Don't Let Bullying in Your Medical Practice Jeopardize Patient Care

October 16, 2013

Studies show that bullying is common in healthcare settings. Here's how to identify it and address it.

In every business, there are likely some employees that do not get along. Physician practices are no exception. However, there is a distinction between personality conflicts and actual bullying in the workplace. When bullying takes place in a doctor’s office or hospital, it can become a patient-safety problem.

As many healthcare providers are aware, rudeness and incivility run rampant in healthcare workplaces. Many of the complaints involve physicians. Is this because professional training does not involve interpersonal skill development? Is it because physicians perpetuate the same harsh treatment they receive during training?

Although every person defines bullying differently, there seems to be general agreement that bullying involves repeated behavior that is unwelcome and unsolicited. Most importantly, the recipient considers the behavior to be offensive, intimidating, humiliating or threatening. Bullying can be done by a supervisor to an underling or by colleagues to each other. 

Vanderbilt University published a study, which found that out of 4,500 healthcare workers, 77 percent reported disruptive behavior by doctors and 65 percent reported it amongst nurses. What is most troublesome is that this disruptive behavior led to medical errors two-thirds of the time, according to this study.

This is hardly surprising. Providers who are bullied may feel emotional, which can impact the attention that a provider gives patients under his or her care. 

The American Nurses Association has reported that between 18 percent and 31 percent of nurses have experienced bullying behavior at work. The behavior can be overt, such as yelling or threatening, or it can be more passive, like refusing to cooperate or perform necessary tasks.

Bullying can result in demoralization and decreased job satisfaction, as well as feelings of isolation, anxiety, sadness and depression. This can also result in increased turnover.

The Joint Commission, formerly the Joint Commission on Accreditation of Healthcare Organizations, published regulations in 2009 dealing with how healthcare organizations and providers should report, discipline, and prevent bullying situations. Within the regulations, the commission recognized that intimidating and disruptive behavior can lead to medical errors, poor patient satisfaction and can cause qualified personnel to seek new positions in more professional environments.

In an effort to recognize and deal appropriately with bullying behaviors, providers and practices should review their own conduct and those of others in the workplace. Bullying can often include less obvious behaviors, such as using a condescending tone with coworkers, refusing to answer questions or perform certain duties, or treating some individuals with open hostility or dislike.

As individuals, there are certain steps doctors can take if they feel they are being bullied:
1. Don’t let your emotions escalate the situation.
As hard as it may be, stay calm and rational to diffuse the situation.
2. Build and maintain a support network. Try to foster relationships with your coworkers who can act as an excellent support system.
3. Document everything. Keep a journal of what is happening and write down the names of anyone who may have witnessed it.
4. Don’t expect to change the bully. Changing the behavior of a coworker may be impossible.

It is the medical practice’s responsibility to remain observant and responsive to any complaints it receives regarding a hostile work environment. Every practice should have employment policies in place that cover bullying, such as those that protect whistle-blowers and prohibit retaliation.

Practices should also have an open door policy when it comes to reporting behavior that is disrupting workplace function. This can, admittedly, be a real challenge if the practice is small or the bully is the founder of the practice or the provider in charge.

Most practices can benefit from bringing in an outside consultant or lawyer to provide training and to help address the issues creating by unprofessional behavior in the workplace. Don’t wait until it’s too late or assume the problem will go away. Bullies will not stop unless they are informed that their behavior is unacceptable and are terminated or appropriately penalized. There is no room in the healthcare workplace for behavior that may negatively affect providers or patients.