Co-worker aggression concerns

MOST health care organisations have policies to deal with aggressive patients but it is aggression from co-workers that causes greatest harm to doctors’ health and happiness, according to new research published in the MJA. (1)

A survey of almost 10 000 Australian doctors from general practice and hospitals found 68% had experienced workplace aggression from a patient or other “external” person in the previous 12 months, and 27% had experienced aggression from a co-worker.

While both kinds of aggression were associated with reduced job satisfaction, life satisfaction and self-rated health, aggression from co-workers was most damaging on all counts.

The researchers wrote that co-worker aggression could be expected to have a greater negative impact than patient aggression because of the greater likelihood of repeated and ongoing exposure.

“Being targeted by those with whom one ostensibly shares the altruistic goals of providing the best possible care may be multiply distressing, particularly for younger and less experienced clinicians, who may not possess the skills or resources to effectively manage aggressive behaviour, especially from more experienced or more senior colleagues”, they wrote.

The study was based on 2010–2011 data from the Medicine in Australia: Balancing Employment and Life (MABEL) longitudinal survey and adjusted for the effects of a range of personal, patient and work-related factors.

It found that 15% of doctors working in general practice reported experiencing aggression from a co-worker, compared with about 30% of specialists. Co-worker aggression was often less “visible” than patient aggression, making it harder for organisations to combat it, the researchers wrote.

They concluded that workplace aggression was a “major professional and health workforce policy concern, in terms of occupational health and safety, and the potential impact on care quality, safety and access”.

A previous report from the MABEL study found that younger doctors were more likely to experience aggression than their older colleagues, as were females, those working in hospitals and international medical graduates. (2)

Professor Simon Willcock, professor of general practice at the University of Sydney, whose research interests include doctors’ health, told MJA InSight there was “undoubtedly a lot of low level bullying in the workplace, not just from medical colleagues but even more so for junior doctors from administrators and other clinical staff such as nurses”.

“The irony is that this often contravenes workplace bullying guidelines but is often fine by people who are senior in the system,” he said.

Professor Willcock said there should be more focus on developing appropriate and effective “resilience strategies” for junior doctors, including the ability to label and resist bullying behaviours.

“Junior doctors often perceive that they have no 'power' to do this, which results in a victim mentality that mirrors the bullying culture”, he said. “Standing up to bullies, without adopting their own bullying tactics, is ultimately the way to go and will lead to the best outcomes for junior doctors.”

Associate Professor Frank Jones, president-elect of the Royal Australian College of General Practitioners, told MJA InSight the issue of bullying was a challenge for general practice principals, particularly those in larger practices.

“I always encourage staff to come straight to my door and discuss things in person if they have a problem with me or another colleague, to prevent tensions from escalating”, Professor Jones said. “Email communication can compound the problems.”

At his practice in Mandurah, WA, which employs more than 30 staff, there was a culture of debriefing after difficult patient encounters to help staff cope with the stresses of the job.

“Dealing with unwell, anxious patients with sometimes unrealistic expectations is stressful, whether you’re the doctor or the receptionist behind the front desk”, Professor Jones said.

Alison Verhoeven, chief executive of the Australian Healthcare and Hospitals Association told MJA InSight it was “in all our interests to ensure safer workplaces for health care professionals”.

She said this included ensuring the physical security of facilities and staff, developing organisational cultures which discouraged bullying and intimidating behaviours, and implementing strategies to better manage violent or high-risk patients and visitors.

1. MJA 2014; 201: 535-540
2. MJA 2012; 197: 336-340

(Photo: skynesher / iStock)