Management Adviser, Trainer and Facilitator
Patricia is an HR specialist in general practice. She was the managing partner of a large practice for more than 10 years, and now provides HR and management advice and training. She is also a trained facilitator and a coach
The new Equality Act defines harassment as:
"Unwanted conduct related to a relevant protected characteristic, which has the purpose or effect of violating an individual's dignity or creating an intimidating, hostile, degrading, humiliating or offensive environment for that individual".(1)
ACAS (Advisory, Conciliation and Arbitration Service) provides a similar definition to bullying.
Sadly, workplace harassment and bullying are not rare occurrences. Many people at some time in their careers experience inappropriate and intimidating behaviour from a superior or colleague, and general practice is no exception. In my work as an HR specialist, I have advised a number of practices about how to deal with this difficult issue, including bullying behaviour by a superviser to subordinates, bullying behaviour by one member of staff to another, and even bullying behaviour by a GP partner to the manager, staff or other partners!
Bulling often, but not always, occurs in private without witnesses, so it may be difficult for the victim to substantiate what has happened. It can include making belittling remarks, constant blaming, using offensive language, gossiping behind someone's back, shouting and deriding them in front of others, setting impossible deadlines or persistent criticism.
Bullies often pick their subjects carefully, choosing those they perceive as being weaker than they are and less likely to stand up for themselves. Bullies even target those who are more capable at doing the job than they are, for fear that their own inadequacies are exposed. Bullying can become a subtle control mechanism. Many people are uncomfortable with confrontation and many avoid it if possible, even when they know that this behaviour should be challenged.
To make matters worse for the victim, the bully does not treat everyone the same. Often the bully has "favourites" or those who are never subjected to unpleasant behaviour and escape for some reason, perhaps because they are perceived by the bully to be less of a threat. Bullies can also be unpredictable, befriending the victim at times while treating them badly at others. This leaves the victim feeling confused and distrustful of everyone.
The effects of bullying can be devastating for the victim and are often underestimated. The victim may be in a position where they feel unable to defend themselves, either because they have a more junior role or because the bully has a forceful personality, sometimes surrounded by perceived allies.
The constant criticism and blaming undermines the victim's confidence. They become fearful, introverted and hyper-vigilant (sometimes mistaken as paranoid). They may doubt their own perception of what is happening and start believing the negative feedback. Although they are desperate to share their feelings with others, they fear taking action because of possible repercussions or they may just be too embarrassed to admit they cannot cope.
The victim may perceive that the practice tacitly approves of the bullying, as no one seems prepared to do anything about it. Victims often fall into a downward spiral that affects their performance and relationships with others: they withdraw, keep their head down and appear subdued.
However, underneath a passive appearance they can suffer from stress, including symptoms ranging from anxiety, depression and insomnia, to physical conditions such as high blood pressure, palpitations and digestive disorders.
Shockingly, some desperate victims of workplace bullying have taken their lives to escape from their misery.
Apart from the unpleasant personal effects, bullying has serious repercussions within the practice. It often leads to poor performance, high absenteeism and low morale. A hostile environment may develop, dogged by resistance to change and a blame culture. Ultimately staff members may leave their jobs to escape.
If no action is taken, management is seen as ineffective because they fail to deal with the bullying, or are viewed with suspicion because they are seen as condoning the behaviour. In this climate, is it any wonder that victims do not come forward to express their difficulties? It is clearly the role of a good manager to be on the lookout for inappropriate behaviours that might constitute bullying or harassment, and deal with them promptly and effectively.
Law and order
Apart from anything else, practices have a legal obligation to ensure that bullying and harassment are not tolerated. The partners cannot hide behind the excuse that they "did not know it was going on", as they are vicariously liable for any inappropriate behaviour of their employees.
An aggrieved employee could make a claim for discrimination or breach of contract, as well as a claim under health and safety legislation or the Protection from Harassment Act. In addition, if the employee resigned then a strong case for constructive unfair dismissal could be made and the employer might be faced with bad publicity and substantial costs.
The legal obligation of employers does not stop there. Staff who are not subject to the bullying but are upset by it are also protected by legislation. The law also covers harassment from a third party (such as a patient or a contract worker – eg, a locum or cleaner) if this has happened on two or more occasions and the employer is aware it has happened but has done nothing about it.
Stamping it out
So what should you do to make sure that bullying never occurs in the first place? Start with very clear policies about bullying and provide examples of what constitutes unacceptable behaviour. State that employees have an obligation to the practice and to colleagues to behave in an appropriate manner at all times. Encourage anyone with any concerns about unpleasant behaviour to talk to someone as soon as possible, ideally a nominated person such as the practice manager.
However, be clear that if concerns are raised about that person, employees must be able to take the matter to someone else, such as one of the partners. Promise to deal with allegations speedily and confidentially, and give reassurances about protecting any employees from victimisation. Make it clear that proven incidents of serious bullying constitute gross misconduct, which might lead to an employee's dismissal from the practice.
Policies should never just sit in a drawer or in a filing system on the computer. Make sure that the policy is communicated to employees through induction, training and staff meetings. Ensure that your supervisors and team leaders are fully aware of the practice's policy and how to implement it. Why not get them to read this article?
Then, as any good manager should do, make sure that you are aware of what is going on in the practice by "walking the floor" regularly and having your ear to the ground. Don't wait to be told at the staff appraisals that an employee is experiencing difficulty with another. Don't turn a blind eye to a member of staff who has a sharp tongue with colleagues or who constantly picks on junior staff.
If you do have suspicions, but no real evidence, sound out the possible victim in a confidential and supportive manner. Encourage them to be honest about what is happening and how they feel. Reassure them that it is your job to deal with problems and that they will be protected from any possible reprisals. Of course, you are not looking for vexatious or malicious allegations between two employees who do not get on! You will have to make a judgement about whether behaviour constitutes bullying or not.
Even if it is not serious bullying, it should still be dealt with. The main indicator you should rely on is what the employee is experiencing and how it makes them feel. Just be aware that different people have different tolerance levels to behaviour from others. For some, unpleasant remarks will be like water off a duck's back; for others they will be hurtful and upsetting.
Depending on the nature of what you find, you may feel it sufficient to have a quiet word with the perpetrator, providing clear examples of what has been happening and how it has made the other person feel. Tell them that if the behaviour continues, you will take more formal action, which may lead to that person losing their job. Make it clear that you will be monitoring the situation and do not expect any reprisals or churlish behaviour.
After a few weeks, follow up with one-to-one meetings with both parties to ensure that your measures are working. Try to assess the atmosphere in general to see if things have improved. Usually, the team spirit picks up at this stage as other people will probably have been aware of the issue and are pleased that it is being dealt with.
Formal actions and disciplinary hearings
Should you become aware of a more serious complaint, a formal investigation should be carried out either by someone in the practice or a person experienced in dealing with these matters from outside the practice. Your primary care trust or local medical committee may be able to recommend a suitable person.
The investigation should include interviewing those involved and others who have witnessed situations of inappropriate behaviour. Careful notes should be kept. The investigator needs to remain objective and look for corroboration of the facts.
Be aware that bullies have no insight into their behaviour and think they are right. They will be all too ready to blame others for being "oversensitive". They may justify their actions furiously or trivialise issues. Bullies often have poor listening skills and, once exposed, can play the "victim" themselves.
If a case of serious bullying is substantiated, the practice must decide on the appropriate action, which is likely to be a disciplinary hearing for the person responsible. Under the statutory disciplinary procedure, the employee should be provided with a summary of the facts before the disciplinary hearing, with enough information so that they can understand the allegations being made.
The employee has the right to be accompanied at the hearing by a fellow worker or a trade union official. The practice may wish to ask witnesses to present evidence. However, if witnesses prefer to remain anonymous, this is generally acceptable as they may fear reprisals themselves. Witnesses statements, anonymised if necessary, are usually admissible as evidence. The employee may also wish to bring their own witnesses and the practice would need to decide if this is appropriate and permissible.
Someone would need to chair the hearing and take notes. Since the practice manager may be involved in providing evidence, a suitable outside person should be used. Two or three partners would normally hear the case and then decide afterwards whether to take disciplinary action, and, if so, what action is appropriate given the circumstances.
Action might consist of demotion or transfer to another area of the practice, together with a formal warning or, in a serious case, dismissal on the grounds of gross misconduct. The employee has the right of appeal. All information and notes of meetings and investigations should be treated confidentially to comply with data protection.
1. Government Equalities Office. Equality Act 2010.
Available from: http://www.equalities.gov.uk/equality_act_2010.aspx