A culture of bullying?

The whole culture at Barts and Whipps Cross University Hospital is a bullying culture and the people responsible are the senior management.

This is a quote from the recently published Care Quality Commission (CQC) report into Whipps Cross University Hospital.1  In total the word ‘bullying’ occurs seventeen times in the report, and bullying was reported as an issue by staff in five different services within the hospital.   What was even more worrying was that senior management seemed to be reluctant to accept that bullying was an issue, in spite of the fact that the Trust had commissioned an external review on staff perceptions of bullying which reported issues with line management, the working environment, work loads, poor behaviour tolerance, and ineffective strategies to deal with these issues.

What are we to make of such findings?  More specifically, is a culture of bullying, accepting for the moment the CQC’s conclusion regarding this matter, a symptom or a cause?  In other words, is bullying of staff by other staff (who may not always be their superiors by the way) a sign of a deeper malaise in the service, or is it the root cause of other issues?  The answer, of course, is that it can be both.  A shortage of staff, for example, can cause waiting times to increase, which can put everyone under more pressure, which can cause mistakes to be made, which can cause tempers to fray, and so on.  On the other hand, if staff are being bullied and harassed (another word which occurs regularly in the report) then staff will become stressed, demotivated, vote with their feet, and so on.  And it’s easy to see how this can become a vicious circle: as staff leave because of bullying, this puts the remaining staff under more pressure, which causes more stress, more fraying of tempers, and more bullying and harassment.

But is it right to talk about a culture of bullying (and harassment)?  I ask this because the term seems to imply that somehow bullying is accepted, even institutionalised.  Referring back to Schein’s definition of organisational culture that I referred to in another post2 which talks about culture ‘as shared basic assumptions’, does this mean that there is a shared assumption that bullying is ‘OK’ in the hospital?  Surely not.  The key question, though, is what are the shared basic assumptions in the hospital?   And is it these basic assumptions that lead, unintentionally,  to bullying and harassment?  Of course, without conducting an in-depth investigation of the culture of the organisation is is impossible to say what these basic assumptions are.  However, it might be interesting to speculate.

Another important question to ask regarding shared basic assumptions is: shared by whom?  As noted by many organisational theorists, there are often a number of cultures within an organisation.  Sometimes the term ‘sub-culture’ is used, although I prefer the term ‘social worlds’.  Within a large hospital trust you could identify a doctors’ culture, a nursing culture, a management culture, a patient culture, and so on.  Each have their own set of shared values and assumptions.  Things get more complicated when members of one culture or social world ‘cross-over’ into another culture.  Take, for example, a senior nurse who has to manage a team of nurses: by profession he or she is a nurse, but in practice he or she is also a manager and has to internalise the values and basic assumptions of managers, which are very different from those of nurses.  The same problem arises when clinicians join the executive board.  Essentially they have divided loyalties: to their profession on the one hand,  and to the trust as a corporate enterprise on the other hand.  Clinicians are primarily (we hope) focused on treating the sick, whereas the corporate enterprise has a number of other priorities, including working within a budget, managing a large, multi-disciplinary workforce, and reaching particular targets.  Sometimes (often perhaps) such priorities conflict with the clinical ones. 

Certainly, within Whips Cross and across the wider trust, there were a number of corporate decisions which appear to have impacted negatively on staff morale and, potentially, on the level of care provided.  These includes the removal of a significant number of posts, and the banding down of a large number of nursing staff.  There were also problems with the installation of a new IT system which created difficulties with patients getting appointments.  Furthermore, there appeared to be a ‘disconnect’ between senior management and the rest of the workforce, which has implications for a sense of shared corporate identity and vision.

Of course, it’s not clear whether such factors would directly ’cause’ bullying and harassment within the hospital, but I think it shows that it is perhaps misleading to speak of a culture of bullying and harassment, which, as I suggested earlier, implies that somehow such behaviour is accepted or even endorsed in the organisation.  Rather, I think it far more likely, and far more useful to explore, that bullying and harassment are the effect or consequence of a set of underlying cultural factors within the hospital which have nothing to do with bullying and harassment.

  1. http://www.cqc.org.uk/location/R1HKH  The quote is on page 70 of the report. []
  2. http://www.therapeia.org.uk/wp/consultancy/2015/03/16/bad-care-home-bad-culture/ []