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.

Statistics show that veterinary surgeons are in one of the professions with the highest suicide rates. This indicates the sector has significant well-being issues, with high levels of occupational stress and burnout. Previous research has focused on environmental factors in isolation, overlooking the influence of personality. This study aimed to establish that personality is a better predictor of occupational stress than environment. UK veterinary surgeons (n=311) completed an online survey composed of three questionnaires; the NEO Five-Factor Inventory, the Maslach Burnout Inventory, and the Job Stress Survey. Multiple regression analysis revealed that personality is a better predictor of occupational stress than environment (p<.001). Neuroticism is the trait that significantly predicts occupational stress (p<.001), and the components of neuroticism that contribute the most to stress are depression (p=.002) and anger hostility (p=.005). Demographic factors such as the number of years the veterinarian has been qualified acted as a mediator between depression and occupational stress (p<.001), and as a moderator between personal accomplishments and occupational stress (p=.028). Overall findings suggest that newly qualified veterinarians are at greater risk of suffering from high levels of occupational stress than those well established in the profession, and that veterinarians with higher levels of depression and anger hostility are likely to experience greater levels of occupational stress. Implications highlight the need for greater awareness of potentially susceptible personality traits in the veterinary admissions process. This would allow for the identification of those at risk and the implementation of interventions.

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Bystander action has been proposed as a promising intervention to tackle workplace bullying, however there is a lack of in-depth qualitative research on the direct experiences of bystanders. In this paper, we developed a more comprehensive definition of bullying bystanders, and examined first person accounts from healthcare professionals who had been bystanders to workplace bullying. These perspectives highlighted factors that influence the type and the extent of support bystanders may offer to targets. Semi-structured telephone interviews were conducted with 43 healthcare professionals who were working in the UK, of which 24 had directly witnessed bullying. The data were transcribed and analysed using Thematic Analysis. The analysis identified four themes that describe factors that influence the type and extent of support bystanders offer to targets of bullying: (a) the negative impact of witnessing bullying on bystanders, (b) perceptions of target responsibility, (c) fear of repercussions, and (d) bystander awareness. Our findings illustrate that, within the healthcare setting, bystanders face multiple barriers to offering support to targets and these factors need to be considered in the wider context of implementing bystander interventions in healthcare settings.

IssueHealth care management is faced with a basic conundrum about organizational behavior; why do professionals who are highly dedicated to their work choose to remain silent on critical issues that they recognize as being professionally and organizationally significant? Speaking-up interventions in health care achieve disappointing outcomes because of a professional and organizational culture that is not supportive.Critical Theoretical AnalysisOur understanding of the different types of employee silence is in its infancy, and more ethnographic and qualitative work is needed to reveal the complex nature of silence in health care. We use the sensemaking theory to elucidate how the difficulties to overcoming silence in health care are interwoven in health care culture.Insight/AdvanceThe relationship between withholding information and patient safety is complex, highlighting the need for differentiated conceptualizations of silence in health care. We present three Critical Challenge points to advance our understanding of silence and its roots by (1) challenging the predominance of psychological safety, (2) explaining how we operationalize sensemaking, and (3) transforming the role of clinical leaders as sensemakers who can recognize and reshape employee silence. These challenges also point to how employee silence can also result in a form of dysfunctional professionalism that supports maladaptive health care structures in practice.Practice ImplicationsDelineating the contextual factors that prompt employee silence and encourage speaking up among health care workers is crucial to addressing this issue in health care organizations. For clinical leaders, the challenge is to valorize behaviors that enhance adaptive and deep psychological safety among teams and within professions while modeling the sharing of information that leads to improvements in patient safety and quality of care.