An overview of the problem of bullying, harassment and undermining in the workplace.

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There has been wide ranging research undertaken on the prevalence and effects of bullying, harassment and undermining in the NHS. For one of the most comprehensive reports, see the Illing Report, published in 2013. 24% of NHS staff working in acute Trusts report bullying and this is in keeping with data from a meta-analysis of 24 countries with prevalences ranging from 11-18%.

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Bullying, harassment and undermining are terms that are often used indiscriminately to describe certain behaviours but they are different.

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Bullying may be characterised as offensive, intimidating, malicious or insulting behaviour, an abuse or misuse of power through means intended to undermine, humiliate, denigrate or injure the recipient.

Bullying may be by an individual against an individual or involve groups of people.

It may be obvious or it may be insidious. Whatever form it takes, it is unwarranted and unwelcome to the individual.

What is crucial here about bullying is the abuse or misuse of power with an intention to hurt the recipient.

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Bullies tend to be people who display behaviours which are:

• autocratic

• tyrannical

• laissez faire

• more aggressive

• hierarchical.

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The influence of organisational culture and change can have a profound influence on whether such people flourish or are guided to more appropriate behaviour. It is very easy to stereotype and ignore the fact that bullying is complex with multiple causes and not just those attributed to individuals, either bullies or victims.

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Harassment, in general terms is unwanted conduct affecting the dignity of men and women in the workplace. It may be related to age, sex, race, disability, religion, sexual orientation, nationality or any personal characteristic of the individual, and may be persistent or an isolated incident.

The key is that the actions or comments are viewed as demeaning and unacceptable to the recipient.

Similarly, it may be by an individual against an individual or involve groups of people.

Harassment is particularly related to the protected characteristics and again both actions and words are demeaning and unacceptable to the individual.

Laws are in place to protect individuals who suffer harassment and there is unlimited compensation where a case is proven. This is not the case for bullying.

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Undermining is characterised in the GMC survey as persistent behaviour which undermines your professional confidence or self-esteem. Undermining injures or destroys by insidious activity or imperceptible stages or attacks by indirect, secret or underhand means, attempting to subvert by stealth.

Undermining is often not overt and its persistence can be extremely damaging.

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Bullying, harassment and undermining behaviour is never warranted or acceptable and the consequences may be far reaching for both individuals and organisations.

The annual cost to organisations of bullying in the UK because of absenteeism, turnover and productivity is £13.75 billion according to the Illing Report (2013).

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In itself this should motivate us all to address this but of particular resonance for the NHS is the association with poor patient care demonstrated by the work of Michael West, and others who has demonstrated a clear association between increased mortality and lower patient satisfaction where teams are dysfunctional and behaviour is poor.

Poor behaviour has a direct impact on the quality of patient care.

For the individual there can be high levels of both psychological and physical distress with implications both at home and at work.

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So what is to be done? Can we make a difference?

What follows in the case studies will broaden your understanding of the issues and help you to consider ways in which you can change and act to make a difference.

Click on the link to the case studies on your screen to be taken to this section of the resource.

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