REPORT - Australian Toxic Workplaces : Bullying rife in Hospitals

VICTORIAN HOSPITALS

A CULTURE of sexual harassment, bullying and intimidation is rife in Victorian hospitals, with an average of three official complaints lodged against staff a week.

Workplace bullying, standover tactics by management and unwarranted sexual advances have been exposed in a Sunday Herald Sun investigation of complaints made by hospital staff.

At least 165 complaints were made about doctors, nurses and other health service workers in two years.

Documents obtained through Freedom of Information reveal 130 complaints were made for bullying between July 2006 and July 2008 last year.

There were 14 complaints of sexual harassment and 22 for harassment and intimidation.

A dozen hospital staff were found guilty of sexual harassment during the period, including eight who faced disciplinary action.

Six major health authorities refused to provide documentation of complaints including Southern Health, which employs more than 12,000 staff across 46 sites including Monash Medical Centre, and Austin Health, which has 6400 employees.

Experts say sexual assaults reported are the tip of the iceberg, with many more cases unreported in hospital wards.

Centre Against Sexual Assault spokeswoman Caroline Wirth said many people were too scared to report sexual assault in hospitals for fear of dismissal.

"People should come forward to report it, but a lot find it really hard to," she said.

Health authorities have also come under fire for sacking only one employee found guilty of sexual harassment. Most were given a warning, counselling or mediation.

Bullying was the most common grievance of health workers, with 95 of 130 complaints substantiated.

There were six resignations on the back of bullying investigations, two dismissals, 11 warnings, six staff relegated to new roles, one transfer and 26 counselling cases.

Fifteen of 21 harassment claims were also substantiated.

Victorian Equal Opportunity and Human Rights Commission chief Dr Helen Szoke said the figure almost certainly under-represents the true problem.

"Our research shows that about 75 per cent of people do not make a complaint because they fear reprisals or feel they will not be believed," she said.

An Eastern Health employee, who asked not to be named, said bullying was condoned and widespread among senior hospital management.

"There is a culture of allowing senior medical staff to get away with behaviour that includes bullying, harassment and other abuses of power," she said.

Opposition Health spokeswoman Helen Shardey said: "Obviously some people haven't got the message that people need to be treated with respect."

Jason Frenkel, a spokesman for Health Minister Daniel Andrews, said it was the responsibility of hospitals to clean up their act.

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NSW HOSPITALS

Royal North Shore Hospital bullying rife

CHRONIC bullying and harassment is rife throughout Royal North Shore Hospital, with staff terrified to speak out and the Nurses Association turning a blind eye to the crisis.

A confidential Government report obtained by The Daily Telegraph found the hospital has been crippled by "endemic" misconduct among nurses, doctors and virtually all other medical staff.

The external investigation was ordered by Health Minister Reba Meagher following revelations in The Daily Telegraph of widespread bullying among nurses at the hospital and "Soviet-style" management techniques.

The new CEO of Northern Sydney Health Matthew Daly has launched an immediate series of overhauls and warned that the heads of bullying staff who refuse to change their ways will roll.

Mr Daly, who investigated similar claims of bullying at Campbelltown and Camden hospitals, is bringing in an external expert to tackle harassment.

The report, by veteran public servant Vern Dalton and nursing professor Judith Meppem, found:

 "THE issues are not isolated to nursing and nursing management but appear to be endemic across the hospital";

 "ACROSS all disciplines there was strong concern expressed about the hospital's bullying and harassment policy (which is 'seen as a joke')";

 "STAFF are afraid to speak up for fear of being belittled, humiliated, publicly embarrassed or victimised";

 "THE local NSW Nurses Association branch is inactive . . . They do not have any significant issues involving RNSH at present";

 A 2003 report on bullying and harassment was covered up and none of its recommendations implemented; and

 "THERE is little evidence that complaints have been taken seriously".

The report found the culture of bullying and harassment was so strong at RNSH that serious doubts were expressed that the very bullying investigation and review would be hindered.

"Bullying is unacceptable in any workplace and needs to be stamped out," Ms Meagher said yesterday.

"In a hospital setting, it undermines confidence when all staff should be 100 per cent focused on patient care."

Mr Daly told The Daily Telegraph he would talk to staff and management.

However, he warned that staff who did not change would be terminated.

"I work very much on the basis of strike three, you're out," Mr Daly said.

Nurses Association assistant secretary Judith Kiejda said nurses had been too scared of reprisals to bring their concerns to the union but the hospital branch had been reactivated recently.
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STEP BACK IN TIME

... 2008

Article: Is your hospital safe? Disruptive behavior and workplace bullying

... 2007

Concern over bullying in hospitals has prompted one doctor to start an action group to help those affected. Helen Francombe reports

The Australian
December 08, 2007

IRENE Langtry had worked as a nurse for more than 50 years and risen to the top of her profession, performing highly responsible work with seriously ill patients.

But problems started after she spoke out in hospital meetings on ideas she felt were in the interests of patient care -- but were not always in step with the new management at her hospital.

A litany of unpleasant incidents followed -- each one seemingly small in isolation, but which had a demoralising effect over time.

"It started with me being excluded from major decisions -- including the hiring of a new member of my team," says Langtry (whose name has been changed to protect her identity). "Then I was falsely accused of arriving late and leaving early."

Managers also sprung on her surprise tests of calculating drug dosages and using equipment that were not relevant to the kind of patients under her care.

"I then received a letter on my desk -- at the end of the day, right before the Christmas holidays -- accusing me of unspecified harassment of another staff member (which was subsequently dropped), that I worried about for 17 days before I could get more details." More incidents followed and culminated in her being demoted to nursing assistant duties, including heavy lifting, which finally forced her to take extended sick leave for stress-related conditions.

Bullying is rife across both nursing and medicine. One Australian study, published in the Journal of Advanced Nursing, found 29 per cent of the nurses interviewed had been verbally abused by fellow nurses, and 27 per cent by doctors, in the preceding four weeks (2006;55(6):778-787).

And as many as 84 per cent of junior doctors in one UK survey reporting they had been bullied at work at some point (BMJ 2002;324:878-9).

One reason bullying has been so hard to stamp out is that colleagues severely punish anyone who has the temerity to challenge the practice. So poor is the current system for dealing with bullying, that doctor Cary Ooi is currently forming an action group for bullied doctors and their supporters called Remedies for Persecuted Doctors.

Ooi -- a Sydney GP with a special interest in personal injury, developmental disability and medical ethics -- says in theory there are "avenues for reporting and dealing with bullies, but they are toothless tigers -- they don't work at all."

The action group aims to protect the human rights of doctors who have been bullied by providing mutual support and publicity about the problem in the first instance, and perhaps through legal channels in the future, says Ooi, who also has a post-graduate qualification in health law and assesses patients in cases of alleged medical negligence.

Doctors from minority groups are common targets for bullies, he says.

"In the extreme, doctor Mohammed Haneef, who was forced to leave Australia, is an example of bureaucratic bullying," he says. His action group plans to invite Haneef to join if he is allowed to return to Australia.

Another group often finding itself in the firing line are doctors who are concerned about patient welfare and are prepared to speak out about dangerous practices, says Ooi. For example, one member of the new group is a GP who was concerned about the high number of prescriptions for a particular drug being given out by the head of his practice, apparently without patients receiving a proper explanation of the risks.

The GP was dismissed after he counselled a patient about the possible harms associated with the drug, Ooi says.

Anyone seen as casting the profession in a bad light -- and commits the cardinal sin of "dobbing" -- is in danger of losing their job, he says. People who even try to air the problem -- never mind bring up specific instances -- find themselves persona non grata.

One such doctor -- an intensive care specialist who declined to be named, or even to risk identification by mentioning the city he works in -- was ostracised by colleagues after writing in very general terms about the bullying problem in a medical journal.

"An action group like this is very welcome, and will hopefully make staff less fearful about speaking out," he told Weekend Health.

However, more effective avenues for dealing with subtle bullying under the disguise of "constructive criticism", as well as intimidation of whistle-blowers, are also needed. He has had a steady stream of trainees who have come to him in tears because of unusual harshness and repeated criticism for insignificant issues, but has felt powerless to help.

"Every day I felt like there was a sword hanging over my head if I mentioned the problem -- no one likes a whistle-blower, especially if they mention anything that starts with the letter B."

Even senior doctors are frightened to report bullying, partly because it can be a difficult phenomenon to define and document, he says.

There is no universal agreement over what is and is not bullying.

Different experiences of discipline between the generations mean that what strikes one person as bullying is just firm direction to another, says a surgeon from a major Sydney Hospital, who declined to be named.

"To me, generation Y is very precious: if you raise your voice they get upset, because they weren't brought up with discipline," he says. "During my training, if you were rebuked the paint would be peeling off the walls."

However, unacceptable aggressive behaviour is still a reality, he acknowledges, and has partly been fuelled by the disappearance of down-time -- which used to give opportunities for nurses and doctors to have morning tea, celebrate a birthday or have an unrushed training session.

"Twenty years ago hospitals would run at 80 per cent occupancy so there were slow periods. Now we are at 100 per cent occupancy most of the time, and every day is a hard day," he says.

A 2007 Australian Royal College of Nursing report, National Overview of Violence in the Workplace, included the following definition of bullying: "coercive, unethical activities which create an environment of fear through acts of: cruelty, belittlement/degradation, public reprimand, ridicule, insult, sarcasm, destructive criticism, persistent nitpicking or devaluation of a person's work efforts, trivialisation of views and opinions and unsubstantiated allegations of misconduct".

Lyn Turney, senior lecturer in sociology at Melbourne's Swinburne University of Technology, says these less overt forms are the hallmark of bullying among the professions, whereas often bullying in the trades, for example, is more obvious -- and easier to deal with.

A number of factors in professional workplaces combine to create a toxic atmosphere ripe for bullying: highly competitive, high-achieving people with a master-apprentice power relationship built into the training process, says Turney. "High achievers are very vulnerable to bullying because they have so much to lose -- you may have spent half your life training to become a surgeon, and then you find yourself at the mercy of the more senior surgeon who has supreme power over your marks and reports."

Bullying often destroys self-confidence, says Turney. This often results in the victim becoming compliant and accepting of the behaviour, as one nurse in an Australian study tells: after many episodes of being directed with a point of the finger to stand silently in the corner while the more senior nurse took over the care of patients, she would "automatically follow the finger" in "non-thinking robotic mode" (Contemporary Nurse 2006;21:228-23).

Bullying is not confined to the health system, says Judith Meppem, former chief nursing officer of NSW, now investigating bullying at Sydney's Royal North Shore Hospital at the request of the Area Health Service.

However, the recent tumultuous times in the management of hospitals have a lot to do with creating a stressful environment that encourages bullying. "The hospitals have had constant change over the last 15 years, and the staff at the grassroots level are affected by it." Strong, consistent leadership that has the confidence to allow staff to disagree is what is needed, she says.

"All staff need to acknowledge that bullying is unacceptable, and that no one is exempt -- including senior people," says Meppem.

And unless all staff are on board nothing will change, she says. If someone is benefiting from the current situation, they will sabotage any efforts to get rid of bullying.

Associate professor Stephen Bolsin, anaesthetist at Geelong Hospital, says the current training system seems to teach junior doctors a "hidden curriculum" of keeping quiet if they see more senior staff committing unsafe practices.

Bolsin himself reported a higher than usual death rate of babies undergoing cardiac surgery at the Royal Bristol Infirmary in the UK in the 1990s -- then found himself unable to get a job anywhere in the UK and so relocated to Australia.

Bullying has been a problem in medicine for a long time, he says. "I remember training with a surgeon who did not consider his day complete unless he had reduced a nurse to tears, and another who threatened female medical students and junior doctors with a negative reference if they wore trousers to work."

Exposure to bad role models perpetuates the problem, he says. "Some of the medical schools are repositories of the worst behaviour, but they don't subscribe to the view that they are bad role models," says Bolsin.

However, there are some strategies to help the profession break out of the current cycle. For example, making the reporting process easier greatly increases the likelihood of junior staff speaking up, he says.

"We also need to evaluate the behaviour of teaching staff and reduce students' exposure to bad role models and increase their exposure to good role models," says Bolsin.