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HOSPITAL staff with self-reported “speaking-up” skills experienced less incivility and bullying from their colleagues, leading researchers to suggest that training in speaking up would help eliminate unprofessional behaviour.
Published by the MJA, the authors surveyed staff in seven metropolitan tertiary hospitals operated by one health care provider in three states between December 2017 and November 2018 about their experience of unprofessional behaviours, their perceived impact on personal wellbeing, teamwork and care quality, as well as about their speaking-up skills.
Over 5000 staff members completed the survey, a response rate of 34%; 4846 respondents (93.6%) reported experiencing at least one unprofessional behaviour during the preceding year, including 2009 (38.8%) who reported weekly or more frequent incivility or bullying; 753 (14.5%) reported extreme unprofessional behaviour. Nurses and non-clinical staff members aged 25–34 years reported incivility/bullying and extreme behaviour more often than other staff and age groups respectively. Staff with self-reported speaking-up skills experienced less incivility/bullying and extreme behaviour, and also less frequently an impact on their personal wellbeing.
“An important new finding was the strong association between self-assessed speaking-up skills and experiencing unprofessional behaviour,” wrote the authors, led by Professor Johanna Westbrook, Director of the Centre for Health Systems and Safety Research at the Australian Institute of Health Innovation.
“Respondents who reported having such skills were 47% less likely to report frequent experience of incivility or bullying and 20% less likely to report extreme unprofessional behaviour from co-workers than colleagues without these skills.
“Reporting speaking-up skills was also strongly associated with lower rates of reporting negative impacts on personal wellbeing, teamwork, and quality indicators.
“Health systems in several countries have invested in speaking-up programs, reflecting the expectation that they will reduce the frequency of unprofessional behaviour.
“That having speaking-up skills reduces the frequency and impact of unprofessional behaviour, as suggested by our results, is therefore plausible,” Westbrook and colleagues wrote.
“The effective elements in these programs need to be identified, as well as factors that support their sustainability and scalability, including the organisational context in which staff are asked to speak up.
“We also found that being comfortable about reporting unprofessional behaviour was significantly associated with staff perceptions of the organisational culture, the effectiveness of their hospital in managing complaints about unprofessional behaviour, and the likely consequences of reporting; staff who believed they would be taken seriously were three times more likely to report bad behaviour.
“Training hospital leaders in how to engage with colleagues to counter disruptive and unprofessional behaviour is critical, including being receptive when staff speak up, and having both the skills and processes for an effective response.”
Also online at the MJA
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Shahina, thank you for sharing the LITFL link, it was well written, pragmatic and meaningful
The most elegant synopsis I have read on the importance of “Listening Down” for safety rather than relying on our team members, especially our juniors, to Speak Up is by Ben Symon:
https://litfl.com/conversations-with-our-fathers/
This is unfortunately a very simplistic and unidimensional view of a complex problem. Regrettably it completely ignores the power dynamics at play for junior doctors whose career progression is often dependent on a culture of acquiescence and the job insecurity inherent in a junior workforce bound by time-limited (often 12 month) employment contracts.
The article mentions that feeling comfortable reporting unprofessional behaviour was associated with staff perceptions of organisational culture to take concerns seriously. Perhaps the lesson then is not to roll out “speaking up” training to eliminate workplace bullying, but rather the reciprocal: to eliminate workplace bullying and the organisational cultures that perpetuate it in order to promote employees feeling safe enough to speak up. The onus to fix a toxic workplace culture should not be on the most junior and vulnerable members of the workforce who are most often the victims of workplace bullying.
DON’T do it kids – remember the first rule of public employment – protect your own arse first. You will get NO THANKS for speaking up, and instead be black-balled (or worse) – I speak from personal experience – so much for a career in medicine – but at least I have a job. Medicine is a profession that eats its young.
I feel this is a really tone-deaf article. It implies that victims of bullying simply didn’t “speak up”. It ignores the entrenched culture of retribution towards doctors who speak up in this profession. How is a junior doctor meant to speak up when the abuser is backed by senior doctors with the power to destroy the junior doc’s career with a few discrete phone calls?
Vascular surgeon Gabrielle McMullen famously stated that a surgical trainee pressured in to sex by a supervisor was better off acquiescing for the sake of her career – such was the culture of retribution towards whistleblowers. I don’t believe much has changed since then.
I haven’t read the study as yet – and will do – but I very much agree with the above comment. And if you happen to be a female in a mid level position calling out poor behaviour from a senior male bully – then it is very unlikely there will be any action taken. Instead it will be assumed that you – the female are too sensitive, too busy with your kids, that time of the month etc. for me – I was persistent – and after some time trying to tackle the problem and to help stop the behaviour to me (a doctor) and other colleagues – mostly non-doctors (many – but not all female) He stayed and I was made redundant. During the redundancy I was told they knew the behaviour was poor, and there were issues in the unit with retaining staff, and I would be better off somewhere else. I am now working in another hospital in a senior position without any issues.
One wonders if bullying by hospital administrators is one of the causes of bullying further down the chain. Unfortunately, there are no authorities or agencies that exist to register companies regarding bully medical administrators. Even the AMA washed their hands of the problem.
I suspect many of the hospital staff with self-reported “speaking-up” skills are potentially the bullies – hence why they are not subject to the bad behaviour. After 45 years as a health care worker, I have observed ‘bullies’ in senior positions who have climbed through the ranks, often standing on others as they go. I think this research misses the problem.