Workplace bullying
BMJ 2003; 326 doi: https://doi.org/10.1136/bmj.326.7393.776 (Published 12 April 2003) Cite this as: BMJ 2003;326:776All rapid responses
Rapid responses are electronic comments to the editor. They enable our users to debate issues raised in articles published on bmj.com. A rapid response is first posted online. If you need the URL (web address) of an individual response, simply click on the response headline and copy the URL from the browser window. A proportion of responses will, after editing, be published online and in the print journal as letters, which are indexed in PubMed. Rapid responses are not indexed in PubMed and they are not journal articles. The BMJ reserves the right to remove responses which are being wilfully misrepresented as published articles or when it is brought to our attention that a response spreads misinformation.
From March 2022, the word limit for rapid responses will be 600 words not including references and author details. We will no longer post responses that exceed this limit.
The word limit for letters selected from posted responses remains 300 words.
I found your article on the silent epidemics of workplace bullying
(1) very interesting. It struck me though that it treats bullying as a
sort of one-to-one encounter between a perpetrator and a victim. As a
result, it also places the onus of fighting bullying on the solitary
victim, even if supported by well-wishing advocates. I believe that
viewing bullying as a result of deviant group behaviour, rather than a
conflict between individuals provides useful insight and may offer a
conceptual framework for effective prevention.
Bullying is not a freestanding phenomenon. It is known, for instance,
that in schools increased supervision of playgrounds decreases its
incidence (2) and that systemic rather than individualistic approach is
necessary (3). Bullying in a workplace is influenced by power
relationships within the group (hierarchical vs. egalitarian), by the
degree of permissiveness in the existing power networks in an
organization, and by accountability of those who are in power, or its
lack.
There are in fact two terms which are currently used in the context
of aggression, harassment and exclusion at workplace: these are bullying,
and less known mobbing (4). Bullying is a concept derived from social
exclusion among schoolchildren (5). Mobbing, on the other hand describes
a phenomenon in biology which involves ‘collective attacks on an
individual animal, typically directed against the predator, but sometimes
occurring within the same species’ (6). In psychology, it is a term
applied to adult environment, and it was first used in description of
outsiders in schools and in the military.
Bullying, or mobbing, are abuse of social power. Therefore, it is
useful to consider them in a perspective of power relationships within
groups (7). Social power is defined as ‘individual’s relative capacity to
modify others’ status by providing or withholding resources or
administering punishments’. In the recent discussion (7) it was proposed
that those who are in powerful position (the bosses) tend to act in a more
disinhibited way (this applies to both positive and negative actions)
than those with less power within a group (the subordinates). I believe
that such disinhibited behavior may in certain circumstances manifest
itself as bullying or mobbing.
Disinhibition may be tempered by ‘the subordinates’, who afford respect
and status to ‘the bosses’ on the basis of their behaviour. However, and
this is bad news, a threat to the legitimacy of these in power (such as
a formal complaint), tends to destabilize hierarchies. Therefore, it may
elicit a self-protective response of an organization. This might be at
least part of the reason why formal complaints from the less powerful
(bullied or mobbed) individuals are not easy to succeed. There is
abundant evidence that to win a case of bullying is an arduous task
which in fact puts a lot of additional pressure on a victim. Such victim
may in fact have to confront the whole power structure of an organization.
This sometimes evokes the Erin Brockovich scenario, which is spectacular
when successful, but such instances are rare.
In any case, complaints and formal proceedings are attempts at late
cure. The fundamental question is what are the best ways of prevention. I
believe that the best prevention is to influence the organizational
culture so that bullying or mobbing becomes unacceptable at its early
stage. Nobody in his right mind would today turn the blind eye on sexual
harassment or substance abuse. Bullying needs to move away from a grey
zone, where it still resides and where too often it can be conveniently
ignored.
Both the bosses and the subordinates need to participate in
preventive actions. The relative effectiveness of each of these groups
would depend on the power structure of a particular organization, i.e.
whether a group is hierarchical or egalitarian.
In highly hierarchical groups the dominant role must be played by
peers of the bullying individuals, loosely called the bosses. This is
because in such structures the subordinate group may hesitate to act due
to self-interest or an instinct for self-preservation. It is
fundamentally important that members of networks to which bullies
themselves belong are prepared to act at the first signs one of their
members showing tendencies to bullying or mobbing. This could stop such
behavior before official complaints threaten the image of the whole
establishment and make fair assessment of the problem difficult.
In more egalitarian groups with the so called smaller distance of
power, the less powerful can exert effective restraining influence on the
behavior of an emerging bully by withdrawing respect or status.
However, changes in organizational culture are unlikely to happen by
goodwill alone. There needs to be an educational effort and open
discussion to enable recognition of unacceptable behaviour patterns. The
author’s Medline search showed that, in relation to the health service,
currently the nursing literature provides more information on bullying
than the medical one.
Finally, an important question is to what extent bullying or mobbing
result from stress at work and defects in organizational structure (4).
Bullying itself may be an instrument of personal dislike, but might also
be related to organizational politics, particularly at times of tension.
There are suggestions that mobbing may be more frequent in organizations
with deficient structure or inappropriate assignment of tasks to
individuals. All this means that identification of bullying behaviour
should prompt an organization to examine its structure in this context,
and to identify and change potential precipitating factors (4).
Thus, to use medical analogy, current therapies for bullying are
palliative. Of course, there need to be tough penalties in proven
cases to act as a deterrent, and the individual victims need to be
encouraged to act. However, uncompromising attitude by peer groups could
be a very effective means of prevention.
References
1. McAvoy BR, Murtagh J. Workplace bullying. The silent epidemics.
Brit Med J 2003; 326: 776-7.
2. Siann, G, Callaghan M, Lockhart R, Rawson L. (1993). Bullying:
teachers' views and school effects. Educational Studies, 19, 307-321.
3. Green S. Systemic vs.individualistic approaches to bullying. JAMA
2001;286:787-88.
4. Schuster, B. Rejection, exclusion, and harassment at work and in
schools: an integration of results from research on mobbing, bullying, and
peer rejection. European Psychologist 1996;1:293-317.
5. Olweus D. Aggression in the schools: Bullies and whipping boys.
Washington, DC: Hemisphere Publishing 1978.
6. Atkinson S, Becker BL, Johanos TC, Pietraszek JR, Kuhn, BC.
Reproductive morphology and status of female Hawaiian monk seals (Monachus
schauinslandi) fatally injured by adult male seals. Journal of
Reproduction and Fertility1994:100, 225-230.
7. Keltner D, Gruenfeld DH, Anderson C. Power, approach, and inhibition.
Psychological Review 2003:110:265-284.
Competing interests:
None declared
Competing interests: No competing interests
Worms Can is a small but evolving support group,
originally set up to help colleagues in a local authority,
and we were very interested to read the article which
was passed to one member by her GP. We have been
closely involved in supporting people who have been
bullied in a variety of ways, some by individuals, others
by the highest levels of management using the
procedures of the organisation to bully and intimidate
employees. Examples of the five categories described
by Raynor and Hoelt can all be identified in the
methods the organisation uses against people.
We would like to endorse the point made in the article,
that communication between general practitioners and
occupational health doctors could do a lot to change
attitudes. In the case of this organisation, the external
occupational health team are well aware of the
enormity of the problem and seem to despair of ever
being able to do anything about it. All the GPs in the
area are also aware of the number of patients they have
whose health problems can be attributed to this one
employer. We feel very strongly that the way to resolve
these problems is to create a forum where they can be
dicussed openly. It is only in this way that people can
learn to recognise the effects that their behaviour can
have on others, and so modify the way they treat other
people.
It must be remembered that it is as difficult for people to
admit they are being bullied as it is to admit they are
bullies themselves, and very often, they are both. We
are particularly interested in helping people who are
resorting to bullying behaviour to understand what they
are doing, and how and why they are doing it. We try to
give sympathy, support and practical advice to anyone
who is bullied or bullying.
Our leaflet can be obtained by visiting our website
www.geocities.com/wormscan or requesting it by email
to wormscan@yahoo.co.uk, or writing to Worms Can
c/o Salisbury & District Council for Voluntary Services,
42 - 46 Salt Lane, Salisbury Wiltshire SP1 1EG
Competing interests:
None declared
Competing interests: No competing interests
I was bullied last year and at this point it still feels like a
horrible, life-changing event. The interesting thing here is that I was
bullied not by other doctors but by other members of a child psychiatry
team, primarily social workers. This team had never previously worked with a
full time doctor. Every move was scrutinised, every action reviewed. This was
a team so dysfunctional that in the 6 months I was there, 5 of the 8
people I worked with resigned or transferred, claiming stress. When I
approached doctors who were in a position to help, their response was for
me to do a daily activity report with entries of what time I came and
left, what I did, what time I took a lunch break, etc, etc. This only stopped
when a representative of doctors in training approached the director and
pointed out that this was illegal and inappropriate. I am an ethnic
minority and female, and I still wonder if the same would have been done to
a white male.
The point of my letter is that bullying happens, and it doesn't
have to be doctors responsible. The structure of modern mental health teams
makes it possible for senior social workers and psychologist to bully a
registrar, and the clinical director of the service chose to side with
people he would have to work with for years, rather than a registrar who
would move on in 6 months.
Competing interests:
None declared
Competing interests: No competing interests
Life can be viewed as an ethological competition in which everyone is
competing for retention of their niche in the social hierarchy and for
advancement. Those who slip a place or two are inevitably going to feel
discomforted in some balancing proportion to the satisfaction of those who
advance in consequence.
The perception of bullying is an interaction between the actual
events and the mental state of the recipient. As well as experiencing
unhappiness and frustration, people can become clinically anxious and/or
depressed. This can be because of bullying or for other reasons, which
can make it difficult to disentangle cause and effect. If a person's
perfomance is impaired because of pathological anxiety or depression they
may well perceive the displeasure of others as an unreasonable response to
their (temporary) impairment of effectiveness.
Competing interests:
Opinions written for both claimants and defendants in litigation. Cases pending
Competing interests: No competing interests
Even when bullies are identified by complaint from a victim, it is
difficult, if not impossible to address the behaviour through disciplinary
means.
For the bullied junior, one powerful force to ensure compliance is
the power of the bully as an inevitable referee in assessment or
appointment processes. Since references are treated confidentially all
parties (including the bully) are aware that the referee acts with
unaccountable power during this process. To “escape” from the bully
requires his or her assistance in the giving of an acceptable reference.
Thus the confidentiality of the refereeing process that rests on the
integrity of the referee may make a significant contribution to bullying
behaviour. An oral reference that is inconsistent with a written reference
might say more about the referee than the job applicant.
In the NHS it would be relatively straightforward for all references
received, including those given orally, to be recorded and forwarded via
the recruiting HR department to the applicant’s HR department so that they
might be reconciled with appraisal documentation. Honest referees would
suffer no detriment, while those giving inaccurate references could be
identified and coached (in the knowledge that they might be caught,
bullies might even be deterred!).While it may be difficult to stop
bullying, its extent could be reduced by increasing accountability over
its levers of power.
Competing interests:
None declared
Competing interests: No competing interests
A Lingering Shadow: Addressing the Enduring Crisis of Workplace Bullying
Dear Editor
In a revealing and disconcerting report issued by the Care Quality Commission (CQC) on 24 January 2024, the alarming persistence of workplace bullying at Newcastle Hospitals NHS Foundation Trust—which runs two of north-east England's biggest hospitals—was brought into sharp focus. This comes despite the passage of over two decades since the BMJ's 2003 editorial "Workplace bullying" poignantly characterised such behaviour as a pervasive yet often overlooked issue. The recent findings from the CQC serve as a stark testament to the enduring nature of workplace bullying, signalling that, regrettably, this critical issue continues to be deeply rooted in professional settings, defying the passage of time and previous efforts to address it.
The persistence of workplace bullying, as illustrated by the CQC's insights within trust—comprising the Royal Victoria Infirmary, Freeman Hospital and Great North Children's Hospital—calls for an immediate, concerted effort to confront and dismantle the systemic and cultural underpinnings that allow such toxic behaviours to thrive, underscoring the imperative for organisations to foster a culture of respect, integrity, and psychological safety.
The report's revelations about the trust are particularly disheartening given the trust's previous 'outstanding' rating. The drastic downgrade to 'requires improvement' is not merely a reflection of compromised standards in safety, responsiveness, and leadership but a manifestation of a deeper, more systemic problem. The normalisation of bullying, as noted by staff members who felt compelled to overlook such behaviour, signals a profound failure in cultivating a workplace environment grounded in respect, professionalism, and ethical conduct.
The significant deterioration in leadership observed by the CQC is especially concerning, as effective leadership is pivotal in setting the tone for an organisation's culture. The fact that staff members reported bullying as a 'normal occurrence' and felt encouraged to 'turn a blind eye' to it indicates a leadership crisis. It reflects a leadership style that, wittingly or unwittingly, enables a culture where bullying is tolerated and embedded in daily practices. This is in direct contrast to the principles outlined in the BMJ editorial previously published, which emphasised the detrimental impact of bullying on individuals' mental health and the overall health of an organisation.
Introducing new leadership at the trust, with a commitment to address these deep-seated issues, offers a glimmer of hope. However, the journey towards real change is arduous and requires a fundamental shift in mindset and organisational culture. The focus should not only be on rectifying the specific instances of bullying but also on understanding and dismantling the structural and cultural elements that allow such behaviour to flourish. This includes revisiting and reinforcing policies, ensuring accountability at all levels, and fostering an environment where transparency, respect, and empathy are the norm, not the exception.
The case of Newcastle Hospitals NHS Foundation Trust is a microcosm of a larger, more pervasive issue in workplaces worldwide. The re-emergence of bullying in the spotlight, after two decades since the original editorial, is a call to action. It serves as a reminder that the journey towards a bully-free workplace is continuous and requires constant vigilance, introspection, and a collective commitment to nurturing healthy, supportive, and respectful work environments.
It is imperative that the revelations of the CQC report catalyse a decisive turning point, prompting not just Newcastle Hospitals NHS Foundation Trust but all institutions to re-evaluate and fortify their strategies against workplace bullying. The time is now for a unified, relentless pursuit of a work culture where dignity and respect are not mere aspirations but unwavering standards, ensuring that the shadows of the past give way to a brighter, more compassionate future for every member of the workforce.
Competing interests: No competing interests