Why we need psychologically healthy workplaces in the healthcare sector

It’s Saturday night and you’ve been in a car accident. Someone who had too much to drink swerved into your lane and caused a bad collision. You are in severe pain and fear that you’ve suffered serious injuries.

The paramedics arrive at the scene and whisk you to the nearest emergency room. Once there, you find yourself being cared for by a doctor and nurse who absorb information about your condition from the paramedics. As they check your vital signs, you pass out….

30 minutes earlier

For the sake of your own already sky-high stress levels, thank goodness you didn’t know that 30 minutes before your arrival, this doctor had been yelling mercilessly at the young nurse for a small mistake, right in front of her colleagues. The nurse was so rattled and embarrassed that she didn’t handle skillfully an emotionally out-of-control patient, who became angry at her and spat on her uniform just minutes before the paramedics wheeled you in.

It’s better you don’t know that your life is in the hands of a doctor with a short temper and a novice nurse who now is very skittish around him.

Violence, bullying, and incivility in healthcare

Folks who work in emergency rooms and psychiatric wards will tell you that physical violence at the hands of patients (and sometimes their family members or friends) can be a significant risk of the job. Healthcare workers can be hit, pushed, kicked, spat upon, and otherwise assaulted (physically and verbally) by the very people they’re trying to help.

In addition, bullying and incivility are common forms of mistreatment in the healthcare workplace. Nurses and nurses’ aides seem to get it the worst, but others are targets as well. The problem is so serious that in 2008, the Joint Commission, an independent, non-profit organization that accredits health care organizations and programs, issued a standard on intimidating and disruptive behaviors at work, citing concerns about patient care. (See blog series about bullying in healthcare, starting here.)

An imperfect storm

Earlier this week, I blogged about the National Conference for Workplace Violence Prevention & Management in Healthcare Settings, hosted last weekend by the University of Cincinnati College of Nursing. We heard a lot about physical violence committed by patients and about bullying & incivility dished out by co-workers.

What happens, however, when the two mix? Let’s say an emergency room treats potentially violent patients on a regular basis and also happens to be a place where employees treat each other so poorly that everyone is on edge? How do the concurrent risks of violence and bullying interact, to the point where workers are routinely stressed out and thus more prone to mistakes?

Let’s zero in on healthcare

This scenario underscores my belief that healthcare is a singularly important sector for studying and responding to disruptive behaviors of all types. The stakes could not be higher: They relate to workers and patients alike. A psychologically healthy healthcare workplace provides everyone with greater peace of mind, ranging from the workers to those of us who seek their help.

U of Cincinnati conference examines workplace violence, bullying, and incivility in healthcare

I just returned from the superb National Conference for Workplace Violence Prevention & Management in Healthcare Settings, hosted by the University of Cincinnati College of Nursing. This was one of those rare conferences where every speech, panel discussion, and poster session offered something informative and thought-provoking.

For the conference website, go here. Podcasts of conference programs will be posted during the summer.

Keynote address

An invitation to be one of the keynote speakers led to my being a part of the conference. Titled “Responding to Workplace Bullying in Healthcare: Ten Propositions,” here were my main points:

1.            The healthcare sector is an ideal locus for developing best practices to address workplace bullying, mobbing, and incivility.

2.            Somehow, someway, the case for taking workplace bullying seriously has to be made to the most powerful stakeholders, especially management.

3.            Medical schools need to inculcate students in the importance of developing and exercising social intelligence in the healthcare workplace.

4.            Nursing schools need to teach students about bullying behaviors and the need for personal resilience.

5.            Nurses’ unions are uniquely situated to raise concerns about workplace bullying.

6.            Physicians and nurses should not be promoted to management positions without training in management skills.

7.            Individuals who treat co-workers abusively should be counseled, disciplined, and – if necessary – dismissed.

8.            The enactment of legal protections against severe, targeted bullying at work could enhance, not hinder, the management and HR functions of the healthcare workplace.

9.            Internal codes of conduct in healthcare institutions should (1) promote responsible speech, (2) nurture civility, and (3) prohibit abuse.

10.          Research must inform practice, which — in turn — must inform research.

Many thanks

I won’t even attempt to provide a sampling of the good stuff we heard, though I will be discussing various presentations and poster displays in future blog posts. For now, I simply want to extend my gratitude to members of the conference committee, especially professors Gordon Lee Gillespie and Donna Gates and coordinator Katy Roberto Marston, for their extraordinary efforts and hospitality:

Gordon Lee Gillespie, PhD, RN, UC College of Nursing; principal investigator
Donna M. Gates, EdD, RN, FAAN, UC College of Nursing; co-investigator
Bonnie Fisher, PhD, UC College of Education, Criminal Justice, and Human Services
William K. Fant, PharmD, University of Cincinnati College of Pharmacy
Barbara Forney, Program Manager, University of Cincinnati College of Continuing Medical Education
Michelle Caruso, PharmD, BCPS, Cincinnati Children’s Hospital Medical Center
Terry Kowalenko, MD, FACEP, University of Michigan Emergency Medicine
Alison C. McLeish, PhD; UC Department of Psychology
Dianne Ditmer, PhD, RN, FACFE, Kettering Medical Network
Christine Luca, MSN, RN, University of Cincinnati College of Nursing
Katy Roberto Marston, Conference Coordinator, University of Cincinnati
Carolyn Smith, PhD(c), RN, Cincinnati Children’s Hospital Medical Center
Ahlam Al-Natour, PhD(c), RN, University of Cincinnati College of Nursing
Peggy Berry, MSN, RN, University of Cincinnati College of Nursing

“Work & Well-Being 2012″ in Chicago: June 28

The American Psychological Association’s Psychologically Healthy Workplace Program will be hosting “Work & Well-Being 2012,” a one-day conference in Chicago, on June 28. Here’s a preview of the topics that will be explored:

High-impact health promotion and wellness efforts … Workplace flexibility as a business strategy … Incentives and recognition … Preventing and addressing bullying and other counterproductive workplace behaviors … Lessons learned from award-winning companies … and more.

I’ll be presenting at the conference. Here are the featured speakers to date:

• Michael P. Leiter, PhD – Director of the Centre for Organizational Research & Development at Acadia University in Nova Scotia. With more than two decades of research on organizational behavior, Dr. Leiter is an internationally known expert on work engagement, burnout and civility in the workplace.
• David Yamada, JD – Professor of Law and Director of the New Workplace Institute at Suffolk University Law School in Boston. An internationally recognized authority on the legal aspects of workplace bullying and author of model anti-bullying legislation that has become the template for law reform efforts across the country.
• Bey-Ling Sha, PhD, APR – Associate Professor in the School of Journalism & Media Studies at San Diego State University. Dr. Sha is an award-winning public relations researcher, teacher and practitioner. Her research areas include cultural identity, international public relations, activism and gender.
• John Randolph, PhD, ABPP – Executive coach, consultant and board-certified clinical neuropsychologist in private practice in Lebanon, NH. A nationally recognized speaker on topics such as executive functioning, positive neuropsychology and leadership development.
• David W. Ballard, PsyD, MBA – Assistant Executive Director for Marketing and Business Development at the American Psychological Association, head of APA’s Psychologically Healthy Workplace Program.
• Matthew J. Grawitch, PhD – Chair of the Organizational Studies Program in the School for Professional Studies at Saint Louis University, an expert on healthy workplace practices.
• Larissa Barber, PhD – Assistant Professor of Psychology, Northern Illinois University, an expert on workplace flexibility and work-home boundary management, as well as work stress and health behaviors.

It promises to be an interesting and engaging program. For more information, go here.

A metaphor for our times: Death and maiming at the racetrack

As if we needed more images of a society putting all at risk for more money: A team of New York Times reporters has documented rising levels of death and catastrophic injuries among jockeys and horses at America’s racetracks (link here). They open with a typical account:

At 2:11 p.m., as two ambulances waited with motors running, 10 horses burst from the starting gate at Ruidoso Downs Race Track 6,900 feet up in New Mexico’s Sacramento Mountains.

Nineteen seconds later, under a brilliant blue sky, a national champion jockey named Jacky Martin lay sprawled in the furrowed dirt just past the finish line, paralyzed, his neck broken in three places. On the ground next to him, his frightened horse, leg broken and chest heaving, was minutes away from being euthanized on the track.

The injury rates are spiking upwards amidst economic pressures facing the racing industry:

…(A)n investigation by The New York Times has found that industry practices continue to put animal and rider at risk. A computer analysis of data from more than 150,000 races, along with injury reports, drug test results and interviews, shows an industry still mired in a culture of drugs and lax regulation and a fatal breakdown rate that remains far worse than in most of the world.

If anything, the new economics of racing are making an always-dangerous game even more so. Faced with a steep loss of customers, racetracks have increasingly added casino gambling to their operations, resulting in higher purses but also providing an incentive for trainers to race unfit horses.

A metaphor for our times

Although the morality of the horse racing comes up from time to time in the media, to me there are much more compelling ethical issues concerning animals. Furthermore, I don’t know much about the world of the sport, and I don’t feel qualified to judge it.

Nevertheless, when the sport becomes unduly hazardous to riders and horses, it’s time to take a hard look at what’s going on. And what we have here is a metaphor for our times: To stoke the betting fires of those chasing a big pay day at the racetrack, man and horse alike are put in harm’s way, speed fueling speed, circling the track over and again, only to end up where they started.

As a result, the jockeys are facing greater than normal risks, and their choices boil down to staying vs. walking away. As for the horses, they don’t decide whether to be juiced up with drugs, and if they are badly injured as a result, they have no role in determining their fates.

Workplace wellness and workplace bullying

When you hear the term “employee wellness,” do you also think about “workplace bullying”?

That question has been buzzing through my head since yesterday, when it was my pleasure to speak at a program on creating healthy workplaces, sponsored by the New England Work & Family Association (NEWFA) — a group of human resources and wellness program professionals committed to supporting work-life balance — and hosted by the Boston College Center for Work and Family.

A tale of two halves

The first half of the program was an interesting panel discussion about workplace wellness programs, featuring presentations by NEWFA members who have developed and managed wellness programs. We heard about a variety of useful, pro-active initiatives, including health education and coaching (e.g., nutrition, exercise, smoking cessation), stress reduction, and mindfulness training.

The second half of the program was my presentation about workplace bullying and the challenges facing HR. Although I framed my remarks within the context of promoting healthy workplaces, it was clear that my piece was about the “dark” side of work. How else to describe a phenomenon that reduces productivity and morale and triggers a long list of negative health outcomes?

Will the twain meet?

Both pieces of the program related to the same general topic, namely, the creation and sustenance of healthy workplaces that embrace both productivity and employee well-being.  However, I couldn’t help but notice how the room tensed up as my talk explored the details about workplace bullying.

As I told the group, workplace bullying is a very threatening topic to many organizations, especially when the behavior is frequent and comes from a top-down direction. After all, boss-to-subordinate bullying is the most common combination, at least in the U.S. Furthermore, bullying and mobbing behaviors tend to be fueled by organizational cultures that enable or even encourage them. In short, bullying at work often points to responsibility at the top.

Contrasts in dealing with senior management

Perhaps this explains a fundamental difference in how and why senior management is consulted by HR.

Speakers on the panel about employee wellness explained that they often didn’t have to go to top management for specific approval about every new initiative they developed. In some cases, they simply went ahead with a program that eventually would become a regular offering, with no apparent pushback from the corner office.

When I talked about incorporating workplace bullying prevention and response into HR practices and training, however, I saw knowing nods in response to my advice to assess management tolerance for such initiatives and to consult legal counsel on liability exposure.

An integrated perspective

Perhaps I’m making excuses for the pizza I enjoyed the other night, but I don’t think we can de-couple bad habits such as unhealthy eating and smoking from undue stress at work. Indeed, it strikes me as ironic that we can talk more openly about wellness programs designed to reduce stress and improve health habits, while sometimes sweeping under the rug work-related conditions — such as bullying — that create a need for them.

In short, the quest for healthy workplaces cannot ignore fundamental conditions of work. It’s why I am thankful that NEWFA and Boston College created a program that allowed us to consider the workplace in a more balanced light.

Global report: Nearly 3 in 10 workers say workplace is psychologically unsafe

If you need support for the proposition that employers need to take psychological health in the workplace more seriously, a Reuters global survey covering some 14,600 workers in 24 nations will give you some backup.

The survey found that nearly three in ten workers deemed their workplaces psychologically unsafe and unhealthy (link here):

Companies around the globe have work to do to improve worker satisfaction because three in 10 employees say their workplace is not psychologically safe and healthy, according to a new poll.

Whether it is due to stress, interpersonal conflict, frustration, lack of feedback or promotion, 27 percent of workers in 24 countries said they are not happy with the psychological aspects of their work environment, the survey by research company Ipsos for Reuters showed.

North America

Some North American readers of this blog will be pleased to know that workers in the U.S. and Canada reported the highest levels of psychological safety at work:

Although many North Americans have fewer holidays than Europeans and may work longer hours and enjoy fewer social services, Americans and Canadians had the highest marks for positively assessing the mental health of their workplace, followed by workers in India, Australia, Great Britain and South Africa.

Nevertheless, Mexico ranked among the worst of the nations surveyed, with 4 in 10 workers giving negative marks to their workplaces.

Overall, not great

The rest of the survey respondents broke down this way:

• “47 percent . . . agreed that their workplace was ‘a psychologically safe and healthy environment to work in’”
• “26 percent hovered on the fence and weren’t sure”

Overall, the results are disturbing. Slightly under half of the respondents agreed that they work in psychologically healthy workplaces. The rest were split almost evenly between “unsafe” and “not sure.”

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Nations surveyed: “Argentina, Australia, Belgium, Brazil, Canada, China, France, Germany, Britain, Hungary, India, Indonesia, Italy, Japan, Mexico, Poland, Russia, Saudi Arabia, South Africa, South Korea, Spain, Sweden, Turkey and the United States.”

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Hat tip: Workplace Issues Today

Burnout in the non-profit sector

In a thought-provoking and important piece for AlterNet, psychologist Michael Bader examines the common phenomenon of burnout in progressive organizations:

Progressive leaders, activists and organizers don’t take care of themselves very well. They get burned out and either don’t know, don’t care, or don’t know how to fix it. . . . It undermines their energy, passion and imagination, and it spreads like a virus through their workplaces and families. Almost every aspect of their lives takes a hit–health, relationships with friends and family, creativity, judgment, concentration, and mood.

Bader points to chronic understaffing, the burdens of constantly fighting defensive wars in an age of right-wing power, and a self-sacrificing “martyr culture” as contributing to burnout among progressive change agents.

Prescriptively, he draws upon lessons from organizational psychology and coaching to recommend how to address burnout, while urging that any fixes must ”start with self-compassion and an ethic of self-care.”

Non-profits generally

It strikes me that Bader’s excellent commentary applies to the non-profit sector generally. I don’t necessarily equate “non-profit” with progressive political leanings, but I definitely see the connections between non-profits and dedication to cause-oriented work.

Non-profit employment attracts those who are drawn to changing society for the better. This can be a good thing: How many people get to earn a living doing something they believe in? However, it also feeds burnout tendencies that are exacerbated during difficult times. And nowadays, this is a brutal time for all but the most privileged non-profit organizations.

Bader’s call for an ethic of self-care may seem elusive to those who are fighting the good fight, but if you find yourself in this situation, take a look at his article and share it with others.

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Related posts

Workplace bullying in the non-profit sector (2011)

When the bullying comes from a board member (2011)

Next on the economic hit list: Public and non-profit sectors (2009)

Dear Apple, please start taking global human rights seriously

photo credit: Wikipedia

Here’s a factory scene from China, as described by Charles Duhigg and David Barboza of the New York Times:

The explosion ripped through Building A5 on a Friday evening last May, an eruption of fire and noise that twisted metal pipes as if they were discarded straws.

When workers in the cafeteria ran outside, they saw black smoke pouring from shattered windows. It came from the area where employees polished thousands of iPad cases a day.

Two people were killed immediately, and over a dozen others hurt. As the injured were rushed into ambulances, one in particular stood out. His features had been smeared by the blast, scrubbed by heat and violence until a mat of red and black had replaced his mouth and nose.

Snazzy products, high profits, and workers at risk

Unfortunately, dangerous working conditions for workers who assemble Apple products are more common than any of us who buy, own, and love these computers and gadgets would like to think. As Duhigg and Barboza add in their report:

In the last decade, Apple has become one of the mightiest, richest and most successful companies in the world, in part by mastering global manufacturing. Apple and its high-technology peers — as well as dozens of other American industries — have achieved a pace of innovation nearly unmatched in modern history.

However, the workers assembling iPhones, iPads and other devices often labor in harsh conditions, according to employees inside those plants, worker advocates and documents published by companies themselves. Problems are as varied as onerous work environments and serious — sometimes deadly — safety problems.

Our responsibility

I own and use a MacBook laptop and an iPad regularly. I think they are excellent products. I own a small amount of Apple stock in my retirement portfolio. I’ve made some money off of it.

Folks like me (and perhaps some of you, dear readers) need to make our concerns known. I’m a latecomer to the Apple world, but I’ve always envied the “hip and cool” image of the company and its followers. Now, however, it’s terribly clear: There’s nothing hip or cool about exposing workers to life threatening and health impairing conditions on the job.

Cincinnati conference to examine violence and bullying in healthcare workplaces, May 11-13

See you on May 11-13?

The University of Cincinnati is hosting the National Conference for Workplace Violence Prevention & Management in Healthcare Settings, scheduled for May 11-13, 2012, in Cincinnati.

Here’s how the organizers describe the conference:

This conference will cover the full spectrum of the workplace violence typology as it directly relates to incivility, bullying, verbal and physical aggression, threatening words or actions, sexual harassment, and physical assaults that occur in healthcare settings (e.g., hospitals, long term care, emergency departments, home health, pharmacies, clinics, and private practice offices).

This conference will provide an opportunity for national and world leadership to prevent work-related injuries by disseminating the current scientific research on healthcare workplace violence, analyzing what changes have been made to alleviate healthcare workplace violence and providing recommendations for minimizing workplace violence for healthcare providers and their patients.

See you there?

I’ve accepted an invitation to give a keynote address at the conference on Friday, May 11, during which I’ll be discussing legal issues relating to workplace bullying and violence.

In addition, the organizers are accepting abstracts for papers, poster sessions, and symposia. The due date is February 17. Go here for the link!

Chief organizers include Gordon Lee Gillespie, Ph.D., R.N. (principal investigator) and Donna M. Gates, Ed.D., R.N.  (co-investigator). Go here to learn about the rest of the conference committee.

Very important focus

I’m delighted that a full-blown, multidisciplinary conference is focusing on this topic. The healthcare workplace is important to everyone, and working conditions can be stressful and challenging. Physical violence, bullying, and other forms of aggression are common occurrences.

Over the years I’ve written a lot about bullying in healthcare. I’ve collected previous posts here:

4-part series on bullying in healthcare

Workplace bullying in healthcare I: The Joint Commission standards

Workplace bullying in healthcare II: Vanderbilt U program for doctors

Workplace bullying in healthcare III: A sampling of legal cases

Workplace bullying in healthcare IV: Nurses bullied and responding

Other related posts

Cheryl Dellasega’s When Nurses Hurt Nurses

Nurse writes about bullying by doctors, other doctors respond

Healthcare bloggers on workplace bullying

Nursing as a Calling: Aspirations and Realities

Alaska nurse blogs about workplace bullying experience

A Flu Tale of Intellectual Bullying?

Can workplace incivility ever be healthy?

Have you ever been in an argument that became heated and angry, but concluded with a resolution of differences and perhaps even the strengthening of a friendship or relationship?  If so, was expressing anger part of the path toward getting to a better place?

Sorting and working through differences can be emotional stuff. We care about what’s being discussed. Egos enter the picture. At times, perceived injustices are involved. On occasion, past baggage can play a role.

Sometimes we need to express our emotions in order to move toward resolution. The decibel level may rise — hopefully not too high — and harsh words may be exchanged before our better natures prevail.

What about work?

Those of us who study workplaces generally assume that incivility is a bad thing. After all, an interaction involving incivility can ruin a work day, especially if it comes from your boss. At times, incivility can elevate into active disrespect and even bullying. When such behaviors run rampant, their sum total makes for a lousy workplace. So…less incivility beats more incivility, hands down.

However, there are times when incivility may be an understandable consequence of a disagreement or difference of opinion. Such exchanges — often marked by the use of otherwise rude, harsh, or offensive words – can clear the air, hopefully paving the way toward a healthy resolution.

In fact, when these feelings are buried, they may lead to passive-aggressive behaviors that only make things worse. On an institutional level, the unavailability of emotional release valves may fuel what psychologists Linda Hartling and Elizabeth Sparks call “pseudo-relational” cultures, i.e., workplace cultures that value superficial “niceness” over constructive change and honest dialogue.

Caveats and definitions

Of course, there are some big caveats here. I’m not suggesting that any workplace become an emotional free-for-all; we all need to exercise a degree of self-control. In addition, when “clearing the air” opens the door to a more powerful party exacting retribution on the less powerful one, well, that compounds a nasty situation. We also need to understand how differing power relationships affect how communications are perceived.

Furthermore, I realize that many definitions of workplace incivility cover behaviors that some of us would deem bullying. Without parsing all those variations, I’ll simply say that when incivility morphs into targeted, abusive bullying that affects someone’s job performance and well-being, it’s never an acceptable method of “resolving” differences.

The role of the law

I think we should leave it to individuals and organizations to wrestle over questions of what constitutes civil vs. uncivil behavior. When it comes to legal standards, I agree with the Supreme Court’s sentiments, repeated in major decisions interpreting sexual harassment law, that the law should not become a workplace “civility code.”

But once that work environment becomes abusive, it’s time for the law to step in. We have some of those protections in place today when situations involve discrimination and harassment based on protected class membership such as sex, race, religion, or disability. Unfortunately, a gaping hole in the law remains with workplace bullying, and that’s why I drafted the anti-bullying Healthy Workplace Bill and why advocates across the country are asking state legislatures to enact it.

Incivility vs. bullying

At times I have used terms such as bullying and incivility somewhat interchangeably. But in reality, there often are stark differences. Workplace bullying is a form of abuse. It involves a party or parties exercising institutional and/or personal power over another in a hurtful way.

By contrast, some expressions of incivility, while not enjoyable or advisable as a general state of affairs, can be part of a process of resolving workplace differences and disputes, at least under the right circumstances.

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Related posts

• For a summary of the insightful work of Drs. Hartling and Sparks, see Typing Your Workplace Culture.
• This is my second, and hopefully more articulate, take on this topic. For the earlier commentary, see Bullying, incivility, and conflict resolution at work.