Estrategia Competitiva de Michael Porter

• Offensive, intimidating, malicious or insulting behaviour, an abuse or misuse of power through means that undermine, humiliate, denigrate or injure the recipient.

• Bullying or harassment may be by an individual against an individual (perhaps by someone in a position of authority such as a manager or supervisor) 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.

5.5.4 Examples offered by ACAS of bullying or harassment include:

• spreading malicious rumours

• insulting someone by word or behaviour

• exclusion or victimisation

• unfair treatment

• overbearing supervision or other misuse of power or position

• making threats or comments about job security without foundation

• deliberately undermining a competent worker by overloading and constant criticism

• preventing individuals progressing by intentionally blocking promotion or training opportunities.

5.5.5 Whilst there was agreement from all contributors we spoke to that staff should be protected from bullying, including as a result of raising concerns, it was noted by some that bullying is often ‘in the eye of the beholder’ and that the term could, on occasion, be misapplied.

5.5.6 Some employers and managers in particular registered concerns that firm management could be seen as bullying. It is clearly necessary for managers and colleagues to give staff instruction and set requirements and targets, and to disagree with them without that amounting to bullying. It is generally how these actions are carried out where problems can arise.

5.5.7 Many of those regarded as bullies by colleagues probably do not perceive themselves as such. They may consider their actions to be ‘firm leadership’, ‘being decisive’ or ‘having a sense of humour’. Sometimes this may be a valid view but sometimes it may not. We all need to be mindful of how the way we speak and act is perceived by others. To an extent, whether people’s experiences meet an objective standard definition of bullying or not is beside the point. If someone believes they have been bullied or harassed and the perception of others around them is that they have suffered or will also suffer in a similar way as a result of speaking up, then they will be less likely to raise a concern in future.

5.5.8 The perception of bullying can have the same detrimental effect as deliberate bullying conduct. The perception of a bullying culture has been a common feature of the system for too long. In the Mid Staffordshire Public Inquiry report70 _it was concluded about the Department of Health that: ‘While there is not a culture of bullying within the DH, an unintended consequence of its directives and policy implementation has been that on occasions they have been perceived as bullying or have been applied oppressively. Reflection is required on how to avoid such a consequence’. It is time that such reflection occurred, not just in the Department of Health but throughout the NHS. Why bullying is bad

5.5.9 The impact of bullying on individuals, on teams and on organisations as a whole are well known. Examples include:

• avoidable stress and resulting illness

• increase in sickness absence leading to stretched teams and/or increased spend on temporary staff

• poor morale and difficult staff relations

• loss of respect for managers and leaders

• difficulties in staff retention

• reputational damage

• patients suffering harm or receiving less than optimal care.

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5.5.10 In the context of this Review the most important consequence is the fact that workers who are bullied, or who see others bullied, are much less likely to raise the safety concerns which any well-led organisation needs to know about and act on. Thus a junior member of staff who notices a potential error being made by a surgeon is far less likely to raise the issue in time to protect the patient if the surgeon is perceived to be a bully. Evidence that bullying is a problem in the health service

“ There exists a culture of bullying within the organisation that was largely covered up. For every case that comes to light, there is an iceberg of events that are simply not reported.”

Figure 5a – Staff experiencing bullying

Source: NHS Staff Surveys 2010, 2011, 2012 and 2013

25 20 15 10 5 0 2010 2011 2012 2013 Note: The wording of the question was not identical in each survey.

(% of

respondents)

5.5.11 There is a range of evidence in addition to that received by the Review that indicates that bullying remains a problem within the health service. For example:

• the 2013 NHS Staff survey71 _{revealed that} just under a quarter of trust staff (22%) had experienced harassment, bullying or abuse from either their line manager or other colleagues. This proportion was, broadly, unchanged from 2012 (23%). Although the question was not identical, it appears to be an increase from 2011 and 2010 where 14% of trust staff reported experiencing harassment, bullying or abuse from staff in the last 12 months.

• the 2013 RCN employee survey72 _{in which} 30.5% of nurses said that they had personally experienced bullying or harassment from a team member or manager in the previous 12 months. There were 9,754 respondents to the survey.

• the 2014 GMC National Training Survey73 _in which 8% of 49,994 respondents reported experiencing bullying and 13.5% of 49,883 reported witnessing bullying.

• a survey of almost 8,000 doctors in the UK74 about the impact of complaints procedures on their welfare, health and clinical practice showed that 20% felt victimised because they had been a whistleblower for clinical or managerial dysfunction.

5.5.12 The type of behaviour that those

responding to the GMC National Training Survey had been exposed to included belittling or humiliation, threatening or insulting behaviour, deliberately preventing access to training and bullying related to a protected characteristic. The vast majority of staff identified by the GMC trainees as responsible for bullying behaviour towards them were registered healthcare professionals mainly consultants or general practitioners within the training post. Relatively few of these trainees reported bullying from management.

71 NHS Staff Survey, Picker Institute Europe, 2013

72 RCN Employment Survey 2013, Royal College of Nursing, September 2013

73 National Training Survey 2014: bullying and undermining, General Medical Council, November 2014

74 The impact of complaints procedures on the welfare, health and clinical practise of 7926 doctors in the UK: a cross-sectional survey, Bourne T. et al., BMJ

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“ It is clear that where a doctor in training is bullied or fears reprisals, they are much less likely to report any patient safety concerns that they have.” 75

5.5.13 In addition, Patients First noted in their contribution that, from the case review they carried out, bullying was reported to have occurred in 79% of the 70 cases they considered.

5.5.14 One view expressed to our researchers suggested a correlation between trusts with a bullying culture and those where people get ‘harmed’ when they raise a concern.

“ This isn’t just about whistleblowing, this is about if you disagree with me and I’m in a position of power, I’m going to treat you so badly that you leave, because it’s going to take me so long to use any HR process to get rid of you and prove you to be incompetent.”

5.5.15 We saw evidence from one contributor of an attempt by a senior member of an NHS organisation to cover up information about bullying. This is totally unacceptable and everyone should be clear that such action will not be tolerated and will have consequences (see 7.5 on accountability).

5.5.16 We also heard about cases where

management failed to take action despite repeated reports of bullying.

Case study: Impact of bullying