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&
Royal Australasian College of Surgeons
The College of Surgeons of Australia and New Zealand
Recognition, avoidance & management
BullyingHarassment
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Bullying and harassment isendemic in the health sector,between all types of staff at all
levels of seniority.
Australian and New Zealandsurveys have found over 50 per cent of
Australian junior doctors have been bulliedin their clinical attachments 1,2
Unfortunately this is worldwide3,4 andincludes undergraduate experiences5,6,7
Bullying costs businesses in Australia andNew Zealand over $21 billion per year 8and the average cost of lost productivityin each case of bullying is about $20,000
The health care environment is oftenhostile with members of the health careteam under increasing stress9
Despite education and awareness there persists a culture of bullying in somemembers of the health care team and this decreases the quality of patient care,creates a poor learning environment and increases psychological stress10,11
Harassment and bullying by surgeons can turn away many of our best and mostgifted from wanting a career in surgery12,13
1 Rutherford, A & Rissel, C. (2004) A survey of workplace bullying
in a health sector organisation, Australian Health Review, vol. 28,no. 1, pp. 65-72.
2 Scott, J., Blanshard, C. & Child, S. (2008) Workplace bullying
of junior doctors: a cross-sectional questionnaire survey, NZMJ
Digest, Vol. 121, No. 1282, pp. 13-5.
3 Finucane, P. & ODowd, T. (2005) Working and training as an
intern: a national sur vey of Irish Interns, Medical Teacher, vol. 27,
no. 2, pp. 107-113.
4Quine, L. (1999) Workplace Bullying in NHS community trust:staff questionnaire survey, BMJ, vol. 318, pp. 228-32.
5 Recupero, P.R., Heru, A.M., Price, M. & Alves, J. (2004) Sexual
Harassment in Medical Education: Liability and Protection,
Academic Medicine, Vol. 79, No. 9.
6 Cook; D.J., Liutkus, J.F., Risdon, C.L., Griffith, L.E., Guyatt,
G.H. & Walter, S.D. (1996) Residents experiences of abuse,
discrimintation and sexual harassment during residency training,
Canadian Medical Association Journal, vol. 154, no. 11, pp.1657-65.
7 Heru, A.M. (2001) Hospitals and the Changing Work
Environment: Promoting Gender Equity and Fair Treatment for
Medical Students, Medicine and Health/Rhode Island, vol. 84,
no. 3, pp. 76-8.
8 McCarthy, P. & Mayhew, C. (2004) Safeguarding the
Presidents View
Itistimetostanduptoworkplacebullyingandharassment
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Ian Gough
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Teaching Supervision & Assessment
Supporting Others
Scholarship & Teaching
Good Behaviours Poor Behaviours
Provides continuous constructive
feedback without personalising the issues
Demonstrates arrogance, rudeness or
disinterest in the training of junior staff
Provides adequate supervision to junior
staff
Fails to delegate appropriately to junior staff
Uses clinical encounters as an opportunity
for teaching of staff
Regularly fails to attend scheduled tutorials
and other teaching sessions Makes themselves available for planned
lectures and tutorials
Is critical of a junior staff member even when
staff could not reasonably be expected to
know
Facilitating education of their students, patients, trainees, colleagues, other healthprofessionals and the community. 14
Management and Leadership
Providing cognitive and emotional help to team members. Judging different team members
abilities and tailoring ones style of leadership accordingly.14
Good Behaviours Poor Behaviours
Provides constructive criticism to team
members
Does not provide recognition for tasks
performed well
Ensures delegation of tasks is appropriate Fails to recognise needs of others Establishes rapport with team members Shows hostility to other team members e.g.
makes sarcastic comments to nurses or junior
medical staff
Gives credit for tasks performed well Puts down junior staff or other hospital
workers
Organisation against Violence and Bullying, Palgrave
Macmillan.
9 Garling, P. (2008) Final Report of the Special Commission
of Inquiry into Acute Care Services in NSW Public Hospitals,Special Commission of Inquiry into Acute Care Services in
NSW Public Hospitals.
10Williams, S., Dale, J., Glucksman, E. & Wellesley, A. (1997)
Senior house officers work related stressors, psychological
distress, and confidence in performing clinical tasks in
accident and emergency: a questionnaire study, BMJ, vol.
314, pp. 713-8.
11 Di Martino, V. (2003) Workplace violence in the healthsector: relationship between work stress and workplace
violence in the health sector, Geneva.
12 Stratton, T.D., McLaughlin, M.A., Witte, F.M., Fosson, S.E.
& Nora, L.M. (2005) Does Students Exposure to Gender
Discrimination and Sexual Harassment in Medical School
Affect Specialty Choice and Residency Program Selection?,
Academic Medicine, vol. 80, no. 4, pp. 400-8.
13Woodrow, S.I., Gilmer-Hill, H. & Rutka, J.T. (2006) TheNeurosurgical Workforce in North America: A Critical Review of
Gender Issues, Neurosurgery, vol. 59, no. 4, pp. 749-58.
14 RACS (2008) Royal Australasian College of Surgeons
Surgical Competence and Performance. www.surgeons.org
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Extracts from RACS Surgical Competence & Performance
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Workplace bullying and harassment can occur at multiple levels between colleagues,
students and employees and also with contractors, patients and family members.
Censor-in-Chief
If a good doctor-patient relationship isfundamental to healing, then a good trainee
trainer/supervisor relationship isfundamental to learning how to heal
Bullying
To bully is to threaten, oppress or tease, either physically or morally, and can include: public
humiliation, perisistent criticism, personal insult, professionally undermining a persons
professional ability, consistently undervaluing effort and abuse of power. Bullying is not
necessarily face to face. It may be by written communication, e-mail or telephone.
Harassment
Unwanted conduct affecting the dignity of men and women in the workplace. It may be related
to age, sex, race, disability, sexual orientation, religion, nationality or any personal characteristic
of the individual and may be persistent or an isolated incident.
The intention or motive of an alleged sexualharasser is not relevant when determining if the
behaviour is unwelcome. The focus is the
perception and experience of the recipient.
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Ian Civil
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Skills for working in a team context is particularly important to ensure that the surgical team hasan acceptable shared picture of the clinical situation and can complete tasks effectively.
Documenting and exchanging information
Collaboration & Teamwork
Giving and receiving knowledge and information in a timely manner to aid establishment of a
shared understanding among team members. 14
Good Behaviours Poor Behaviours
Is collegiate and professional in dealings
with members of department and practice
Does not listen to team members or practice
staff
Listens to, discusses and appropriately
acts upon concerns of team and staff
members
Needs help from assistant/staff member
but does not make it clear what assistant is
expected to do
Considers others points of view in diffi cult
situations
Refuses to accept clinical opinions of others
05
TheCollege is
committedto
fairness&
equality
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Bullying, discrimination and harrassment will breach legal obligations. Bullies
can face legal action. It is necessary to distinguish between the legitimate
interaction of a manager or supervisor and the employee or Trainee. Good
management will not constitute bullying.
It is reasonable to have discussions and work requirements about:
Turning up to work on time
Being prompt for ward rounds and operating sessions
Completing administrative issues
Ensuring patients are properly reviewed
Achieving successful patient handover
Employers have a duty to identify bullying and harassment and take steps to eliminate and prevent
it. The College as an educational body has a duty to eliminate and prevent it (www.surgeons.org).
Employees/Trainees also have legislated responsibility for others who may be affected by bullying actsin the workplace.
College Solicitor
Good Behaviour Poor Behaviour
Decisive Inconsistent, random, impulsive
Accepts responsibility Abdicates responsibility
Shares credit Plagiarises, takes all the credit
Acknowledges failings Denies failings, always blames others
Consistent Poor interpersonal skills
Confi dent Exclusive self-interest
Fair, treats all equally Is contemptuous of patients or staff
Seeks and retains people more
knowledgeable and experiences than self
Singles people out, shows favouritism
Values others Withholds information, releases selectively,uses information as a weapon
Includes everyone Unable to value, constantly devalues others
Leads by example Includes and excludes people selectively
Truthful Dominates, sets a poor example
Insecure and arrogant
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Michael Gorton
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Bullyingisbehaviourthatis
perceivedasunreasonab
le
&inappropriate,thatis
intimidating,threatening
and/orhumiliating
Communicating Effectively
Communication
07
Good Behaviours Poor Behaviours
Encourages the surgical team to ask
questions
Is discourteous to staff or patients
Demonstrates empathy and compassion
when breaking bad news
Routinely interrupts or dismisses the
comments of patients, families, colleagues
or staff
Shows awareness and sensitivity
to patients from different cultural
backgrounds
Shows insensitivity to the impact of language,
culture or disability on communication
Extracts from RACS Surgical Competence & Performance
Communication occurs between Fellows, Trainees, other health professionals as well as patients
and their families
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So what can you do about it?
Say, STOP! This is often the most effective and powerful measure.
Say that you fi nd this behaviour unacceptable
Document threats or actions taken by the bully
Discuss concerns with your supervisor or someone equivalent like your
mentor if the supervisor is the problem
Consider making a complaint under the Employers harassment and
bullying policy
Consider making a complaint under the Colleges harassment and
bullying policy
Seek support from the Royal Australasian College of Surgeons Trainees
Association (RACSTA), your peer network, colleagues or Human RightsCommission. Email [email protected] about the issue or give the Support
& Advocacy Portfolio Chair of RACSTA a call
Seek support from the Dean of Education or Executive Director of Surgical
Affairs (Australia & New Zealand) at the College
Trainees Association Chair
Anyone who has suffered from the bullying
behaviour of others should be offered directsupport and if needed mediation or counselling.
The fact that the harassment and bullyingwas not intentional is no defence!
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Responding to cultural & community needs
Professionalism
Demonstrating commitment to patients, the community and the profession through the
ethical practice of surgery.
Having awareness and insight
Health Advocacy
Demonstrating understanding of the impact of culture, ethnicity and spirituality on surgical care
and considering the broader health, social and economic needs of the community.14
Good Behaviours Poor Behaviours
Adopts a courteous approach to other
staff and patients
Stubborn, refuses help when it is clearly
required
Responds positively to questioning,
suggestions and objective criticism
Blames junior or medical staff or others for
poor outcomes
Admits to errors Books inappropriately long lists
Recognises poor outcomes and the need
to refl ect and improve
Berates or humiliates subordinates
Reflecting on individuals surgical practice and having insight into its implications for
patients, colleagues, trainees and the community.14
09
Good Behaviours Poor Behaviours
Contributes to community education and
development
Insensitive to different patients backgrounds
cultural beliefs or attitudes
Communicates effectively with people
from culturally and linguistically diverse
backgrounds and uses interpreters
Discriminates on the basis of culture,
ethnicity or religion
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Methods of Complaints Resolution
Informal Internal Process(there are no formal findings of misconduct with this process)
Emphasises the future
How will we work together in the future?What practices will we put into place in the future to avoid this problem?
Processes include:
A manager (or someone else with appropriate skills and authority) mediates
a discussion,
Outcome is in hands of parties but mediator controls process,
May involve increased education and expectation
Ongoing observations to ensure better behaviour
Remember, education is the first key step to insight
For formal internal/external resolutions see appropriate human resources policies
Complaints Resolution
1.Self management2. Informal internal process
summary below but see Discrimination & Harassment
policy, Fellows, Trainees & International Medical
Graduates at www.surgeons.org
}
3.Formal internal process4. External resolution option
see College policies or your Employers human resources
department or Human Rights Commission.
Enquiries to the Dean of Education and the Executive
Director of Surgical Affairs (Australia and New Zealand).
}
Self Management
Principle Examples
1. Stay calm and polite 1. Please
2. Focus on the behaviour, not the person 2. Stop touching me
3. Indicate the effect of the behaviour on your
feelings
3. When you touch me, I feel uncomfortable
4. Include a clear request that the behaviournot happen again 4. Im asking you to please not touch meagain
5. Ask for agreement or at least
acknowledgement that you have been heard
5. Is that ok?
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Bullying
is BannedNo more
Intimidation
Vexatious Reports
Malicious Rumours
Threats, yelling, screaming, offensive
or inappropriate language
Undermining work performance
Refer to College policies on Discrimination/
Harassment at www.surgeons.org
Key Points
Workplace bullying takes many different forms, but results in
intimidation of and distress in the victim
Bullying may reflect prejudice, personality problems, poor
systems, or a serious failure in communication or relationship
skills Bullying is common in the health service, as in other workplaces,
occurring within and between all levels of staff
Bullying damages doctors, especially those in training, often
seriously
Clinical environments in which bullying occurs may be less
safe for patients
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