Tackling bullying and undermining in the NHSBMJ 2019; 365 doi: https://doi.org/10.1136/bmj.l1667 (Published 09 April 2019) Cite this as: BMJ 2019;365:l1667
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I read Abi Rimmer’s article titled “Tackling bullying in the NHS” with interest. The article reports the GMC initiative to help doctors call out colleagues’ unprofessional behaviour. It quotes the GMC Chair Clare Marx who highlighted the importance of good clinical leadership in tackling unprofessional behaviour. I could not agree more with Clare Marx who said “ A big part of that is the development of leadership skills and crucially tackling unprofessional behaviour towards colleagues: anything from basic rudeness to outright bullying and undermining.”
I am slightly concerned about the debate about bullying and undermining which tends to ignore the hard facts evidenced repeatedly by the NHS national staff survey. The recently published results of the 2018 NHS staff survey show that the bullying from immediate line managers as a serious cause of concern in the NHS1.
According to the survey,13.2 per cent of the staff reported at least one incident of bullying or harassment by a manager. It would be difficult to root out this evil if the line managers themselves exhibit such behaviour and they could be seen as role models and it would be difficult to hold others to account. The fact that this trend is increasing in the NHS is an extreme cause for concern. One way to tackle this problem would be in ensuring that prospective line managers carry the confidence and support of the maximum number of colleagues whom they manage. This factor is often overlooked in organisations during interviews for such posts which may be the reason for this increasing trend in many acute NHS providers. This can result in staff disengagement which would be detrimental to patient care and organisational reputation. West and Dawson2compared engagement scores in the NHS staff survey with a wide range of outcome data. They showed that patient experience improves, inspection scores are higher and infection and mortality rates are lower where there is strong staff engagement. Some authors are of the opinion that “Senior leaders and line managers need to role model and champion these behaviours and set the tone so that the workforce feels secure and can get on with their work without worry or fear of recrimination should they raise any concerns.”3 The NHS constitution pledges ‘to engage staff in decisions that affect them and the services they provide… “All staff will be empowered to put forward ways to deliver better and safer services for patients and their families.”4 Although NHS organisations would be keen to follow the constitution, unless this principle is also applied in the teams which deliver the care on the floor, staff disengagement and the resultant poor care may be a great threat to patients and the concerned organisations.
Unless we address this issue, bullying and undermining will continue to increase in the NHS and the impact on acute specialities will be much more with a direct effect on patient safety.
2. West M, Dawson J (2012). Employee Engagement and NHS Performance http://www.kingsfund.org.uk/leadershipreview
Competing interests: No competing interests