(*In bellow, numbers in parentheses indicate the numbers of the slides that Dr. Cowie was referring to in her talk. The actual images of these slides are collected at the end of the lecture.)
Very nice to meet you today. Thank you very much for inviting me to talk to you. I’m very happy to be here at Ritsumeiken University. My talk is on bullying in the workplace. In school settings, it is known as ijime, and I’m not sure if it is also known as that in the workplace, is it? Yes. And my talk is on the impact of bullying, which causes negative emotions on the workplace, and particularly on the workplace of caring for patients.
Until recently, the subject of bullying was actually not talked about. It was taboo. Many, if not most, organizations said “we don’t have a problem of ijime in our organizations.” However, recent attention, a lot of it from the mass media, from radio and television, has led to a more detailed analysis of the phenomenon. It’s become clear that very many people in the workforce have a very negative experience of going to work. In fact, it was people from Scandinavia, the Scandinavian countries, Norway, Sweden, and Denmark, who pioneered much of the research into ijime that we know about today (#1).
There is quite a lot of literature on workplace bullying now. We should really begin by defining it. There are quite a number of definitions, and some refer to negative acts directed to a person, as an individual, but negative acts can also relate to more general constructs such as gender or ethnic group. And then we have other terms such as sexual harassment or racial harassment, which are used.
But a very all-encompassing definition would be that “workplace bullying is a perceived or actual verbal, emotional threat or physical attack on an individual’s person or property by another individual, group or organization.” You can see it operates at the level of the individual, the group, and the whole organization.
Now Professor Pam Smith spoke about the National Health Service as an organization devoted to care. But as she mentioned, every year the Healthcare Commission does a survey, and we have got the most up-to-date statistics for the rather negative experiences that staff experienced in the National Health Service. We had hoped comparing one year to the other, that they would have got better, but they actually have stayed more or less the same for four years.
And as you can see form the slide (#2), the biggest threat to the staff actually comes from those people they’re caring for, the patients and from their relatives. You can see that 23% of NHS staff reported being bullied by patients in some way. 18% reported they’d been bullied by patients’ relatives. 8% reported they’d been bullied by their managers, and 13% by colleagues: these are lower percentages, but still serious. So in fact the Healthcare Commission every year recommends stronger policies and the need for a cultural change.
One of the Scandinavian researchers, Stale Einarsen, describes it as an evolving process: it doesn’t happen all at once, somebody is bullied. It happens gradually, so that it gradually becomes the accepted thing to do. It’s often triggered by some kind of conflict in the workplace. An example of that might be an argument over the time of leave, of annual leave, or who works overtime and when, with people wanting to have, in our country, Christmas Day to be with their families, or New Year’s Day, or in the case of overseas nurses, they would like an extra day so that they can get a cheaper airfare home to their own country. So there may be a conflict like this, which could be relatively small and could be relatively easily resolved. But if is handled badly,―― and Pam Smith spoke of the leadership, the necessity of good leadership, ―― if it’s handled badly, one person can be disadvantaged. They have to work on Christmas Day, they do not get to take advantage of the cheaper airfare, and they feel disadvantaged and people then see them as more vulnerable, and therefore someone that can always be put upon, always have to work the shifts that nobody wants to work. And over time, these people become gradually humiliated, intimidated, frightened or even punished, or apparently punished by their colleagues (#3).
And just to describe this in a little more detail, Einarsen says, and I think very accurately, in its early stages it can be quite difficult to identify as bullying. It can be something so small you’d think “am I imagining this, is it in my mind, something that’s not really happening?” But as time goes on, the behavior becomes more direct, and if it gets very bad, the target person, the victim, may well be avoided by colleagues, isolated, and humiliated in public. And as conflict continues, the attacks become more frequent, because people can do them with impunity; they get away with it. The targeted person gets demoralized, even develops mental health problems, less able to cope, and becomes more inefficient, so everyone says they’re hopeless as a colleague, and you can see how it becomes a downward spiral (#4).
I want to give you one example. This is from research that Pam Smith-sensei and I and another colleague Helen Allen did, where nurses from overseas ―― they came from Africa, the Philippines and other countries, ―― often experienced this kind of treatment. At first they couldn’t quite identify what was the matter, and one of them gave a really moving account. She said, “I come in in the mornings, and no one says good morning to me.” Konnichi-wa. It’s easy to say good morning. “Nobody says good morning to me, so I don’t say good morning to them, and it’s as if I was invisible.”
Here (#5) we have a categorization of the different types of bullying behavior that people report experiencing in the workplace, and as you can see, it is far from the kind of physical bullying that is the most common idea of what bullying is, very loud, aggressive, threatening behavior. But as you can see, some of it is quite subtle, quite indirect, quite insidious, so you could almost imagine that it’s in your mind and it’s not really happening, yet a bit of you feels hurt, you’re emotionally hurt, and you don’t really know why.
I think the categorization is quite useful, so for example your professional status could be threatened, you’re humiliated in public, and you’re told you’re not working hard enough, and you’re belittled, you’re made to feel small. One of the ways they did this to the overseas nurses is that they often said you can’t work as a nurse, but you can work as a carer, which is a lower grade of salary and lower status in the hierarchy; you’re not, for example, allowed to do medicines, allowed to do drugs, if you’re a carer. And so they felt very humiliated. That’s one example.
The next category is the threat to personal status. These workers, care workers and nurses, are given threatening comments, called names or given insults. And an example of this actually would be from a patient, where a patient says I don’t want to be treated by that black nurse.
Isolation: I already gave you the example of no one saying good morning to a person, and that is a very cruel thing. Social exclusion: where you just don’t speak to the person, so they feel like a non-person, and that can actually extend to withholding information from them, so when they go to meetings, they don’t have the information and the knowledge that they need. So again, it’s as if their invisible, as their contribution isn’t as good as it would be if they had the information.
And then, sometimes they are given unrealistic workloads. There’s another type of bullying behavior, where the deadlines are so impossible, so they don’t meet them and they fail. So they’re then defined as being inefficient. And a related one is destabilized, being destabilized, set up to fail. Given meaningless things to do, or their work is devalued in some way, for example, around their language, perhaps people say, you know, the language, one can’t understand what they’re saying, that kind of thing. And once again that undermines the person. They lose confidence in their ability to deliver care.
The final one is unwanted physical contact. Sometimes, of course, the obvious one is sexual harassment. But it is not confined to sexual harassment. It can also be unwanted physical contact. And an example of that is when a manager puts a heavy hand on your shoulder, which of course you’re not allowed to do that. So it’s unwanted, because it is saying “I am superior to you and you will work according to my rules.”
Now the outcomes, or consequences for people experiencing this in the workplace, can potentially be very, very severe (#6). When this bullying happens regularly, people can start to get ill. Of course, that makes it worse. They’re always off, being sick. That means that they’re not good colleagues, they’re inefficient, unreliable. Again you can see the downward spiral. But even if they’re not off sick, they can have severe emotional reactions of fear, or anxiety, helplessness, or shock. These are not emotions that are conducive to the emotional labor that Professor Smith was talking about in her lecture. Perceptions of people in these circumstances can be very negative. They get to fear their workplace and feel undermined in their workplace. Workplace is not a pleasant place to be for these people. In extreme cases, people have noted, the symptoms can be similar to Post-Traumatic Stress Disorder, which, as you know, people usually get when they have a shock or a trauma, but the emotional reactions can be very similar. Of course if you are experiencing this over a long period of time, you’re affected.
But paradoxically, many colleagues are affected as well, even though they’re not direct targets of bullying. The outcomes for patients are not any better, if the staff, or some of the staff, are experiencing this―─that’s the targets, the direct targets. And some of those who observe that happening would have similar fear. For the patients the staff’s negative emotions can impact on the quality of care. The staff, if they’re preoccupied with themselves, becomes less attentive to their patients, just less able to give themselves emotionally to their patients, so the outcome is that the patients may feel neglected or that they are treated as objects rather than persons. So this then affects the motivations of the patients (#7).
If it’s just left without any intervention, this is what usually happens. Some colleagues will support a bullied person, but many don’t, for a number of reasons. They might be afraid that they might be the next victim, or they may simply go along with the majority who are neglecting or being aggressive toward this person. It takes quite a lot of courage to stand up and defend a person who is being so treated by the colleagues. People who are in unions get some support, but many are reluctant to go to their union because sometimes the behavior is so subtle and indirect it is hard to pinpoint what’s actually going on. And then you see, as I said before, the bullied person may gradually have become inefficient, and they are categorized as people who have a personality problem. So they’re blamed, and they may come to blame themselves; “I’m just not good at this job.” And third parties in the organization are seldom interested in acknowledging the emotional damage done to such people. So in point of fact, the reality is that many leave the workplace.
Charlotte Rainer, on the basis of interviewing people as they leave through human resources, estimates a quarter, 25%, are leaving the workplace due to being bullied, which is a great waste of human resource and money (#8).
So is there anything that we can do? Fortunately, yes there is. An important thing, that is actually what unions often recommend to individuals, is to gather descriptive information on what is happening, and keep a diary, keep a log of the event as they happen. They may seem small in isolation, but over time they can amount to a form of bullying. Get information on the causes, why this is happening, and what are the consequences in this particular workplace, and gather information on interventions or actions that can be taken to resolve the problem. There is quite a lot available that you can do (#9).
I’m going to start where people put in a formal complaint, which is one line of action, and then it will go to what we call arbitration where the person meets with the managers, and they’re represented by their union representative (#10). And a very formal process takes place. The bad thing about this is that the arbitrator, which is normally employed by the organization, retains power over the process, and usually has obligations to the organization, and can punish and blame. And usually the outcome is win-lose. And that’s not a good outcome. One wins, maybe the employee wins, and stays on. But then everyone sees them as a troublemaker. Maybe they lose, and then the organization gets rid of them, maybe gives them some money to go away. Either way, it’s very unpleasant. And normally the outcome is not very good this way.
You can imagine that if you win, and you are allowed to go back to the workplace, your manager still hates you because you got out a complaint against them. So technically you won, but actually, probably, you’ll stay there for a little bit and leave anyway because you’re so unsatisfied.
I’m going to suggest some alternatives, which are effective (#11). Conciliation is an intervention that happens much earlier. You don’t wait for arbitration, where everyone really is as in a court of law. You actually intervene at an earlier stage with a trained mediator or a conciliator, who brings the two parties together in a neutral way. And these people are not of a very high status in the organization, but respected colleagues. And they remain very non-judgmental, non-punitive of either side. Instead of focusing on what happened in the past, they’re working toward how effectively we can work together in the future. Their aim is win-win, that nobody goes away feeling I lost, neither the bullied person nor the person accused of being bullying.
I’m going to give you an example. One of the examples I told you before was an overseas nurse from the Philippines who wants to go home to see her family. But if she’s only allowed so much leave, and if she comes back to do her shift as usual on the Monday, her airfare is going to be _200 more. So she says “please may I catch a plane a day later, and come back on Tuesday instead of Monday?” The manager initially might think, “no we can’t have that, these people are always trying to get extra time off.” If the conciliator came in, they could reach a compromise. One possibility would be a day of unpaid leave. But there might be other ways. And also what happens is the conciliator helps the manager to understand the huge emotional labor given by this nurse in leaving her family behind, sometimes her children, in order to earn money to help people who are quite poor in her family. So there’s a greater compassion elicited, and a greater understanding. The nurse feels “they understand my situation; they understand the hardships I go through without complaint.” And everyone feels better. The emotional climate is better.
Second to last slide is some examples of good practice that has been developed in the UK National Health Service (#12). One is to introduce policies to do with dignity at work, where everyone can expect to be treated with dignity and respect in their workplace. Hopefully over time, that will begin to reduce the percentages of people saying that they’re being bullied. Another idea has been to have direct hot line to the chief executive. It would take some courage to pick up that phone and ring the chief executive. But it’s there, and if the chief executive is a truly open and listening person, he or she would be ready to respond to that call. And then designated persons deal with organizational culture and attitudes towards race. That is a bug issue in the UK, which is a very multi-ethnic society, with the difficulties and conflicts that can arise when people from different cultures are trying to work together.
Now in one trust, ten support workers were trained to provide empathic assistance and guidance about the complaints procedures. And that’s a form of conciliation. They are there to kind of defuse complaints before the person internalizes them and gets very angry about them; and to try and change behavior before it gets very, very bad, basically to foster a climate of emotional literacy in the workplace, and to provide support to everyone; that is, people who think they are being bullied, people who observe people being bullied, and also for the perpetrators, because sometimes the bullies are very hard-pressed themselves. That’s why they’ve become bullies, because they’re very, very stressed. Because they in turn may feel that they’re being bullied by the organization, to meet impossible deadlines, so there’s a greater compassion and understanding of why people are behaving in the way they do, because there’s always a reason for this kind of behavior.
And I should add, with regard to patients, many NHS trusts have a no zero-tolerance policy, which says “we will not tolerate aggressive or violent behavior towards any of our staff.” My feeling is, and research in the school bullying domain shows, that this is not a very effective way. But it is an attempt, and most hospitals and clinics will have a poster up with a zero-tolerance policy on it. I think it doesn’t really work with the very aggressive patients and their relatives, but that is one step that NHS is taking.
And final slide, last slide (#13), really summarizes what I’ve been saying. It is very important to understand the origins of ijime in the workplace; to try and to understand why it’s happening, what are its outcomes, what is the impact on the workforce, not only the direct targets, but those who see it, the whole emotional climate of the workplace; and how important it is to work with relationships, to foster what we might call emotional literacy, so that emotional labor is able to come into its own right in the workplace, since people are not so preoccupied with their own unhappiness. Of course, this doesn’t come without training. It is very important to train the managers in leadership skills so they are modeling this behavior and so that they have this attitude towards their staff, and that they also understand that emotions are there in the workplace. We need to regulate them in our workplace. We can’t be allowing our own emotions to spill out all over the workplace, because we’re there to be caring and supportive of our patients, and that is the point of us being there. So there needs to be a climate that takes care of us, the workforce as well, and that will help, in turn, the patients and their families.
Well, thank you very much for listening to me, and I look forward to the discussion and the questions and answers that will happen in response to the two sessions that we have offered you. Thank you very much.
□Cowie, Helen 20090319 “Bullying in the Workplace” 安部 彰・有馬 斉 『ケアと感情労働――異なる学知の交流から考える』，立命館大学生存学研究センター，生存学研究センター報告8，pp.34-45.