Sunday, 21 September 2014

Bullying - a personal story and some strategies

This is my personal story, only a small story.   

In the early 1990s, in Ancoats Hospital, Manchester I was a Senior House Officer in Orthopaedics. I was warned when I joined about one of the consultants, Mr X, who had a habit of hitting junior doctors assisting him at surgery with instruments when the going got a little difficult. That was the most useful informal induction that I could have ever had. It was bound to happen. I could attempt to prepare for it. 

My options, when it happened, were a) to lodge a formal complaint with the hospital - as though that often did any good to anyone b) to lodge an assault complaint with the police - which may or may not have got any result but the career would have ground to a halt. So possibly option 'a' was better. Hmm.... Time to think, time to plan... I had a plan. 

Then one day, it happened, it was bound to. I was assisting Mr X and his forceps rapped my knuckles. Use some imagination to visualise the scene that I describe next. The instrument I was holding flies off in one direction, I leap sideways and backwards and slump down the theatre wall, wailing and shaking my hand. The theatre nurses go red, Mr X goes pale. I immediately start apologising 'sorry Mr X that must have caught a sensitive nerve or something'. I proceed to take off my gloves and gown; I say 'I will be back soon' and walk off to the coffee room. It was an intermediate type of operation, no harm to patient occurred. 

Very soon Mr X finishes the operation, walks camly across to the coffee room has an arm around my shoulder and says 'Are you okay son?'. I simply mumbled some meaningless neutral words. A few days later, same theatre coffee room, I had a request for Mr X. It was not a busy job, my colleagues were excellent and willing. My main interest was surgery (not orthopaedics) Hence, I wanted to attend Sir Miles Irving's unit at Salford Hospital for half of the week. As a young surgeon in training, preparing for examinations and the unknown future, hungry for every morsel of surgical knowledge and exposure - that was exactly what I wanted then. Mr X's answer, immediately and as expected was 'of course you can'. Apparently Mr X was never so easily convinced to agree to a request. 

It was a trade off. I knew that it would happen. I worried about conventional approaches not benefiting anyone. I was young and proud, I could not simply let it go. So I planned the scenario to get the best benefit for me under the circumstances. What was done to me was illegal, it was assault. Acting as per law would have put my career at risk. We can choose not to press on according to law. That is what I did. I also used intelligence, planning and emotion to use the situation and get what I wanted, my own compensation method. What I asked for was not illegal, it was discretionary and the discretion was used for my benefit. Since then........ I have got older and wiser. Was it ethical? Was it moral? I do not know, the reader can make up his/her own mind about it.

What is bullying?

Bullying carries on. Sometimes bullying these days takes the form of using 'clinical governance', 'patient safety', 'mandatory' issues, 'job planning', 'appraisal', 'pay progression', 'revalidation', in fact the most noble and most benign of tools can become a weapon in the hands of the unworthy.  At the extreme there can be threats of 'disciplinaries', 'NCAS referrals', 'GMC referrals', etc.

Bullying exists when there is a threat present in an atmosphere when it should not be present. 

The difficulty in dealing with bullying is about feeling, perceptions of various parties in the mix such as the victim, perpetrator or investigator. In my view it is not about feelings. There should be a threat, tangible, palpable, hopefully something can be proven, something that has a previous record. For any given person, when observed, measured data shows performance/behaviour within an acceptable band and yet others around this person use their power based on opinions to set or impose conditions when none should be set or imposed then bullying exists. 

TYPES of Bullying and Dealing with it

Bullying due to Pressure: Normal persons can show expressed behaviours of a bully when there are excessive pressures e.g. shortage of resources such as staff, equipment, money or an excess of work such as too many patients or too much regulation. These can be resolved without reference to the bully; simply by providing the right resources and systems. Here, the management becomes responsible for bullying and even more responsible for solving the problem. My personal opinion as an observer of work environment is that expressed bullying behaviour due to work pressures is responsible for about 40% to 50% of all cases of bullying.

Bullying due to personal deficiency of knowledge: People express bullying behaviour expressed initially as aggressiveness and eventually abusive behaviour to camouflage their personal deficiencies of knowledge and the consequent lack of confidence. This sometimes happens consciously but often without people even realising it. Operational data will often identify proof of deficiencies in these individuals; this evidence may not be in the outcomes but in process data. It will be ideal if the individuals are able to recognise this by themselves often they need a little pointer from friendly colleagues. In this case, resolution takes the form of additional development of the individual concerned. Technical development or non-technical development, often both will be needed. Team training could be a route to accomplish this. Again, my personal opinion as an observer of these issues is that this kind of bullying accounts for 40% to 50% of bulliers.

Bullying due to inherent pathological behaviour: A small number of individuals have bullying as a psychological personality trait. These individuals will not recognise themselves or accept the view of others that they have personality issues. These individuals may even often have excellent medical/clinical outcomes. These people often are mis-recognised as excellent performers with an assertive personality and are actually promoted up the hierarchy – they will shine till the day they burn the whole edifice down. We need a mature special method of dealing with these people. These people need to be put in a space with a small group of mature trusted people (staff who are trusted by the individual and by the organisation) so that they can carry on their clinical work without affecting wider morale of the organisation. That would be possible; but it will require immense managerial effort to do so. These individuals should never be given positions of power. A smaller number will play up at the end of all this, they will need to be taken up through formal systems.

Instead of dealing with bullying as above, we currently either ignore it or when we are not able to ignore we deal with it through rules and law. Both are inappropriate.

Individuals coping with bullying

Those of us who are not in a position to implement the above methods will need personal mechanisms to cope. Since the dated example described above, I have been of course bullied. Sometimes I have ignored, sometimes I have suffered it (on one occasion nearly 2 years) for obtaining long term gains, sometimes I have confronted the bully. I have never had to write in an official bullying and harassment complaint; will not hesitate to do that if the circumstances were right. Also never hesitated to wage personal campaigns to make everyone aware of the bully, bullying and mechanisms to cope – never hesitated to retaliate by damaging the image or reputations of bullies; I never do it lightly, only after significant evidence and deep thought. 

In the personal mechanism to cope with bulliers it is important to think, plan and practice extensively on how and when to confront the bully, when done right bullies stop bothering you. I have in my personal capacity helped one or two persons do so. It is sad that we may have to do this to protect ourselves when the systems let us down. Sadly this method only protects us and the bully moves on to someone else.

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I have already blogged about some of the organisational principles to resolve bullying titled 'Fearless Healthcare is what we want'