It’s time to stop bullying in the NHS – for the sake of patients

The Guardian Professional. Thursday 25 September 2014 08.30 BST
Bullying whistleblowers has damaged staff health and cost employers sick pay and turnover
Robert Francis
Robert Francis is conducting an independent review into whistleblowing in the NHS. Photograph: Martin Godwin

Bullying in the NHS is a serious problem. Robert Francis’s 2010 report into the Mid Staffordshire hospital scandal said “an explanation for staff’s reluctance to come forward with concerns was that they were scared”, witnesses described “an “endemic culture” of bullying”, and the report provides graphic examples of the victimisation of those who did raise concerns.

The omission of bullying from the 290 recommendations in his 2013 report was a serious mistake that Robert Francis could remedy in his currentindependent review into whistleblowing in the NHS. Since 2010, NHS bullying has further increased. According to the NHS national staff survey, the proportion of staff reporting being bullied, harassed and abused by colleagues and managers rose from 14% in 2010 to 22% in 2013. Staff surveyed said under half of these cases were reported while the proportion of cases being reported fell from 54% in 2004 to 44% last year.

Bullying damages staff health and costs employers sick pay and turnover. Crucially, it is also bad for patient care. Staff are less likely to raise concerns and admit mistakes if there is a culture of blame and bullying. Recent research found “a strong negative correlation between whether staff report harassment, bullying or abuse from other staff in the NHS staff survey and overall patient experience” and “a strong negative correlation between whether, in the NHS staff survey, staff reported harassment, bullying or abuse from other staff and whether patients reported being treated with dignity and respect”.

System leaders agree. Sir Ian Kennedy, who chaired the Bristol Royal Infirmary inquiry, warned five years ago that “one thing that worries me more than anything else in the NHS is bullying … We’re talking aboutsomething that is permeating the delivery of care in the NHS.”

Evidence commissioned by Lord Darzi concluded there was a “pervasive culture of fear in the NHS and certain elements of the Department for Health”. NHS leaders understand the link between bullying and raising concerns arguing that “confidence to report bullying is directly related to confidence to report workplace concerns” and that “bullying is a word whispered in the NHS. No one wants to operate under a climate of fear and everybody needs to have a zero tolerance approach.” It is no surprise therefore that another recent staff survey found only 40% of staff felt concerns they raised would be dealt with appropriately.

Despite such overwhelming evidence, there is no major national initiative on NHS bullying. We could learn from the US. There, the US Joint Commission, an independent, non-profit organisation that accredits healthcare organisations and programmes has issued a standard on “behaviours that undermine a culture of safety” to tackle “intimidating and disruptive behaviour at work”.

This 2008 standard set out some of the extensive evidence that intimidating and disruptive behaviours can foster medical errors, contribute to poor patient satisfaction and to preventable adverse outcomes, (and) increase the cost of care. It stressed that safety and quality of patient care is dependent on teamwork, communication, and a collaborative work environment.

The standard states “to assure quality and to promote a culture of safety, healthcare organisations must address the problem of behaviours that threaten the performance of the healthcare team.”

Research shows that staff who are cared for will provide better care. But if staff lack support, appreciation and respect and are bullied, research confirms it will damage patient care and safety. As Robert Wachter put it: “You’ll know you’ve achieved a safe culture when you see someone low in the hierarchy – say a new nurse – reminding a senior physician to wash his or her hands, and the physician responds by simply saying ‘thank you’ then turns to the sick or gel dispenser”.

We need that culture throughout the NHS, now, with zero tolerance of bullying, so that all staff, at all times, can raise concerns without fear of detriment. Let’s hope Robert Francis gets this one right this time.

 

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