1. DR Sam Farley Department of Psychology, University of Sheffield
Exploring trainee doctor’s experiences of work-related bullying NACT Conference, 17th January 2017
DR Sam Farley
Department of Psychology, University of Sheffield

2. Session Overview
Aim: To explore at least one way that you could act to prevent bullying among medical students.
Objectives:
Discuss the available evidence on bullying in the NHS.
Reflect on your own experiences of dealing with cases of bullying among medical students.
Discuss what you feel would be the most effective thing you could implement to prevent bullying.

3. Introductions
(1) Name
(2) Educational Role
(3) Workplace

4. Workplace Aggression Incivility Abusive Supervision Social Undermining
Workplace Violence
Workplace Bullying
Cyberbullying

5. Workplace Bullying: A Definition
A situation in which one or several individuals persistently, and over a period of time, perceive themselves as being on the receiving end of negative actions from superiors or coworkers, and where the target of the bullying finds it difficult to defend him or herself against these actions (Einarsen & Skogstad, ; Nielsen & Einarsen, 2012; Olweus, 1993).

6. Key Feature 1: A power imbalance.
Involves a perceived power imbalance between the perpetrator and the victim.
Bullying involves a power imbalance e.g. organisational hierarchy difference, physical size, number of allies
Source of power may be related to position in the organisational hierarchy (usual for cases to involve a manager bullying a subordinate). However upwards bullying also exists, where a number of subordinates can bullying the manager, gang up to undermine them. The source of power is not always associated with the hierarchy, could be associated with access to resources, knowledge & expertise, number of friends within a workplace. If you’re very smart, know process you may have the capability to bully others.
Conflict between two parties of equal strength is NOT bullying!

7. Key Feature 2: Exposure to repeated behaviours over a period of time
You
incompetent
%$&%&
Researchers have tried to operationalise bullying, suggesting that in order to classify someone as bullying, they should have experienced at least one or two negative acts per week over a period of about six months.
However, the criticism of this approach is that bullying in many cases is an escalating process, whereby at the beginning a target may experience negative behaviours relatively infrequently, but as time goes on they become more and more regular. So this operational method may not capture those in the initial or middle phases of the bullying process. So in effect, the method reduces a complex process to a strict either-or phenomenon.
NOT BULLYING!
TIME

8. Key Feature 2: Enduring repeated behaviours over a period of time
Researchers have tried to operationalise bullying, suggesting that in order to classify someone as bullying, they should have experienced at least one or two negative acts per week over a period of about six months.
However, the criticism of this approach is that bullying in many cases is an escalating process, whereby at the beginning a target may experience negative behaviours relatively infrequently, but as time goes on they become more and more regular. So this operational method may not capture those in the initial or middle phases of the bullying process. So in effect, the method reduces a complex process to a strict either-or phenomenon.
TIME

9. Key Feature 2: Enduring repeated behaviours over a period of time
Researchers have tried to operationalise bullying, suggesting that in order to classify someone as bullying, they should have experienced at least one or two negative acts per week over a period of about six months.
However, the criticism of this approach is that bullying in many cases is an escalating process, whereby at the beginning a target may experience negative behaviours relatively infrequently, but as time goes on they become more and more regular. So this operational method may not capture those in the initial or middle phases of the bullying process. So in effect, the method reduces a complex process to a strict either-or phenomenon.
TIME

10. Key Feature 2: Enduring repeated behaviours over a period of time
Researchers have tried to operationalise bullying, suggesting that in order to classify someone as bullying, they should have experienced at least one or two negative acts per week over a period of about six months.
However, the criticism of this approach is that bullying in many cases is an escalating process, whereby at the beginning a target may experience negative behaviours relatively infrequently, but as time goes on they become more and more regular. So this operational method may not capture those in the initial or middle phases of the bullying process. So in effect, the method reduces a complex process to a strict either-or phenomenon.
TIME

11. Key Feature 2: Enduring repeated behaviours over a period of time

12. Key Feature 2: Enduring repeated behaviours over a period of time

13. Key Feature 2: Enduring repeated behaviours over a period of time
BULLYING!!!
TIME

14. Bullying in the health sector
Studies consistently find that bullying occurs to a greater extent in the health and social care sectors (Leymann & Gustafsson, 1996; Meschkutat et al, 2002; Niedl, 1995; Piirainen et al, 2000; Vartia, 1993; ).
NHS staff survey: Percentage of staff experiencing harassment, bullying or abuse from other staff in last 12 months:
2012: 23.6%
2013: 23.2%
2014: 23.5%
2015: 24.8%
Large representative study of more than one million UK workers found the average prevalence of bullying was 10.6% (Hoel & Cooper, 2000).

15. Risk Groups
Studies suggest junior doctors are particularly at risk of bullying (GMC, 2013; Quine, 2002).
Also indications that nurses are exposed to more bullying (Quine, ; 2001).
The perpetrator is most likely to be a line manager (Quine, 1999; ).

16. Why, in a sector that’s very purpose is to heal and look after people, should so much bullying occur?

17. Possible Explanations: Working Conditions
Stressful working conditions predict engagement in bullying (Leymann, 1996). These may be:
Job related: role conflict, role ambiguity and workload predict bullying perpetration (Baillien & De Witte, 2009; Reknes et al, 2014).
Team related: team conflict and leadership (Baillien et al, 2014).
Organisationally related: organisational change and social climate predict bullying (Baron & Neuman, 1996; Coyne et al, 2003).

18. Possible Explanations: Personality & Social Learning
People may engage in bullying to protect their own self-esteem (Einarsen et al, ) or use it as a way to get things done / feeling in control.
Social learning theory suggests that people model their behaviour on ‘accepted others’. Thus, if a bullying culture is the accepted norm, employees will adopt this behaviour to fit in with their work environment (Bommer, Miles and Grover, 2003; Zagenczyk et al, 2008).
It’s also difficult to objectively appraise the quality of a doctor / nurses work, which provides seniors with an opportunity to attack (Einarsen et al, 2011).

19. What can employers do to prevent bullying?

20. Focus on the Working Community
Measurement of bullying
Develop and disseminate a bullying policy.
Monitoring policy success
Education on bullying and harassment
Train staff to manage bullying complaints
Identify organisational areas associated with risk of bullying
Develop clear reporting processes
Corrective
Measures
Preventative
Measures
Investigate bullying complaints
Train staff in conflict management
Provide support to victims
Mediation
Focus on the Individual
Source: Tuckey, M. (2016). A case for focussing on organisational systems / Finnish Occupational Health & Safety Act

21. Questions?

22. Group Discussion 1
In your groups discuss:
Your experiences of dealing with cases of bullying among medical trainees. What happened? how did you act? Was the situation resolved?
If you haven’t experienced any bullying cases among trainees, is this because they aren’t reporting? If you think ‘no’, what is your Trust doing well?

23. Group Discussion 2
In your groups discuss:
(1) How do you feel you could be most effective in preventing or reducing workplace bullying experienced by medical students?
(2) Are there any barriers preventing you from implementing strategies to prevent bullying?

24. Summary
Workplace bullying occurs more in the health profession than in most other sectors.
Trainee / junior doctors and medical students are particularly at risk of being bullied.
The causes of workplace bullying are multiple and often differ across cases.
Support on bullying and harassment is available from several sources: CIPD (2015), ACAS (2014) and HSE (2009).

25. Email: s.j.farley@sheffield.ac.uk

26. Group Discussion 3
(1) If you did want to intervene in some way to prevent the bullying of trainee doctors, what would the next steps look like?