Workplace bullying in the Australian health context: a systematic review

What is the nature, extent and impact of bullying in surgical settings? Insights of surgeons in Australia and Aotearoa New Zealand

BACKGROUND

A significant body of literature has examined the impact of verbal and non-verbal bullying in surgical settings, where a central focus has been on the experiences of trainee and junior members of the surgical team, women in surgery and other health professionals, such as nurses. Research on how surgeons' perceive or experience bullying is more limited. Therefore, this study aims to investigate the views of surgeons on negative and disrespectful verbal and non-verbal behaviour and bullying in surgical settings, including its impact on surgeons themselves and the surgical staff they oversee.

METHODS

Semi-structured interviews were undertaken with surgeons between February and November 2019. Questions explored surgeons' perceptions of interpersonal communication and behaviour in their surgical workplaces in the preceding 6-months. A narrative analysis approach was used to code, interpret, and report the interview data.

RESULTS

Thirty-one interviews were conducted with surgeons (19 male and 12 female), from Australia (26) and Aotearoa New Zealand (5) from 10 surgical specialties. Three themes were identified with associated subthemes: bullying (five subthemes), non-verbal bullying (seven subthemes), and impact and outcomes of bullying (six subthemes).

CONCLUSION

This study revealed a notable shift in the reported verbal and non-verbal bullying behaviour among surgeons, demonstrating a decrease in intensity, physicality and violence for the 6-months prior to interviews conducted in 2019, when compared with surgeons' historic experiences. Despite reported behaviour being more subtle and indirect, it nonetheless continues to have a marked impact on many surgeons as well as the staff they oversee.

Drivers of unprofessional behaviour between staff in acute care hospitals: a realist review

BACKGROUND

Unprofessional behaviours (UB) between healthcare staff are rife in global healthcare systems, negatively impacting staff wellbeing, patient safety and care quality. Drivers of UBs include organisational, situational, team, and leadership issues which interact in complex ways. An improved understanding of these factors and their interactions would enable future interventions to better target these drivers of UB.

METHODS

A realist review following RAMESES guidelines was undertaken with stakeholder input. Initial theories were formulated drawing on reports known to the study team and scoping searches. A systematic search of databases including Embase, CINAHL, MEDLINE and HMIC was performed to identify literature for theory refinement. Data were extracted from these reports, synthesised, and initial theories tested, to produce refined programme theories.

RESULTS

We included 81 reports (papers) from 2,977 deduplicated records of grey and academic reports, and 28 via Google, stakeholders, and team members, yielding a total of 109 reports. Five categories of contributor were formulated: (1) workplace disempowerment; (2) harmful workplace processes and cultures; (3) inhibited social cohesion; (4) reduced ability to speak up; and (5) lack of manager awareness and urgency. These resulted in direct increases to UB, reduced ability of staff to cope, and reduced ability to report, challenge or address UB. Twenty-three theories were developed to explain how these contributors work and interact, and how their outcomes differ across diverse staff groups. Staff most at risk of UB include women, new staff, staff with disabilities, and staff from minoritised groups. UB negatively impacted patient safety by impairing concentration, communication, ability to learn, confidence, and interpersonal trust.

CONCLUSION

Existing research has focused primarily on individual characteristics, but these are inconsistent, difficult to address, and can be used to deflect organisational responsibility. We present a comprehensive programme theory furthering understanding of contributors to UB, how they work and why, how they interact, whom they affect, and how patient safety is impacted. More research is needed to understand how and why minoritised staff are disproportionately affected by UB.

STUDY REGISTRATION

This study was registered on the international database of prospectively registered systematic reviews in health and social care (PROSPERO): https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021255490 .

Interventions to address unprofessional behaviours between staff in acute care: what works for whom and why? A realist review

BACKGROUND

Unprofessional behaviour (UB) between staff encompasses various behaviours, including incivility, microaggressions, harassment, and bullying. UB is pervasive in acute healthcare settings and disproportionately impacts minoritised staff. UB has detrimental effects on staff wellbeing, patient safety and organisational resources. While interventions have been implemented to mitigate UB, there is limited understanding of how and why they may work and for whom.

METHODS

This study utilised a realist review methodology with stakeholder input to improve understanding of these complex context-dependent interventions. Initial programme theories were formulated drawing upon scoping searches and reports known to the study team. Purposive systematic searches were conducted to gather grey and published global literature from databases. Documents were selected if relevant to UB in acute care settings while considering rigour and relevance. Data were extracted from these reports, synthesised, and initial theories tested, to produce refined programme theories.

RESULTS

Of 2977 deduplicated records, 148 full text reports were included with 42 reports describing interventions to address UB in acute healthcare settings. Interventions drew on 13 types of behaviour change strategies and were categorised into five types of intervention (1) single session (i.e. one off); (2) multiple session; (3) single or multiple sessions combined with other actions (e.g. training sessions plus a code of conduct); (4) professional accountability and reporting programmes and; (5) structured culture change interventions. We formulated 55 context-mechanism-outcome configurations to explain how, why, and when these interventions work. We identified twelve key dynamics to consider in intervention design, including importance of addressing systemic contributors, rebuilding trust in managers, and promoting a psychologically safe culture; fifteen implementation principles were identified to address these dynamics.

CONCLUSIONS

Interventions to address UB are still at an early stage of development, and their effectiveness to reduce UB and improve patient safety is unclear. Future interventions should incorporate knowledge from behavioural and implementation science to affect behaviour change; draw on multiple concurrent strategies to address systemic contributors to UB; and consider the undue burden of UB on minoritised groups.

STUDY REGISTRATION

This study was registered on the international database of prospectively registered systematic reviews in health and social care (PROSPERO): https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021255490 .

Using resilience and passion to overcome bullying and lack of meaning at work: a pathway to change-oriented citizenship

Purpose

This study adds to human resource management research by addressing relevant questions about how and when employees' suffering from workplace bullying may direct them away from voluntary efforts to improve the organizational status quo. It postulates a mediating role of beliefs about work meaningfulness deprivation, as well as beneficial, moderating roles of two personal resources (resilience and passion for work) in this link.

Design/methodology/approach

The research hypotheses were tested with survey data collected among employees who work in the construction retail sector.

Findings

A critical reason that bullying victims refuse to exhibit change-oriented voluntarism is that they develop beliefs that their organization deprives them of meaningful work, which, as the authors theorize, enables them to protect their self-esteem resources. The extent to which employees can bounce back from challenging situations or feel passionate about work subdues this detrimental effect.

Practical implications

When employees feel upset about being bullied at work, their adverse work conditions may translate into work-related indifference (tarnished change-oriented citizenship), which then compromises employees' and the organization's ability to overcome the difficult situation. Managers should recognize how employees' personal resources can serve as protective shields against this risk.

Originality/value

This study details the detrimental role of demeaning workplace treatment in relation to employees' change-oriented organizational citizenship, as explained by their convictions that their organization operates in ways that make their work unimportant. It is mitigated by energy-enhancing personal resources.

Psychometric qualities of measurement tools used to determine workplace horizontal violence: A rapid review

RATIONALE AIMS AND OBJECTIVES: Horizontal violence has been defined as aggressive or hostile behaviour directed at an individual or between colleagues from the same working group. Measuring the prevalence of horizontal violence requires valid measures. To date, there has not been a review of the psychometric properties of available measurement tools for horizontal violence.

METHOD

A rapid review of the MEDLINE and BUSINESS EBSCO databases was conducted to identify studies testing the validity of any measure of horizontal violence in any workplace setting. Title and abstract and full-text screening, data extraction and quality appraisal were completed by two researchers working independently. The COnsensus-based Standards for the selection of health Measurement Instruments (COSMIN) was used to determine the methodological quality of studies, including details of the psychometric properties of included papers.

RESULTS

Fourteen papers reporting 17 studies were included in the review. Seven measures of horizontal violence (Civility Norms Questionnaire Brief; Negative Acts Questionnaire-Revised; Inventory of Violence and Psychological Harassment; Leyman Inventory Psychological Terror Mobbing of Single Cases of Harassment in Employees Relations; Shortened Negative Acts Questionnaire-Revised; Uncivil Workplace Behaviour Questionnaire) were identified. Most included studies were methodologically robust. Six measures had strong psychometric properties except for the Mobbing of Single Cases of Harassment in Employees Relations (MSCH) where key information about psychometric properties was not reported.

CONCLUSIONS

We identified six measures of horizontal violence that had good psychometric properties. The Negative Acts Questionnaire-Revised has been most extensively tested in different settings but is not necessarily a more precise measure than others.

The effect of workplace bullying on burnout: the mediating role of affective well-being

Purpose

This study aims to examine the impact of workplace bullying on employees’ burnout by investigating the mediating effect of affective well-being (AWB).

Design/methodology/approach

Data of 532 employees from diverse organizations in Portugal were collected. These data were collected using anonymously completed structured questionnaires available online.

Findings

The results support the research hypotheses proposed, confirming that workplace bullying is related to both AWB and burnout. Moreover, affective workplace bullying partially mediates the relationship between workplace bullying and burnout, indicating that the victims have their AWB reduced, and, consequently, increase their burnout levels.

Practical implications

The findings suggest that organizations can foster employees’ AWB and reduce the level of burnout by encouraging organizations to develop preventive policies and practices to safeguard against bullying at work.

Originality/value

To this date, only a few studies have examined mediating and moderating variables (Nielsen and Einersen, 2018) and none include AWB as a mediator of the relationship between workplace bullying and burnout. This study answers the call for further empirical research from those who have argued that more information is needed to understand the workplace bullying phenomenon and contributes to the growing debate on this topic and its effects on employees.

Workplace bullying and turnover intentions of nurses: the multi-theoretic perspective of underlying mechanisms in higher-order moderated-serial-mediation model

PURPOSE

This study examines the relationship between workplace bullying (WPB) and the turnover intentions (TIs) of nurses, both directly and indirectly, i.e. through serial mediation of psychological contract violation (PCV) and poor employee wellbeing (EWB). And that with the moderating effect of servant leadership (SL) on its final path to TIs of nurses.

DESIGN/METHODOLOGY/APPROACH

A total of 285 nurses voluntarily participated in the survey through convenient sampling from 13 different district hospitals. The authors performed partial least squares structural equation modeling (PLS-SEM) to test the study's measurement and structural models.

FINDINGS

Overall, results indicated 62% prevalence rate of WPB and TIs of nurses had 67% variance explained by the exogenous factors. Workplace bullying was found to have direct as well as indirect relationship with TIs of nurses. For the latter, PCV and poor EWB were found to have partially mediated, both singly and serially. The moderating effect of SL on the serial mediation pathway was negative and significant.

ORIGINALITY/VALUE

Drawing on a tripartite theoretical perspective, this study illuminates the mechanism underlying WPB-TIs relationship with an advanced multivariate statistical technique in the nursing work setting in a developing country.

Causes of coercive management behaviour, dimensions and occupations

Purpose

The purpose of this paper is to identify the specific causes of individual dimensions of coercive management behaviour (CMB) and identify the relationship between individual causes of CMB and the deployment of individual dimension of CMB as well as propose the matching of anti-CMB solutions to occupational types.

Design/methodology/approach

This study used a sample of 371 respondents randomly selected from 10 of 100 accredited universities in Ghana. The data were gathered using an instrument that was measured on five-point Likert scale, ranging from “strongly disagree = 1” to “strongly agree = 5”. Then the least squares regression analysis was also used in testing the hypothesis.

Findings

This study identified the potent effect of causality in determining the CMB in organisations. Again, a regression of the individual causes on individual dimensions of CMB clearly shows that there is a strong relationship between specific causes and individual dimensions of CMB. The results show clearly that each CMB cause has a different effect and unequal level of significance in relation to specific dimensions.

Research limitations/implications

Though this research attempted to find the relationship between causes of CMB and the CMB dimensions deployed in universities, the identified causes are only the causes elucidated through a new scale developed Doe (2018). Other possible causes of CMB were not factored into this research’s objectives. It is possible therefore that further research can link some other causes not mentioned in this work to dimensions of CMB which are intimidation, threat to personal standing, threat to professional standing, social isolation and work-related harassment. It is therefore suggested that more research will be necessary to ascertain which dimensions produce which effects and in what proportion in victims of CMB. Second, as a result of the fact that this is a novel area, formulating a hypothesis for the mediation of occupational types in the relationship between causes and dimensions is difficult. Hence, although the findings present a theory of a moderation of occupational characteristics on the relationship between causes of CMB and specific dimensions of CMB in the university, this theory was not tested. However, in spite of this, the researchers propose this perspective as the paper’s contribution to the body of the literature as a novel research interest worth looking into. It is thus relevant and significant to ignite research interest in this direction. Finally, data used in the study was conjoint thereby leaving no room for a comparative analysis of public versus private universities. This limitation should therefore provide a base for further research.

Practical implications

The research findings have practical policy implications. This includes providing the basis for designing policies that suit the needs of employees in any organisation. This therefore prevents a one-size-fits-all approach which may not be effective in all cases. Second, corporate governance is enhanced through the identification and resolving of context-specific factors that provide the seedbed for institutionalised bullying. Theoretically, the research findings also have implications. The findings enhance the cause and effect discussion of the phenomenon in the sense that being able to identify what causes more harm to the well-being of employees in a given organisation provides the vital link to crafting the right context-specific antidote to the phenomenon. Again, the relationship between causes of CMB and dimensions of CMB has been established. Having established this relationship, it is recommended that research focus should be directed at investigating differences in organisational cultures of various occupations and how they contribute towards providing the ideal environment for the causative factors in the CMB phenomenon to thrive. The establishment of the relationship between occupation types and causes and/or dimensions of CMB will unearth the critical nexus that needs to be found between type of occupations and the reverse relationship they have with causes through the lens of the dimensions deployed in the organisation. This will further enhance the understanding of the CMB phenomenon.

Originality/value

This study contributes significantly to research by bringing to attention of researchers and practitioners the linkage between causes and dimensions of CMB and thus enables organisations to tailor solutions to this phenomenon to the most pertinent causes of the dimensions experienced by victims.

Coercive management behaviour causes scale: validation and reliability

Purpose

The purpose of this study is to provide a link that will close the gap in the field in respect of the methods used to measure the causes of coercive management behaviour (CMB) in universities and analogous institutions. Second, cultural and geographical differences and absence of studies of the phenomenon in the African university context have instigated researchers’ decision to design new scales to identify and measure the causes of CMB in the workplace.

Design/methodology/approach

A total of 371 respondents were surveyed in a cross-sectional survey using a developed scale which had 20 items. The study adopted the latent variable approach to scale development.

Findings

Following an exploratory factor analysis done, five factors were extracted for the measurement of causes of CMB. A Cronbach alpha for all five factors to measure causes of CMB revealed validity for the administrative, social, organisational, cultural and governance elements. The research therefore surmised that the instrument developed to measure causes of CMB proposed is valid.

Research limitations/implications

The study provides a vital bridge in the gap between the occurrence of CMB and the identification and measurement of its causes in universities thus contributing to knowledge.

Practical implications

As a nation that is heavily imbued with culture, there is need to push for modifications in culture at the national level and within the African setting so as to ensure curtailment or total eradication of CMB for the future.

Originality/value

The study brings to research attention hitherto unmarked causes of CMB by providing a validated instrument that can be used to measure causes of the phenomenon.