The Scalpel's Blog

Are you changing a bullying culture or contributing to it?

Karen Lynas, interim managing director at the NHS Leadership Academy, discusses how leaders can tackle the bullying culture in their organisations. 

I suspect many of us in the NHS, far too many of us, know someone who has experienced bullying, or worse, experienced it ourselves. I have watched a close friend of mine suffer. Over a period of a year, her confidence was sapped, her joy was drained and then her hope of any change was stripped away. It was brutal to watch and I can't imagine how debilitating it was for her to experience. 

We know it’s a chronic problem in the NHS. Nearly a quarter (24%) of NHS workers said they had been bullied or harassed in the workplace, according to the 2014 staff survey. This will no doubt create a toxic environment for patients and staff. This culture is not what any of us joined the NHS to experience. And beyond the human impact, what’s the immeasurable impact on patient care, engagement, efficiency and productivity? We absolutely must break that awful cycle. The only way we can improve patient care is to ensure our staff are cared for. The 2015 staff survey highlighted some worrying figures: 

• 37% of all staff reported feeling unwell due to work related stress and pressure
• From this, 63% of staff reported coming to work in the last three months (prior to the survey), despite feeling unable to perform their duties or the requirements of their role 

This means that many of those who care for others didn’t feel as though they were up to the job but still came into work. Clearly we need to look at how to care for our 1.4 million strong workforce, who work to help people during what’s often the most vulnerable time of their life. 

So what is bullying, and how do you know if you are part of the problem? Needless to say it isn’t easy to get a single definition. Different writers use different frames of reference and as the research into bullying in the workplace has increased over recent years, so have the views around what the components are. There’s some high-level consensus though about what is meant by bullying. Most people talk about bullying being behaviour which: 

• Includes harassment, social exclusion, offensive or dominating behaviour
• Is regularly experienced and over a period of time (there isn’t agreement about how often or for how long that behaviour continues for it to be referred to as bullying, but it’s not an individual incident)
• Occurs when one person has power over another - it’s in the abuse and misuse of that power that bullying arises 

Over my 25-year career in the NHS, although I can’t say I have ever been bullied, I can say I have experienced brutal, confidence sapping disregard and disrespect. But my treatment, while feeling personal, didn’t feel like it came with any intent to bully. There was no maliciousness in it. It was just clumsy, unskilled, unfair and born of the unspoken frustrations of someone not getting what they wanted from me, or trying to undermine me. It was about power, but it wasn’t about abusing theirs with deliberate attempt to harass me, it was about trying to assert power over me. 

My abiding shame though is that I have been accused, more than once, of being a bully. My accusers have always been women. 

For context I think of myself as a huge supporter of women in the NHS. It’s something I speak about and write about often. In 2016 it still irritates me that I need to talk about the need to have greater diversity in NHS leadership and suggest that it might not be ok that our Arm’s Length Bodies – all of our significant NHS national bodies – are led by chairs and chief executives that are white men. I mean really? I know many women, who I applaud, promote and celebrate often, who I would dearly love to see recognised for their contribution. If I’m such a champion of women then why is it that my impact on some women around me has led them to feel bullied by me? What is it I am doing, what is my behaviour, what’s my responsibility for becoming that which I most loathe? 

I could of course cite every little detail of what I have been accused of and I could rationalise it away for you, to explain my behaviour and how it was interpreted. That's not the point though is it? Experiencing bullying isn't about the intent of the perpetrator, it’s about the experience of the person who is feeling bullied. It doesn't matter what my intent was, it matters how it felt for the person experiencing my behaviour. 

In the incidents reported about me the consistent theme has been my challenging of performance and outcomes and the way I’ve done it, which has felt personal not professional. I’ve spent a long time reflecting on the incidents, my behaviours, what was really going on for me at the time and what I might do differently next time to manage this better. From that, from the research and from wise advice from informed colleagues, I’ve come up with a few suggestions you might think about in your own behaviour, to make sure the impact you have on people is what you want it to be. These tips are for those of you that might have been accused of bullying or are nervous about the culture you are creating, and of course assumes that you want to positively address those concerns. 

1. Managing emotions: A key skill for a good leader is to be able to manage their emotions positively. We all get angry, upset, irritated and frustrated. There are certainly plenty of things sent to try us at the moment. Good leaders create a climate for their staff that is conducive to positive, efficient and effective work, providing context and cover when needed, and being honest and open about the realities we all operate within. But an emotional outburst has no place at work. I’ve said before that leaders, particularly senior ones, create ripples they are not always aware of. Behaviour is visible and every action interpreted and re-interpreted, whether you like it or not. You can be honest and authentic in how you behave but the impact of an emotional outburst from you is unhelpful and can have a far reaching impact.
2. Consistency and equity: The most devastating impact of bullying is when treatment of one person seems so out of step with the treatment of everyone else. You may have a set of standards that you want to work by. You certainly have a very clear responsibility to communicate well about what you want and why you want it. You need to have a consistent approach with your employees and make sure they understand what you need from them. It’s important that consistency is both over time and across people, there’s nothing more frustrating as not knowing from one day to the next what ‘good’ looks like because it changes with your mood.
3. Challenging behaviour: I have written before about this in the NHS; we don’t always do it well. Feedback about lack of performance, under performance or inappropriate behaviour needs to be timely, specific and professional. Leaving it to fester or springing it on people as part of an annual review is hopeless. People need feedback as soon as possible to the incident in question. Be specific and positive -name exactly what is wrong or absent and talk specifically about what good looks like. General, non-specific, personal commentary has no place in feedback. And manage the emotions, this is not personal it’s a professional conversation. Also make sure you treat everyone equally – that there’s no “special” treatment for one person over another. It needs to be an equal footing for everyone. If this is an area you struggle with get some support and development – it’s never too late.
4. Reflection and review: Always look back and see what you could do better. A good leader will strive to improve themselves and in turn will have an impact on their team and ultimately patient care. Assess yourself. Understand what your strengths are and which areas you might need some support on. And remember, we’re all human – we’re not perfect. But evaluating yourself will help you become the best you can be. My most important learning has come from developing the habit of being reflective about my behaviour – particularly the difference between intent and impact and how I can get better at that. Coaching and mentoring can be invaluable here and again it’s never too late to start.
5. Open conversations: Build an environment where your team can have open conversations with you. There’s nothing worse than a collusive, hidden culture where people don’t have the confidence to give their honest views. A good test for this is in reviewing staff surveys. Ideally your staff survey, pulse surveys or 360s should reflect more or less what you understand to be true. If there’s a huge discrepancy between what you thought was happening and what people are reporting then your big problem is that you don’t have an open culture; there isn’t a place for people to go to voice their views, and the open conversations that are happening everyday are not honest and authentic. Or that is happening and you’re just not listening!
6. Arbitration and support: You can do everything in your power to create the kind of culture and climate that’s fit for people to thrive in, and you won’t always get it right. And if it’s right for most people it’s unlikely to feel right for everyone. This is where external support for you and those concerned comes in. For many there’s a fine line between performance management and bullying. Intent and impact are different. What you’re trying to say and what somebody may interpret is something to be wary of - particularly in email communication where knowing the difference can be difficult and could be misconstrued. An external, neutral perspective can help both parties adopt a new understanding of what’s happening and options for resolution. Don’t be afraid to ask for help, early, if you want to do all you can to create the environment you are striving for. 

We need to open ourselves up to really understand our impact on others. Recognising our behaviours, what we do, and how this affects people around us is vital.  Do you know how it feels to experience your leadership? Are you a good leader? Or do you simply think you are, but really you don’t know? That’s where our leadership development programmes come into play: 

• Our Edward Jenner and Mary Seacole programmes are aimed at people who are starting their journey in healthcare leadership
• Our Elizabeth Garrett Anderson and Nye Bevan programmes are for people at more senior levels
• Our Intersect programme aims to help leaders work effectively across systems 

Being a leader who really cares about your staff and understanding yourself and the impact you make will really help you develop your team. Only then will we begin the process to eradicate bullying from a health system which is meant to be there to care for people. 

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