Discrimination in the surgical discipline: an international European evaluation (DISDAIN)

Abstract

Background Negative workplace experiences (NWPEs), such as gender discrimination, bullying, sexual harassment and ethnic discrimination, are concerns in today’s surgical society. These negative experiences potentially impair surgeons’ performance and might impact patient care or outcomes negatively. This study aimed to assess the experience of NWPEs across the European surgical workforce. Methods A prospective online 34-point questionnaire was designed using a combination of Likert scale, multiple-choice and short-answer questions. Invitations were distributed through surgical associations via email/social media between 1 September and 15 November 2019. Data were analysed using non-parametric methods. Results Some 840 complete responses were included in the analysis. The distribution across genders and stage of surgical training was even. Of the respondents, 20 per cent (168 respondents) considered quitting their job, 4.5 per cent (38) took time off and 0.5% (4) left surgery due to NWPEs; 12.9 per cent of females and 4.4 per cent of males experienced some form of physical harassment. Females and those in training were significantly more likely to experience or witness gender discrimination and sexual harassment. Just over half of the respondents (448) did not report negative experiences, with most of these (375 respondents) being unaware of whom to report to. Nearly a fifth of respondents felt that NWPEs influenced patient care or outcomes negatively. Conclusion NWPEs were frequent, especially among females and those in training. While a substantial proportion of respondents experienced physical harassment, many individuals were unaware of how to raise concerns. Adverse effects on patient outcomes, surgical training and workforce retention indicate a need for urgent action.

Prevalence and health correlates of workplace violence and discrimination against hospital employees – a cross-sectional study in German-speaking Switzerland

“…Discrimination and unfair treatment at the workplace is usually less prominent and prevalent than workplace violence and aggression but nevertheless present and quite common in health care settings and among hospital staffs and particularly physicians [ 7 , 10 , 11 , 23 ]. However, strongly varying proportions up to 70% of the examined physicians in specific subgroups or specialties had experienced (or witnessed) and reported age, gender or racial discrimination during their medical careers depending very much on the age, gender, ethnic origin or country and study [ 7 , 9 – 11 ].…”

“…In spite of such studies and systematic reviews on the general, global, national or setting-, gender- or profession-specific prevalence, the true extent of workplace violence and discrimination in the health care sector is difficult to assess, as a high number of unreported cases must be assumed [ 10 , 20 , 24 ]. Reported or assumed reasons for a systematic underreporting of experienced or witnessed workplace violence and discrimination are that employees do not anticipate a change or that they underestimate or are afraid of its negative consequences [ 10 , 20 , 25 ].…”

“…In spite of such studies and systematic reviews on the general, global, national or setting-, gender- or profession-specific prevalence, the true extent of workplace violence and discrimination in the health care sector is difficult to assess, as a high number of unreported cases must be assumed [ 10 , 20 , 24 ]. Reported or assumed reasons for a systematic underreporting of experienced or witnessed workplace violence and discrimination are that employees do not anticipate a change or that they underestimate or are afraid of its negative consequences [ 10 , 20 , 25 ]. Underreporting of workplace violence against nurses or workplace discrimination against physicians is a particular problem in health care because of the direct patient contact or the power structures in hospital settings (unequal power relations between the health professions or sexes).…”

“…Underreporting of workplace violence against nurses or workplace discrimination against physicians is a particular problem in health care because of the direct patient contact or the power structures in hospital settings (unequal power relations between the health professions or sexes). Health professionals who are victims of violence or discrimination at the workplace tend to excuse or downplay the aggressive or unfair and discriminatory behavior of patients, relatives, colleagues or supervisors, for example with the health status of the patients [ 26 ] or due to existing structures or missing contact persons and responsible authorities [ 10 ].…”

“…But in contrast to the prevalence, the consequences of workplace violence and discrimination against health care workers are less studied and evaluated. However, there is evidence from several studies that such negative experiences at work among clinical nurses and physicians or other health professionals are associated with specific health and work-related outcomes such as burnout, sleep problems, job dissatisfaction or turnover intention [ 3 , 8 , 10 , 28 ]. A systematic review revealed a broad range of negative consequences of workplace violence in the health care setting [ 29 ], which can be divided into seven categories: physical consequences (direct injuries of the body), psychological consequences (as depressive or burnout symptoms), emotional affecting (as anxiety), adverse effect on the workplace functioning (as decrease in productivity), negative impact on health care quality (as patient safety), social consequences (on private and family life) and financial consequences (as the loss of income due to absences from work).…”