‘Timely’ guide aims to address bullying in health service

The resource has been informed by a two-year study and provides tips on the different interventions that can be implemented to address ‘unprofessional behaviours’ between co-workers in health settings.

“So far, interventions have very much focused on this notion of bad apples”

Justin Aunger

Unprofessional behaviours are defined in the guide as “any interpersonal behaviour by a staff member that acutely or frequently undermines, humiliates, intimidates, or drives distress or harm to other staff, in the healthcare workplace”.

Examples of such behaviour cited in the document – titled Addressing unprofessional behaviours between healthcare staff – included bullying, incivility, harassment, microaggressions and discrimination.

At an online event launching the guide, Dr Justin Aunger, research fellow at the University of Surrey, which led on its development, said unprofessional behaviours were “quite rampant” in the NHS.

The guide pointed to data from the latest NHS Staff Survey which found that 19% of staff had experienced harassment, bullying or abuse from colleagues, and 11% had experienced it from managers.

Within these overarching numbers, certain groups were flagged as being disproportionally impacted, including women, Black and minority ethnic staff, staff who identify as LGBTQ+, disabled people and staff at the lower ends of organisational hierarchies.

The researchers, which also included academics from the universities of Leeds, Hull, Plymouth and Birmingham, and Macquarie University in Australia, reviewed literature from 148 UK and international sources to help build the guide.

It sets out a number of options available for tackling unprofessional behaviour in healthcare settings including ‘quick wins’ as well as longer term interventions.

Dr Aunger said the focus should be on improving the culture at an organisational and system level, rather than focusing only on individuals who are behaving badly.

“So far, interventions have very much focused on this notion of bad apples, that there’s a few people in organisations that are behaving badly and that it is not a systemic problem,” he said.

“However, based on our research findings, we found that oftentimes things that are causing professional behaviours are at a systemic or organisational level.

“And so just focusing on a few badly behaving individuals does not necessarily stop the systems that cause more behaviours to emerge that are bad.”

“We’ve got this hideous phrase about nurses eating their own young”

Jill Maben

The guide stated that organisations with a “psychologically safe culture”, where staff at all levels feel able to speak up, tended to have the least unprofessional behaviour.

It noted that encouraging staff to call out bad behaviour when they are witness to it as bystander was helpful but only if a culture existed in the organisation that protected workers who spoke up.

Meanwhile, Dr Aunger stressed said that interventions introduced against unprofessional behaviour should be “designed with the end goal in mind of improving patient safety and staff wellbeing”.

In addition, he added: “We want to highlight, of course, the undue burden on women, ethnic minority and disabled staff, as well as people from LGBTQ+ backgrounds: this impact needs to be acknowledged, and it needs to be incorporated into the core design of these interventions going forward.”

Jill Maben

Speaking to Nursing Times, project lead Professor Jill Maben, from the University of Surrey and a nurse by background, said unprofessional behaviour could be “really traumatising” for staff on the receiving end.

As well as negatively impacting patient safety and staff wellbeing, Professor Maben said staff retention could be affected.

“We know that what we’re calling unprofessional behaviours, but bullying, incivility, microaggressions, harassment, is quite widespread in the NHS,” she said.

“We know that there’s sometimes a culture that really doesn’t encourage people to speak up, and often people need to whistleblow about such things.

“And often the person targeted by such behaviours is the person who ends up leaving, so it can have a big impact or retention issues; also on patient safety, and on staff wellbeing – making staff anxious, stressed, unwell and having to take sick leave if they’re particularly targeted.”

While the research that underpinned the guide covered all professional groups, Professor Maben said there were known issues in nursing in relation to the experiences of early career nurses, for example.

“What I’d say in nursing is that we know there can be a challenging culture, particularly for newly qualified nurses or students; and we’ve got this hideous phrase about nurses eating their own young,” she said.

She also noted the fact that nursing is a 90% female workforce, adding that “we could imagine that there might be misogyny and sexism going on, towards nurses by others, perhaps”.

She said the prevalence of unprofessional behaviour in the NHS became clear following the introduction of the Freedom to Speak Up Guardians and the large numbers of reports they were seeing in relation to bullying.

“I think that was quite surprising and really pointed to the scale of the problem,” she said.

The guardian scheme was introduced off the back of recommendations made by Sir Robert Francis almost 10 years ago aimed at improving the culture in the NHS.

Professor Maben said the fact culture issues and unprofessional behaviours were still so widespread in the NHS showed that “this is a rather endemic issue that we haven’t really managed to address for all sorts of reasons”.

“It’s a knotty, thorny problem. We’re hoping our guide goes some way to showing what the evidence tells us, what the causes are beyond individuals and these bad apples, what there is out there, what are the systematic, systemic interventions that we could think about implementing,” she said.

She further highlighted the potential benefits for retention, recruitment and patient safety, noting that “we know that if we make [the NHS] a great place to work, people will come because it’s very rewarding and they want to give great care”.

“But actually, if you’re not being treated well at work, and you’re having to deal with all these rather hideous issues, you’re not going to be able to give great care,” said Professor Maben.

“So, it’s in all of our interests as a nation that we tackle these issues, and we make it a great place to work, and we deal with this pervasive culture that can be really so damaging to people.

“We don’t want to damage any more staff and have them leave. We’ve got staff leaving for all sorts of reasons, we don’t need to add to it with bullying and harassment.

“So, [the publication of the guide] is enormously timely and enormously important.”