreased camaraderie infecting the department. Staff members call out sick in droves, leading to excessive absences. The remaining case managers struggle to manage the workflow and become more resentful; coverage is subpar at best. Mob mentality manifests as disgruntled staff take their annoyance out on the new manager, who promised to unfreeze positions and hire staff ASAP. Unfortunately, the manager’s efforts are unsuccessful. Fifty-eight percent of primary care professionals have been exposed to mobbing on at least one occasion (Erdogan & Yildirim, 2017).
Antagonism can become the norm in organizations where team members vie for limited resources. Workplace relationships become fraught with dysfunctional dynamics, marked by hostile and oppressive behaviors. An implicit message of "length of stay is too high" or "return on investment isn’t demonstrated" can unintentionally encourage competition among staff. More assertive, if not bullying, behaviors are reframed as "do anything necessary to get the job done." This mandate makes it acceptable to have verbal confrontations with colleagues, clients, and caregivers as opposed to respectful professional communications. In a work atmosphere where these toxic behaviors become the norm, even the best employees can be drawn into negative performance patterns; they simply follow the path of least resistance.
For more, see The Essential Guide to Interprofessional Ethics in Healthcare Case Management.