Bystanders and Bullying Ann Connell, Director of Allied Health MHAID Services 3DHB MHAIDS 3DHB Professional Leaders & Directors Nov 2015

Kitty Genovese Bystander intervention programmes are based on a theory of bystander behaviours first developed by social psychologists Bibb Latane and John Darley in the 1960s. Their work was inspired by the highly publicised murder of Kitty Genovese in NY City – 37 witnesses saw and heard the young woman being stabbed to death outside her apartment, yet none called police or attempted to intervene.

To intervene Bystander Behaviour Notice Interpret as problem Decide personal action required Choose action Implement action Bystanders are individuals who witness criminal acts or instances where community norms are violated. Their action or lack of action can worsen, maintain or improve the situation. We are interested in bullying/ harrassment – intentional, repetitive acts in the context of power imbalance Bibb and Latane identified a five step process necessary for successful bystander intervention: a bystander must notice that something is happening, interpret it as a problem, decide that the problem requires personal action, choose what form that action will take, and finally implement that action. So why do people get stuck ?

Bystanders are less likely to help if there are others present Bystander Effect Bystanders are less likely to help if there are others present Pluralistic ignorance Diffusion of responsibility Evaluation apprehension This is the bystander effect: bystanders are less likely to intervene when other bystanders are also present. Why ? Pluralistic ignorance: as bystanders try to process whether they are witnessing circumstances that require intervention, many attempt to appear unconcerned and nonchalant so as to not look like they are overrreacting. When no one acts, they come to falsely perceive each other as approving or being unconcerned. The bystanders believe that if something were indeed amiss, other people would be doing something, and since they are not, the situation must not be as dire as they originally perceived. Diffusion of responsibility: occurs during the third step, after someone has identified the situation as a problem and is deciding whether they themselves should assume personal responsibility for intervening. If only one person is present, they feel a deeper sense of personal responsibility to help as any help could only come from them – but if others are present, each bystander sees their share of responsibility as divided equally with others and thus can choose not to act relatively free from guilt. Bystander interventions seek to counteract these effects by teaching that the passivity of bystanders is part of what allows harms like bullying and workplace harrassment to flourish Later researchers added a third component: Evaluation apprehension is the fear of being judged by others when acting publicly

Moral disengagement Rationalise and justify Euphemistic labelling Minimising harm Dehumanisation Attribution of blame Albert Bandura Social Cognitive theory – a number of mechanisms through which people rationalise and justify harmful acts against others, this also part of the bystander behaviour Euphemistic labelling – “not bullying, just teasing” Distortion of consequences – “they weren’t really upset” Treating people as less than human – “they don’t deserve to be treated any better” Attribution – blaming the victim, seeing them as provoking the behaviour. Bullies do tend to pick targets who are submissive, insecure, in low status or low power positions in the group. MHAIDS 3DHB Professional Leaders & Directors May 2015

Participant Roles Pure bullies Pure victims / provocative victims Bully assistants Bully reinforcers Bystanders Defenders Assistants: offer active support to the aggressor (unusual but not unknown in the workplace, common in schools, usually a way of ensuring they do not become a victim themselves, and may gain social standing) Reinforcers: give the bully an audience by laughing or watching, passing on text messages Bystanders: are aware of events but do not act (there may also be people who are uninvolved, unaware) Defenders: actively try to stop the bullying Thinking about the DHB as an organisation – for bullying occurs within a framework of suitable targets (victims), motivated perpetrators, and the presence or absence of capable guardians. “Bullying by immediate supervisors and managers is in the context of workplace dynamics and stratification with formalised power differentials. The guardian role is both with people and with the organisation through systems of control and accountability. Workplace bullies tend to emerge in settings characterised by organisational chaos. “managerial bumbling results in chronic problems and disruptions”. (Roscigno et al 2009) MHAIDS 3DHB Professional Leaders & Directors May 2015

Overcoming social inhibition High status Well-liked by peers Empathetic Emotionally stable Cognitively able Above about age 9, potential defending behaviour is inhibited by the expectations and norms of the group. Individuals who overcome social pressure and defend victims tend to have high social status and be well-liked by peers, along with the other, along with a few other characteristics – most of them are difficult for us to control, but paying attention to how we recruit to leadership positions and what we value means that we are more likely to have people in the high status positions who can do this

Barriers to speaking out It’s not my business I could get bullied myself I didn’t know what to do Bystanders must choose – do they speak out about what they witness, or are they silenced, either by themselves or others ? Bystanders often feel confused, isolated themselves, and stuck. Research participants talk about fear: both fear of becoming a victim themselves, and the more subtle anxiety that sharing your private views could be used as social ammunition against you in the future. It is emotionally easier to be silent – the naive hope that “if you don’t talk about it, and just forget it, it will go away. It is uncomfortable – desire to intervene positively is overcome by a sense of ambiguity and social exposure leading to inaction. While empathy is necessary for defending behaviour to occur, on its own it isn’t enough. This leads to feelings of guilt and shame. Research on cyberbullying showed 49% - not my business - 13% of respondents explicity put the responsibility to act with the victim himself or herself 32% feared being bullied themselves as a result of acting 31% lacked the knowledge or skills or sefl-efficacy to help

What works? Lots of programmes, little research, face validity but actual impact unclear, cautiously optimistic -Schools - bullying US Colleges, Military – sexual and relationship violence (University of New Hampshire “know your power” campaign)’ “Bringing in the Bystander” Workshops to teach participants techniques and strategies they can use if they witness harms occurring, often incorporate realisitic scenarios that the target audience is likely to experience. Information, social media NZ – antiviolence campaign Successful interventions must hit several target areas: Awareness Responsibility Norms Risks of taking a stand / making a complaint Institutional context

Common law – no duty to rescue Busybody, tattletale ... Changing Social Norms ? Common law – no duty to rescue Busybody, tattletale ... History and inertia Changing social norms so that people are more likely not to look the other way when others are in danger is is a component of the bystander programmes . The programmes attempt to challenge the social norms that support, condone or permit the harms by encouraging bystanders to identify, confront and speak out against them, for example, it is thought that teaching bystanders to not tolerate derogatory language that can cause speakers to rethink their manner of communication. Hmmm. Not so easy There is a wider societal context of legal norms embedded in common law of no duty to rescue or intervene that is reflected in a general social expectation of not meddling in other peoples business (labels: busybody, tattletale, interfering old biddy) And – hospitals are places with a long history of being a certain way, fondly held by those at the top of the heap. Hospitals are strongly hierarchical places, and bullying fits in as a method of maintaining social hierarchies. Recent Health Leadership forum run by HQSC had young doctors from all over the country, a few nurses, and a tiny number of self-funded allied health people. The young doctors – house surgeons, registrars – were given financial and other support to attend, saw this as right and proper as they were destined to be leaders. The young doctors might be concerned about being bullied themselves, but they are also being socialised into the role. The literature around clinical leadership pays little attention to the responsibilities of the role. BMA doc on clinical leadership under “personality, behaviours and moral values” talks about good clinical leaders being inspiring, exuding charisma, needing to be resilient, determined and to retain strong mental and emotional resolve when under pressure. They should demonstrate enthusiasm and passion for their role and their wider profession as well as a cheerful disposition to see them through difficult times. They have to help colleagues to feel empowered in their own roles and have empathy”. You could read into that an expectation that they treat other people well but it isn’t explicitly stated

Factors conducive to bullying Work design - hierarchical Inadequate behaviour of leaders Socially exposed position of the target Low morale Hierarchical workplace Cleary et al 2010 Bullying is especially associated with workplaces that are hierarchical; the bully frequently holds superior power to that of the target MHAIDS 3DHB Professional Leaders & Directors May 2015

Culture of the organisation Leadership and responsibility Role models Capacity to deal with the perpetrator Bullying is less common in organisations that are able to promote a positive and respectful workplace atmosphere. They emphasise respect as the foundation of working relationships and value demonstrating respect with one another and with clients (patients). Some aspects include equitable reward systems, valuing diversity among employees, and establishing effective and inclusive work teams. Some things that are inherent in DHBs (value given to some roles marked by high salary and other favourable conditions) perpetuate the hierarchy and beliefs about particular roles. Situational factors influence both bullies and bystanders – the overall ‘health” and culture of the organisation, its capacity to tolerate bad behaviour of all sorts, has to be part of the solution because these influence the social structure If the employer is seen to “do nothing” then the institution itself functions as a “silent bystander”. When perpretrators of harms receive no “punishment”, the DHB is seen as complicit in the behaviour. Any bystander intervention programme must be embedded within a comprehensive framework of prevention, with clear policy that is acted on. The disciplinary authority that the employer has must be used. It is important that the role of the bully or harrasser is not overlooked. Some of the bystander programmes assume that you simply cannot change a perpretrators behaviour so leave all the responsibility for change with the victims and onlookers. Employers can look at ways of encouraging the bully to change their behaviour. Similarly, understanding the impact of processes on the victim – exposing their experience of bullying to employer, union representatives, tribunals can feel deeply shaming. The overall power dynamics of the organisation also play a role – if the managers themselves feel bullied along with other employees by depersonalised rules and lack of

Employer responsibilities Policy, policy, policy (we really mean it) Our leaders are good and will do the right thing Look after ourselves first Healthy team functioning Policy: there is a policy, we are serious about the policy, we have thought through the mechanisms and we are prepared to follow through. Having a policy that we don’t enforce is counterproductive as the organisation is seen as having knowledge but choosing to ignore it. Some research indicates that bullying at work is not random or unexpected, and that much of it results from disputes that have been allowed to fester. Failures by employers to act at potential intervention points exacerbates the problem as the bully feels that their behaviour is tolerated or condoned by the employer. However, if the bully knows that there will be consequences, this can prevent or stop the behaviour. We will do the right thing for you as an employee (this does need careful thinking – if the bullying person is a senior surgeon in a difficult to recruit to area, they are indeed in a powerful position. Work on educating them, the bigger organisational culture of teamwork and the value of all roles). Without high level, visible leadership on the right ways to treat people, any initiative will be treated with scepticism. Senior leaders need to understand the quality aspects of doing this – looking after employees results in a more effective and productive workforce that will produce better quality work. Some of this is how leadership positions are configured. If senior roles are only available to medical staff, this cements in the belief that these people are the most important people, and for some, this will give them the idea that this means they can treat others any way they choose. Valuing and supporting healthy team function is also important – if people feel well connected generally, there are fewer potential targets. If colleagues feel connected with a victim they are more likely to intervene..

Training Mentoring Manager and Leaders Recognise tension and conflict Emotional intelligence Guidelines for roles – positive behaviours Mentoring Line managers have the responsibility for implementing the strategies and intervening when they are made aware of a problem. Workplace bullying is often a result of long periods of unresolved conflict, or patterns of behaviour that have developed over long periods of time. Looking after ourselves includes giving people in leadership and management roles the right training and support – again a challenge. Recent Health Leadership forum run by HQSC had young doctors from all over the country, a few nurses, and a tiny number of self-funded allied health people. The young doctors – house surgeons, registrars – were given financial and other support to attend, saw this as right and proper as they were destined to be leaders. The young doctors might be concerned about being bullied themselves, but they are also being socialised into the role. The literature around clinical leadership pays little attention to the responsibilities of the role. BMA doc on clinical leadership under “personality, behaviours and moral values” talks about good clinical leaders being inspiring, exuding charisma, needing to be resilient, determined and to retain strong mental and emotional resolve when under pressure. They should demonstrate enthusiasm and passion for their role and their wider profession as well as a cheerful disposition to see them through difficult times. They have to help colleagues to feel empowered in their own roles and have empathy”. You could read into that an expectation that they treat other people well and

Awareness Specifics – what it is, what to do Opportunities to practice What does a healthy team look like ? Social marketing What does the bullying behaviour look like ? This is both for bystanders and victims – if people have some criteria for categorising inappropriate behaviour, then it is easier to interpret the situation as one in which intervention is appropriate. Providing people with exemplars of problem behaviours using both old school and modern media. Skill building around what people can do to help is important – and this is beyond bullying. Knowing what constitutes a healthy team environment and what can be done to support it also needs to be part of the programme