Yesterday the Medical Journal of Australia outlined that between one-quarter and half of doctors and nurses in Australia have been bullied, discriminated against or harassed at work.
Doctor depression and patient deaths
Workplace bullying in hospitals has been shown to cause depression, anxiety and fatigue among health workers. It can also reduce performance and levels of self-esteem.
These symptoms, along with stress and poor staff satisfaction at work, leads to higher staff absenteeism, impacting continuity of patient care and increasing the workload in already overstretched hospital clinics and wards.
While we don’t have data from Australia, a survey of staff from more than 100 United States’ hospitals give us some clues about the impact. More than two-thirds (71%) of respondents – mainly nurses and doctors – agreed unprofessional behaviour and poor communication contributed to medical errors.
Worryingly, over one-quarter of respondents (27%) believed unprofessional behaviour had contributed to a patient’s premature death.
'Taught by humiliation'
Good communication among clinical teams is central to safe care. When team members feel unable to speak up due to negative consequences, care will be compromised.
One study showed medical teams who were treated rudely by an “expert observer” performed significantly worse in a simulated situation where they had to manage a sick infant compared to teams who were treated respectfully.
The teams subjected to rudeness shared less information with each other, and didn’t seek help as often. This led to poorer clinical outcomes for the patients in the simulation.
We can draw parallels with the experience of junior doctors and medical students in Australia, who report being routinely “taught by humiliation” and mistreated during clinical training rotations.
Junior clinicians are regularly subjected to rudeness, hostility and aggressive questioning from their teachers. These are the “expert advisors” they’re also supposed to approach for help to manage the patients in their care.
Where do we go from here?
The effects of unprofessional behaviour of health workers are too great to ignore. But pronouncements of a “zero tolerance” for such behaviours are unlikely to bring about change.
Instead, we need evidence-based interventions to reduce the prevalence of negative behaviour, minimise its impact on staff and patients, and normalise a culture of safety and respect.
Culture change is incredibly hard. Unfortunately, there is very limited evidence about the types of interventions which work and bring about change. We’re currently evaluating a large-scale system intervention, called Ethos, at St Vincent’s Hospitals across Australia.
The program aims to enable and empower staff to speak up when they see a problem via a confidential electronic reporting system. Trained colleagues then relay the information back to individual staff involved to encourage self-reflection and correction. Our four-year evaluation will measure how effective this program is at creating real change in behaviours.
We need more system-wide interventions to address the complex problem of bullying and harassment in our health system. But it’s important these interventions are subject to rigorous evaluations which measure both their effects on unprofessional behaviours and clinical outcomes.
If you work in healthcare and would like to share your experience of workplace bullying or provide a tip-off, please send us a Facebook message. We will not reveal your identity without your permission.
Johanna Westbrook is Professor of Health Informatics and Patient Safety, Macquarie University. Neroli Sunderland is a Research Fellow at the Centre for Health Systems and Safety Research, Macquarie University.
