When people learn that I pivoted from broadcast journalism to health care, they are rightly surprised: the two fields don’t seem to have a lot in common. But in my experience, they share at least this: both occasionally celebrate a culture of blame, celebrity and an eat-your-young mentality that fosters fear, undermines team work and discourages whistle blowing. In a health care environment, this type of workplace bullying has even been associated with harm to patients.
First and foremost, the vast majority of journalists and health care professionals are good, caring, collaborative people who go into these fields hoping to make the world a better place. But events over the last year at my former employer, the CBC, have me thinking about bullying in the workplace in general. And I don’t think the CBC is unique in its failure to intervene and prevent this type of behavior.
In medical education, we talk about “the hidden curriculum.” It’s not the stuff we’re taught in the lecture theatre, it’s the stuff we learn by watching our superiors in action day after day. As students, whether we are residents or nurses or physician assistants, we are exposed to an array of medical professionals whose behaviours and attitudes we soak up like sponges. And we often model those behaviours as we move from student to practitioner.
Unfortunately, students are sometimes exposed to sarcasm, shouting, dismissiveness and disruptiveness from the very people they’re supposed to emulate. In a 2011 survey of more than 800 physicians in a variety of health care settings, almost 75% reported they had witnessed disruptive behavior within the previous month, which included “degrading comments or insults, refusal to cooperate with others, and speaking loudly, characterized as ‘yelling.’” The chain of bullying can vary depending on the players in each setting, but the hierarchical nature is familiar: senior doctors bully residents, senior nurses bully residents and junior nurses, senior residents bully the junior residents and so on. You think public shaming on social media is bad? Try getting pimped – that’s how we describe being deliberately grilled by your staff physician about things way above your knowledge base. The humiliation is heightened when it happens in a group or in front of the patient.
Disruptive behavior by just one or two members of the health care team sends ripples through the work environment, creating stress, frustration, insecurity and low morale. But the harms extend beyond those wearing the stethoscopes. When surveyed, doctors and nurses say that disruptive behavior by health professionals is strongly linked to adverse events; 71% feel it is linked to medical errors and 27% link it to patient mortality. According to people on the front line, we’re hurting our patients when we bully each other.
Perhaps Jian Gomeshi thought that his tantrums, his sarcasm, his shunning of certain producers was justified because his standards for his radio program were high, and he put the quality of the program above all else. In fact, this is how bullies in health care justify their behavior. Their usual defense is that they are the Erin Brockovitches of superior patient care, loudly “outing” ineptitude to force change on a stagnant system. Sometimes, “these physicians become folk heroes to younger physicians who envy their fortitude in confronting the power of the bureaucracy.”
So while the CBC ordered a full-scale independent investigation of l’affaire Ghomeshi, what are health science programs and hospitals doing to identify and prevent disruptive behavior among health care workers?
We know that medical schools are making ethics, communication and team building part of the official, not just the hidden curriculum. This is welcome. And the hospitals I’ve worked in have clear policies against abusive and unwelcome behavior. But so did the CBC. I worry that health care workers who have little seniority and rank further down the power-pecking-order may feel too vulnerable to come forward in a formal complaints process, which is how many of Mr. Ghomeshi’s coworkers apparently felt. The report for the CBC contains nine recommendations to better protect employees, including an anonymous hotline, frequent workplace surveys and an ombudsperson who would oversee respect in the workplace. These ideas could be adopted in hospitals if they aren’t already. When I look back on my career in the media I see that the “host” culture sometimes put egos ahead of journalism. Let’s all make a commitment that in health care, no behviour will be tolerated that doesn’t put patients first.