The subject of bullying within medical leadership has come to the fore once more. Sir Leonard Fenwick, the highly experienced Chief Executive of Newcastle-upon-Tyne Hospitals NHS Foundation Trust was recently sacked for gross misconduct. His dismissal followed accusations of bullying and abusive behaviour.
Unsurprisingly, Sir Leonard denied the accusations. He acknowledged that he was well known for “being a little strident“. Other comments he made in response to the allegations included: “I’m not a bully but can show some measure of intolerance on occasions“; “There are those who may feel a little timid or a little anxious bit I do look at outcomes and quality“; “I may have strong words – but that’s management”
This is not an isolated issue. Numerous incidents, studies and reports have thrown the spotlight into this dark area over the years. Take, for example, the output of the 2016 NHS Staff Survey. With over 400,000 responding, 13% said they had experienced harassment or bullying from their manager on more than one occasion. That’s one in eight. And the problem is not restricted to formal line-management interactions. The figure increases to 18 % when bullying and harassment from other colleagues is included. That’s almost one in five.
Part of the difficulty arises from a lack of understanding about what bullying actually is. This is a common point of discussion during our regular Advanced Team Communication Skills Course for Doctors.
So what is bullying?
The obvious example is the school bully stealing your lunch money. In the adult world, it is a label which can be applied to a range of behaviours. Many of these, unfortunately, are presented to us on television as entertainment. Think of Gordon Ramsey cursing, insulting and humiliating the people he claims to be helping. Yet bullying can be far more complex and subtle than this in the adult world.
Sir Leonard used the phrase “that’s just management”. We often identify the impacts of unwelcome behaviours in others but not in ourselves. Many people can’t see themselves as a bully with all of the school-ground connotations that the word can have.
It helps to be clear what bullying is not. It is not being told that your performance is below what is required or that you have done something wrong. Some people do erroneously cry “bully” when they hear a message that they don’t like. We need to hear these things in order for standards to be maintained and improved.
The difference between bullying and leadership or management lies within the way that the message is delivered. Bullying is the use of force, threat, or coercion to abuse, intimidate, or aggressively dominate others.
What’s the solution?
Like many other issues which you face as a doctor, the solution often begins with getting to the root of the problem. The aspect of leadership and management where bullying accusations usually arise is in the effort to get things done through the actions of other people. There are always things which need done, sometimes urgently. The difference between positive action and bullying is in your behaviour when trying to achieve this.
People often think in terms of a dichotomy of being passive or aggressive and aim to strike a balance. This can prove to be a little simplistic however as our behaviour and the way that it is interpreted by others is multi-dimensional. For example, ‘passive-aggressiveness’, in its many forms, can also constitute bullying. Yet many people are unaware that they are guilty of adopting such attitudes. There are also cultural variations. Behaviour, language and humour which is welcome within some social groups can abhorrent to others. Then there is context. Your communication during a life and death emergency should rightfully differ from your approach to a teaching session, team review or negotiating situation.
We are human and sometimes we get it wrong. Self-awareness and being attentive to the impact we are having on others through good follow up communication and feedback is always helpful. If you realise you may have had a negative effect on someone when trying to get things done then a genuine apology can go a long way to building good working relationships.
The key route to effectively getting things done is through developing an understanding of the differences between passive, aggressive, and passive-aggressive behaviours in comparison to assertiveness. Developing tactics for assertiveness is also the key to dealing with any bully.
Update June 2018: We explore these matters further in our new book Team Communication for Healthcare Professionals.
