June 2018 - Dr Ahmed Saeed Yahya, higher trainee in psychiatry working in a NHS Trust in East London

This month’s guest blog is an article brought to us by Dr Ahmed Saeed Yahya, a Higher Trainee in Psychiatry working in a NHS Trust in East London.

Dear Colleague

I wrote this article with two colleagues who work as Consultant Psychiatrists.  Many thanks for including this in your guest blog.

This is a follow up to the report on staff burnout which was included in last year’s monthly Scottish newsletter. Bullying can lead to increased feelings of burnout in employees. We highlight the importance of recognising bullying behaviours, and how good leadership can make a positive impact. We hope you enjoy this blog article and find this of benefit to your practise.

Dr Ahmed Saeed Yahya (Speciality Trainee in Psychiatry)

Targeting Workplace Bullying: Emphasis on Good Leadership with Across the Board Approach

Dr Ahmed Saeed Yahya (Speciality Trainee in Psychiatry), Dr Nisha Shah (Consultant Perinatal Psychiatrist) and Dr Jude Chukwuma (Consultant Psychiatrist)

About the authors

Dr Ahmed Saeed Yahya is a Specialist Registrar in Psychiatry who is currently based at East London NHS Foundation Trust. Dr Nisha Shah is a Consultant Perinatal Psychiatrist with the North East London NHS Foundation Trust. Dr Jude Chukwuma is a Consultant Psychiatrist with the Cygnet Hospital Group.

Introduction

Workplace bullying remains a topical area within the healthcare environment. The healthcare sector has one of the highest incidences.¹ There is concern that the culture of bullying is underreported within the NHS and other healthcare settings. It remains prevalent and pervasive across the specialities.

In this short article we highlight the importance of recognising bullying behaviours, and how good leadership can make a positive impact. We make reference to the Francis inquiry report which examined the causes and failings of an NHS Trust. Workplace bullying was a likely contributory factor, with staff failing to raise concerns because of potential retribution and other consequences of whistleblowing.

Our interest in this area has grown since our publication on ‘Employee Burnout’ in the Royal College of Psychiatrists Scottish Newsletter.² Bullying can lead to increased feelings of burnout in employees. Burnout describes a state of physical and emotional exhaustion that occurs following prolonged exposure to emotionally exacting work situations/environments.³

Discussion

To recognise bullying behaviours it is important to have an understanding of bullying and be aware of the different manifestations. Bullying is defined as a situation in which an individual perceives that he/she is the target of negative actions and/or attitudes, perpetuated persistently over time by one or more others. Isolated or one-off instances of negative behaviour are not usually classified as bullying.⁴ Examples of bullying can include mistreatment, disrespectful attitudes or inappropriate behaviours. Incivility, rudeness and/or other disrespectful behaviour/s consistently perpetrated with an ambiguous intent to cause harm to the other can also be forms of bullying. Bullying can be either covert or overt in form.⁴

Authoritarian ineffective styles of leadership have been linked to lower levels of job satisfaction, and can be associated with bullying. The Mid Staffordshire report raised concerns that there was a culture of fear and compliance amongst staff within the NHS. In that report, Robert Francis recommended that such a culture be abandoned, and that efforts should instead focus on fostering an environment of ‘openness, honesty and transparency.’⁶ We could not agree more. However, it would have been helpful to make some specific recommendation/s expressly targeting work place bullying in the report.

Einarsen et al have divided ‘bullying’ into three categories which include; work related, person related and physical intimidation.⁵ Work related bullying behaviours can include allocating excessive and unmanageable workloads to an individual, disregarding an individual’s professional opinion or undermining an individual’s competence. An example is by consistently assigning work to the individual which is below or above the individual’s competency. The intention being to ridicule and/or humiliate the individual.⁵

Person related bullying can include persistently and repeatedly ignoring or excluding a person (the victim) from conversations/meetings, hinting or signalling in suggestion that a person (the victim) gives up employment, and/or integrating the victim into workplace gossip or rumours. Others may include physically intimidating behaviours manifesting in threats of violence, invasion of personal space or acts of actual physical abuse.⁵

The place of leadership

Good leadership plays a significant role in alleviating bullying in the work environment. The Royal College of Psychiatrists places huge emphasis on good medical/clinical leadership, and it is imperative that this approach is applied across the board.

We write in support of good leadership and good distributed leadership, whereby senior clinical leaders and managers model the behaviour expected of staff within their organisations. This approach would form the backbone for the implementation of strategies to facilitate/filter a positive cultural change across organisations.

Conclusion

Ideally, good leadership should permeate all aspect and levels of health services, from senior management to frontline. Efforts should be channelled towards adequately resourcing and monitoring individual jobs and job demands to prevent bullying.⁵ Emphasis should be placed on staff empowerment through distributed leadership to prevent bullying as well as protect employees from bullying behaviours.⁴ Staff should feel confident to whistleblow without fear of retribution.

Organisation leaders play a key role in addressing workplace bullying. They should lead by example, particularly in the area of work place conduct. They should not only ‘talk the talk but walk the talk’ and ensure an across the board approach. There should be the right balance between hands-on and hands-off approaches to leadership, including emphasis on task orientated leadership when appropriate.⁴ Training and refresher training to create awareness about systemic factors in the aetiology of bullying and the beneficial effects of good leadership should be encouraged.

We must acknowledge that there seems to be an increasing drive to improve awareness and tackle workplace bullying. A strategy implemented by the NHS has been to change the current culture of apprehension and fear to one of ‘openness, honesty and transparency.’

The national staff survey and national training survey remain helpful tools in identifying bullying. There should be continued focus on promoting a collaborative culture through education and team communication programmes. Progress should continue in introducing policies and strategies that deter bullying at all levels and across the board.

References

1 Allen BC, Holland P, Reynolds R. The effect of bullying on burnout in nurses: the moderating role of psychological detachment. Journal of Advanced Nursing 2015; 71: 381-390.

2 Yahya AS, Phillips M, Naguib M, Chukwuma J. Assessing the utility of the Oldenburg Burnout Inventory for staff working in a Psychiatric Intensive Care Unit… A Pilot Study, rcpsych.ac.uk 2017:1-7.

3 Maslach C, Schaufeli W, Leiter M. Job burnout. Annual Review of Psychology 2001; 52: 397-422.

4 Olsen E, Bjaalid G, Mikkelsen A. Work climate and the mediating role of workplace bullying related to job performance, job satisfaction, and work ability: A study among hospital nurses. Journal of Advanced Nursing 2017; 73: 2709-2719.

5 Rodwell J, Demir D, Steane P. Psychological and organizational impact of bullying over and above negative affectivity: A survey of two nursing contexts. International Journal of Nursing Practice 2013; 19: 241-248.

6 The Mid Staffordshire NHS Foundation Trust Public Inquiry Chaired by Robert Francis QC, www.health.org.uk.