ObjectivesTo examine the prevalence and impact of bullying behaviours between staff in the National Health Service (NHS) workplace, and to explore the barriers to reporting bullying.DesignCross-sectional questionnaire and semi-structured interview.Setting7 NHS trusts in the North East of England.Participants2950 NHS staff, of whom 43 took part in a telephone interview.Main outcome measuresPrevalence of bullying was measured by the revised Negative Acts Questionnaire (NAQ-R) and the impact of bullying was measured using indicators of psychological distress (General Health Questionnaire, GHQ-12), intentions to leave work, job satisfaction and self-reported sickness absence. Barriers to reporting bullying and sources of bullying were also examined.ResultsOverall, 20% of staff reported having been bullied by other staff to some degree and 43% reported having witnessed bullying in the last 6 months. Male staff and staff with disabilities reported higher levels of bullying. There were no overall differences due to ethnicity, but some differences were detected on several negative behaviours. Bullying and witnessing bullying were associated with lower levels of psychological health and job satisfaction, and higher levels of intention to leave work. Managers were the most common source of bullying. Main barriers to reporting bullying were the perception that nothing would change, not wanting to be seen as a trouble-maker, the seniority of the bully and uncertainty over how policies would be implemented and bullying cases managed. Data from qualitative interviews supported these findings and identified workload pressures and organisational culture as factors contributing to workplace bullying.ConclusionsBullying is a persistent problem in healthcare organisations which has significant negative outcomes for individuals and organisations.

ContextMany health services and systems rely on the contribution of international medical graduates (IMGs) to the workforce. However, concern has grown around their regulation and professional practice. There is a need, in the absence of strong evidence and a robust theoretical base, for a deeper understanding of the efficacy of interventions used to support IMGs’ transition to their host countries. This study seeks to explore and synthesise evidence relating to interventions developed for IMGs. It aims to provide educators and policy makers with an understanding of how interventions should be developed to support IMGs in their transition to the workplace, particularly looking to identify how and why they are effective.MethodsThe realist synthesis involved an initial systematic search of the literature for the period January 1990 to April 2015. Secondary searches were conducted throughout the review in order to inform and test the developing programme theory. The context, mechanism and outcome data were extracted from all sources meeting the inclusion criteria. Fourteen case studies were included to further aid theory refinement.ResultsSixty‐two articles were identified, describing diverse interventions of varying intensity. A further 26 articles were identified through a secondary search. The findings illustrate that, alongside a developed programme, ongoing support and cultural awareness at organisational and training levels are crucial. Individual differences must also be taken into consideration. This will ensure that IMGs engage in transformative learning, increase their levels of self‐efficacy and cultural health capital, and reduce feelings of stress and anxiety. These factors will have an impact on work, interactions and cultural adjustment.ConclusionsOrganisational, training and individual contexts all play a role in IMGs’ adjustment during the transition process. Establishing ongoing support is critical. A list of recommendations for implementation is given.

The conceptual complexity identified in the findings suggests that the use of 'professionalism' as a descriptor, despite its vernacular accessibility, may be problematic in educational applications in which greater precision is necessary. It may be better to assume that 'professionalism' as a discrete construct does not exist per se, and to focus instead on specific skills, including the ability to identify appropriate behaviour, and the organisational requirements necessary to support those skills.

Employee silence, the withholding of work-related ideas, questions, or concerns from someone who could effect change, has been proposed to hamper individual and collective learning as well as the detection of errors and unethical behaviors in many areas of the world. To facilitate cross-cultural research, we validated an instrument measuring four employee silence motives (i.e., silence based on fear, resignation, prosocial, and selfish motives) in 21 languages. Across 33 countries (N = 8,222) representing diverse cultural clusters, the instrument shows good psychometric properties (i.e., internal reliabilities, factor structure, and measurement invariance). Results further revealed similarities and differences in the prevalence of silence motives between countries, but did not necessarily support cultural stereotypes. To explore the role of culture for silence, we examined relationships of silence motives with the societal practices cultural dimensions from the GLOBE Program. We found relationships between silence motives and power distance, institutional collectivism, and KNOLL ET AL.