Steve Fouch

Bullying and NHS Culture

Steve Fouch is CMF Head of Nursing, and formerly worked in community nursing, HIV & AIDS and palliative care. He serves on the International and European regional boards of Nurses Christian Fellowship International.
The views expressed do not necessarily reflect those of CMF.

It seems hard to credit that an organisation whose primary focus is the care of the sick, disabled and the vulnerable should have an appalling reputation for bullying and intimidation of staff.  However in survey after survey of NHS staff at least one quarter and up to one third of all those who respond say that they have experienced bullying from colleagues and managers at some point. One in ten say that they have experienced discrimination in the workplace, and that figure is double for black and minority ethnic staff members, and nearly as high for disabled employees.

Yes, in a service designed to care for the disabled there is discrimination against disabled staff members!  And let’s not forget that black and minority ethnic doctors and nurses are a significant part of the NHS workforce, and have been for many years.

And I am not even mentioning the abuse meted out on frontline staff by members of the public – this is just discrimination and bullying by other NHS staff.

The causes are many – sometimes it is managers who are themselves being pressurised to meet targets who bully their staff – kicking down the line.

Alarmingly, in a recent survey, over half of those who had experienced bullying reported that they felt it had been because they had raised concerns about care standards, patients’ safety or had stood up for colleagues facing discrimination.

Sometimes it may be the culture of a team that singles out those who don’t fit in – perhaps because of ethnicity or disability. However, this is particularly true where a culture of ‘getting by’ on the minimum effort has developed, often because so many of the team are already ‘burnt out’. Any staff member who seeks to give their best shows everyone else up in a bad light and becomes an obvious target. Ironically, those who seek to raise standards can find themselves accused of bullying.

The impact of this intimidation is hard to gauge. There are many anecdotal reports of health professionals leaving the NHS because of chronic bullying and discrimination. A recent Guardian survey suggests that up to a third of those experiencing bullying have been forced to leave their jobs. This is at a time when we are facing some of the most serious recruitment short falls in the history of the NHS; are we, in effect, bullying experienced staff out of the workplace?

It is certainly true that research shows a strong correlation between ‘disruptive behaviours’ and the occurrence of adverse events and compromises in patient safety. Or as the Chief Executive of NHS England has put it, ‘staff wellbeing and high-quality patient care are two sides of the same coin’.

In a recent conversation with a nurse who has been through bullying and being forced out of a job, the issue was broadened out for me.  It is not just workplace bullying, but the fact that so many colleagues just won’t back up or support the bullied individual for fear of becoming a target. The culture of fear and intimidation leaves many of those facing bullying isolated and even ostracised by their colleagues. Bullying can be as much a sin of omission as one of commission.

Workplace culture plays a big part in shaping us as professionals. But culture is not static – it something we create with each other; how we are as professionals shapes our workplace culture as well. It is not just managers that shape the culture, we all have a role.

While a lot is being said about the role of leadership in shaping NHS culture at the moment, it is important to understand that leadership is not just the senior staff member taking responsibility; all of us need to assume appropriate responsibility for our team and ourselves regardless of who is in charge.  It is about being proactive in building teams rather than waiting on someone else to lead. And the core quality needed by such leaders is compassion – not just for patients, but for colleagues.

Robert Francis pointed out in 2013 that the only way for the NHS to change and break out of a negative spiral that promotes bullying is for every member of staff to be involved in bottom up culture change.

For Christians this is another reminder that we are salt and light in our workplaces, and that means taking responsibility for encouraging the best in our colleagues as well as modelling care and compassion in our practice.

However, this also puts us in danger of burnout!  Feeling a responsibility to care for our colleagues above and beyond the call of professional duty can be more than we can sustain. So we cannot do this alone.  We need to be caring for ourselves physically and spiritually, particularly finding others to pray with us and support us spiritually either in our churches or fellow Christians in our workplaces.  We need also to find and work with like minded colleagues of any or no faith who share a common concern to create a better working environment.

We have to also recognise our limitations – we cannot solve all the problems around us! However, we can make small differences wherever we are. Lots of small differences, over time, can lead to big changes.

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