2011 bullying harassment

8/6/2019 2011 Bullying Harassment

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&

Royal Australasian College of Surgeons

The College of Surgeons of Australia and New Zealand

Recognition, avoidance & management

BullyingHarassment


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Bullying and harassment isendemic in the health sector,between all types of staff at all

levels of seniority.

Australian and New Zealandsurveys have found over 50 per cent of

Australian junior doctors have been bulliedin their clinical attachments 1,2

Unfortunately this is worldwide3,4 andincludes undergraduate experiences5,6,7

Bullying costs businesses in Australia andNew Zealand over $21 billion per year 8and the average cost of lost productivityin each case of bullying is about $20,000

The health care environment is oftenhostile with members of the health careteam under increasing stress9

Despite education and awareness there persists a culture of bullying in somemembers of the health care team and this decreases the quality of patient care,creates a poor learning environment and increases psychological stress10,11

Harassment and bullying by surgeons can turn away many of our best and mostgifted from wanting a career in surgery12,13

1 Rutherford, A & Rissel, C. (2004) A survey of workplace bullying

in a health sector organisation, Australian Health Review, vol. 28,no. 1, pp. 65-72.

2 Scott, J., Blanshard, C. & Child, S. (2008) Workplace bullying

of junior doctors: a cross-sectional questionnaire survey, NZMJ

Digest, Vol. 121, No. 1282, pp. 13-5.

3 Finucane, P. & ODowd, T. (2005) Working and training as an

intern: a national sur vey of Irish Interns, Medical Teacher, vol. 27,

no. 2, pp. 107-113.

4Quine, L. (1999) Workplace Bullying in NHS community trust:staff questionnaire survey, BMJ, vol. 318, pp. 228-32.

5 Recupero, P.R., Heru, A.M., Price, M. & Alves, J. (2004) Sexual

Harassment in Medical Education: Liability and Protection,

Academic Medicine, Vol. 79, No. 9.

6 Cook; D.J., Liutkus, J.F., Risdon, C.L., Griffith, L.E., Guyatt,

G.H. & Walter, S.D. (1996) Residents experiences of abuse,

discrimintation and sexual harassment during residency training,

Canadian Medical Association Journal, vol. 154, no. 11, pp.1657-65.

7 Heru, A.M. (2001) Hospitals and the Changing Work

Environment: Promoting Gender Equity and Fair Treatment for

Medical Students, Medicine and Health/Rhode Island, vol. 84,

no. 3, pp. 76-8.

8 McCarthy, P. & Mayhew, C. (2004) Safeguarding the

Presidents View

Itistimetostanduptoworkplacebullyingandharassment

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Ian Gough


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Teaching Supervision & Assessment

Supporting Others

Scholarship & Teaching

Good Behaviours Poor Behaviours

Provides continuous constructive

feedback without personalising the issues

Demonstrates arrogance, rudeness or

disinterest in the training of junior staff

Provides adequate supervision to junior

staff

Fails to delegate appropriately to junior staff

Uses clinical encounters as an opportunity

for teaching of staff

Regularly fails to attend scheduled tutorials

and other teaching sessions Makes themselves available for planned

lectures and tutorials

Is critical of a junior staff member even when

staff could not reasonably be expected to

know

Facilitating education of their students, patients, trainees, colleagues, other healthprofessionals and the community. 14

Management and Leadership

Providing cognitive and emotional help to team members. Judging different team members

abilities and tailoring ones style of leadership accordingly.14


Provides constructive criticism to team

members

Does not provide recognition for tasks

performed well

Ensures delegation of tasks is appropriate Fails to recognise needs of others Establishes rapport with team members Shows hostility to other team members e.g.

makes sarcastic comments to nurses or junior

medical staff

Gives credit for tasks performed well Puts down junior staff or other hospital

workers

Organisation against Violence and Bullying, Palgrave

Macmillan.

9 Garling, P. (2008) Final Report of the Special Commission

of Inquiry into Acute Care Services in NSW Public Hospitals,Special Commission of Inquiry into Acute Care Services in

NSW Public Hospitals.

10Williams, S., Dale, J., Glucksman, E. & Wellesley, A. (1997)

Senior house officers work related stressors, psychological

distress, and confidence in performing clinical tasks in

accident and emergency: a questionnaire study, BMJ, vol.

314, pp. 713-8.

11 Di Martino, V. (2003) Workplace violence in the healthsector: relationship between work stress and workplace

violence in the health sector, Geneva.

12 Stratton, T.D., McLaughlin, M.A., Witte, F.M., Fosson, S.E.

& Nora, L.M. (2005) Does Students Exposure to Gender

Discrimination and Sexual Harassment in Medical School

Affect Specialty Choice and Residency Program Selection?,

Academic Medicine, vol. 80, no. 4, pp. 400-8.

13Woodrow, S.I., Gilmer-Hill, H. & Rutka, J.T. (2006) TheNeurosurgical Workforce in North America: A Critical Review of

Gender Issues, Neurosurgery, vol. 59, no. 4, pp. 749-58.

14 RACS (2008) Royal Australasian College of Surgeons

Surgical Competence and Performance. www.surgeons.org

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Extracts from RACS Surgical Competence & Performance


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Workplace bullying and harassment can occur at multiple levels between colleagues,

students and employees and also with contractors, patients and family members.

Censor-in-Chief

If a good doctor-patient relationship isfundamental to healing, then a good trainee

trainer/supervisor relationship isfundamental to learning how to heal

Bullying

To bully is to threaten, oppress or tease, either physically or morally, and can include: public

humiliation, perisistent criticism, personal insult, professionally undermining a persons

professional ability, consistently undervaluing effort and abuse of power. Bullying is not

necessarily face to face. It may be by written communication, e-mail or telephone.

Harassment

Unwanted conduct affecting the dignity of men and women in the workplace. It may be related

to age, sex, race, disability, sexual orientation, religion, nationality or any personal characteristic

of the individual and may be persistent or an isolated incident.

The intention or motive of an alleged sexualharasser is not relevant when determining if the

behaviour is unwelcome. The focus is the

perception and experience of the recipient.

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Ian Civil


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Skills for working in a team context is particularly important to ensure that the surgical team hasan acceptable shared picture of the clinical situation and can complete tasks effectively.

Documenting and exchanging information

Collaboration & Teamwork

Giving and receiving knowledge and information in a timely manner to aid establishment of a

shared understanding among team members. 14


Is collegiate and professional in dealings

with members of department and practice

Does not listen to team members or practice

staff

Listens to, discusses and appropriately

acts upon concerns of team and staff

members

Needs help from assistant/staff member

but does not make it clear what assistant is

expected to do

Considers others points of view in diffi cult

situations

Refuses to accept clinical opinions of others

05

TheCollege is

committedto

fairness&

equality



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Bullying, discrimination and harrassment will breach legal obligations. Bullies

can face legal action. It is necessary to distinguish between the legitimate

interaction of a manager or supervisor and the employee or Trainee. Good

management will not constitute bullying.

It is reasonable to have discussions and work requirements about:

Turning up to work on time

Being prompt for ward rounds and operating sessions

Completing administrative issues

Ensuring patients are properly reviewed

Achieving successful patient handover

Employers have a duty to identify bullying and harassment and take steps to eliminate and prevent

it. The College as an educational body has a duty to eliminate and prevent it (www.surgeons.org).

Employees/Trainees also have legislated responsibility for others who may be affected by bullying actsin the workplace.

College Solicitor

Good Behaviour Poor Behaviour

Decisive Inconsistent, random, impulsive

Accepts responsibility Abdicates responsibility

Shares credit Plagiarises, takes all the credit

Acknowledges failings Denies failings, always blames others

Consistent Poor interpersonal skills

Confi dent Exclusive self-interest

Fair, treats all equally Is contemptuous of patients or staff

Seeks and retains people more

knowledgeable and experiences than self

Singles people out, shows favouritism

Values others Withholds information, releases selectively,uses information as a weapon

Includes everyone Unable to value, constantly devalues others

Leads by example Includes and excludes people selectively

Truthful Dominates, sets a poor example

Insecure and arrogant

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Michael Gorton


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Bullyingisbehaviourthatis

perceivedasunreasonab

le

&inappropriate,thatis

intimidating,threatening

and/orhumiliating

Communicating Effectively

Communication

07


Encourages the surgical team to ask

questions

Is discourteous to staff or patients

Demonstrates empathy and compassion

when breaking bad news

Routinely interrupts or dismisses the

comments of patients, families, colleagues

or staff

Shows awareness and sensitivity

to patients from different cultural

backgrounds

Shows insensitivity to the impact of language,

culture or disability on communication


Communication occurs between Fellows, Trainees, other health professionals as well as patients

and their families


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So what can you do about it?

Say, STOP! This is often the most effective and powerful measure.

Say that you fi nd this behaviour unacceptable

Document threats or actions taken by the bully

Discuss concerns with your supervisor or someone equivalent like your

mentor if the supervisor is the problem

Consider making a complaint under the Employers harassment and

bullying policy

Consider making a complaint under the Colleges harassment and

bullying policy

Seek support from the Royal Australasian College of Surgeons Trainees

Association (RACSTA), your peer network, colleagues or Human RightsCommission. Email [email protected] about the issue or give the Support

& Advocacy Portfolio Chair of RACSTA a call

Seek support from the Dean of Education or Executive Director of Surgical

Affairs (Australia & New Zealand) at the College

Trainees Association Chair

Anyone who has suffered from the bullying

behaviour of others should be offered directsupport and if needed mediation or counselling.

The fact that the harassment and bullyingwas not intentional is no defence!

08

Matthew Peters


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Responding to cultural & community needs

Professionalism

Demonstrating commitment to patients, the community and the profession through the

ethical practice of surgery.

Having awareness and insight

Health Advocacy

Demonstrating understanding of the impact of culture, ethnicity and spirituality on surgical care

and considering the broader health, social and economic needs of the community.14


Adopts a courteous approach to other

staff and patients

Stubborn, refuses help when it is clearly

required

Responds positively to questioning,

suggestions and objective criticism

Blames junior or medical staff or others for

poor outcomes

Admits to errors Books inappropriately long lists

Recognises poor outcomes and the need

to refl ect and improve

Berates or humiliates subordinates

Reflecting on individuals surgical practice and having insight into its implications for

patients, colleagues, trainees and the community.14

09


Contributes to community education and

development

Insensitive to different patients backgrounds

cultural beliefs or attitudes

Communicates effectively with people

from culturally and linguistically diverse

backgrounds and uses interpreters

Discriminates on the basis of culture,

ethnicity or religion



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Methods of Complaints Resolution

Informal Internal Process(there are no formal findings of misconduct with this process)

Emphasises the future

How will we work together in the future?What practices will we put into place in the future to avoid this problem?

Processes include:

A manager (or someone else with appropriate skills and authority) mediates

a discussion,

Outcome is in hands of parties but mediator controls process,

May involve increased education and expectation

Ongoing observations to ensure better behaviour

Remember, education is the first key step to insight

For formal internal/external resolutions see appropriate human resources policies

Complaints Resolution

1.Self management2. Informal internal process

summary below but see Discrimination & Harassment

policy, Fellows, Trainees & International Medical

Graduates at www.surgeons.org

}

3.Formal internal process4. External resolution option

see College policies or your Employers human resources

department or Human Rights Commission.

Enquiries to the Dean of Education and the Executive

Director of Surgical Affairs (Australia and New Zealand).

}

Self Management

Principle Examples

1. Stay calm and polite 1. Please

2. Focus on the behaviour, not the person 2. Stop touching me

3. Indicate the effect of the behaviour on your

feelings

3. When you touch me, I feel uncomfortable

4. Include a clear request that the behaviournot happen again 4. Im asking you to please not touch meagain

5. Ask for agreement or at least

acknowledgement that you have been heard

5. Is that ok?

11


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Bullying

is BannedNo more

Intimidation

Vexatious Reports

Malicious Rumours

Threats, yelling, screaming, offensive

or inappropriate language

Undermining work performance

Refer to College policies on Discrimination/

Harassment at www.surgeons.org

Key Points

Workplace bullying takes many different forms, but results in

intimidation of and distress in the victim

Bullying may reflect prejudice, personality problems, poor

systems, or a serious failure in communication or relationship

skills Bullying is common in the health service, as in other workplaces,

occurring within and between all levels of staff

Bullying damages doctors, especially those in training, often

seriously

Clinical environments in which bullying occurs may be less

safe for patients

2011 bullying harassment

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