When a school-age child bullies a peer, the consequences are typically standard — reprimand from an adult and possibly detention. When a working professional bullies a peer, often the bully faces no consequences but the target of the bullying is left dealing with emotional trauma and considering the financial and professional repercussions of speaking up or leaving the workplace altogether.
Although workplace bullying comes in less obvious forms than schoolyard bullying, sources say it remains an issue in health care and could affect the bottom line of a business that does not deal with problems effectively.
A deeper look
There is one particular reason that might explain why bullying occurs in the workplace — it is legal.
Unlike harassment, defined by the United States Department of Labor as “unwelcome or discriminatory behavior based on any characteristic protected by law,” no state has passed a workplace-specific anti-bullying law, according to the Workplace Bullying Institute.
“While similar to harassment, bullying often involves recurring incidents that mentally humiliate or intimidate a target,” Ann Oros, human resources coordinator at Scheck & Siress Prosthetics Inc., told O&P News. “You could have someone [teasing] or making a demeaning comment,” she said “Anything that is inappropriate and [intentionally] upsets someone could be considered bullying.”
According to a 2013 Workplace Bullying Institute survey, health care is one of the prime industries prone to workplace bullying. A reported 35% of American workers have been targets of bullying and of those, 27% work in health care, the survey found.
Survey results showed poor workplace relationships, lack of apt management and fear of competition could lead to bullying. Brad Mattear, LO, CPA, territory and strategic account manager at Cascade Orthopedic Supply, agreed.
“I think a big part of it is insecurity,” Mattear said, “or protection of your turf. On the technician side [their] way of making a living is by fabricating and honing their trade. If they feel that is threatened or they have to pass on knowledge, in some cases, they could be reluctant.”
Thomas Karolewski, MA, CP/L, FAAOP, supervisor of the Orthotics and Prosthetics Clinic at the Edward Hines Jr. Veterans Affairs Hospital, suspects some bullying triggers are innate to the profession.
“A lot of [it] occurs [because] people care,” he said. Since health care professionals are motivated to help others, they may be sensitive to others and “care about how they are thought of,” he said, which could lead to vulnerability that is taken advantage of by coworkers.
That includes coworkers, supervisors, “even vendors who come in with their products,” Karolewski said, and it does not always come from the top down. “It [could be] employee to employee or employee to office staff,” he said.
Personal, professional impacts
Bullying could cause profound emotional effects, sources said. Targets often experience low confidence, anger, shame and helplessness and enact hypervigilance or avoidance behavior in anticipation of the next event.
“You remember those situations for the rest of your life,” Joyce Perrone, consulting partner at Promise Consulting Inc. and De La Torre O&P Inc., told O&P News.
“There is no reason for it. It is unfair and it can cause permanent emotional damage in someone’s life,” Karolewski added.
In 2012, the Workplace Bullying Institute conducted an online survey asking people who had been targets of bullying to report bullying-related health complications. A total of 516 participants completed a comprehensive 52-item checklist.
Findings showed anxiety as the most common psychological symptom, experienced by 80% of respondents. About 49% of respondents were diagnosed with clinical depression. Insomnia, loss of concentration, mood swings and pervasive sadness also were reported, ranging from 50% to 77%.
In addition, 74% of respondents reported feeling betrayed by their coworkers, and 63% reported a lingering distrust of corporate institutions.
Targets of bullying also experienced severe physical symptoms, according to the survey. A total of 61% of respondents reported heart palpitations, and 60% reported high blood pressure. Migraines and digestive issues also were initiated or worsened as a result of bullying, findings showed.
Nearly 30% of respondents reported post-traumatic stress disorder, and 19% reported acute stress disorder. A total of 52% reported panic attacks and 17% reported agoraphobia.
About 29% of respondents contemplated suicide, while 14% contemplated violence against others.
In total, 71% of respondents sought treatment from a physician, 63% saw a mental health professional and 22% were prescribed psychotropic medications.
But the target is not the only one affected by workplace bullying; the entire office is influenced, according to Mattear.
He said the O&P profession is driven by teamwork and when bullying persists, it could undermine the performance of that team.
“If you leave bullying unchecked, it harms the mental, physical [and] emotional output of your employees,” he said. “It affects morale and creates a contentious environment.”
That environment could lead to suppressed creativity, increased anxiety and reduced productivity. Karolewski said it could even lead to absenteeism and turnover for targets.
“The person may quit,” he said. “If someone is being bullied, they might start taking time off of work, begin calling in sick — they do not want to come because they do not want to be subjected to that.
“Then someone has to pick up the slack, so now you are overloading other people in the office. You are pulling somebody away from their duties to train a somebody new,” he said. “That costs time and money.”
According to the Workplace Bullying Institute, the cost of turnover-related activities to the employer equals 1.5-times the departed worker’s salary. Also, though rarely applicable, some targets may threaten with a lawsuit, which could result in extensive legal fees if successful.
“It is almost impossible to figure out the indirect costs of bullying,” Karolewski said, “but I have seen figures anywhere from several thousand to a couple million [dollars], depending on the size of the corporation. This is something you need to put under wraps because it could be expensive to the company.”
It is also expensive for the patient. A poor group dynamic could lead to poor patient care, Karolewski said, adding that “lack of proper teamwork could reduce the quality of treatment.”
“If someone takes time off, someone else has to see their patients [and] they may not be comfortable if there is no continuity of care,” he said. “Patients are perceptive. They can see when a system is flawed or when there are internal issues. If they are not happy or receive substandard care, they may go somewhere else.”
‘A silent epidemic’
The severity of bullying is wide ranging, sources said.
“It could take form [ranging from] gossiping and teasing to shouting and intimidating,” Perrone said. “Someone could say something nasty and then add, ‘Oh, I was just joking,’ in order to make it acceptable.”
“Everybody likes to have fun,” Mattear added, “but at some point it crosses the line. When it is happening to a specific person on a [regular] basis, that is where you get into that zone of bullying.”
Many cases of bullying are not that apparent, and can often go unrecognized, according to Perrone.
“There are certainly pockets of it, but you do not always see it,” she said. “Unless it is something extreme or physical, it is not always obvious when bullying is occurring.”
Karolewski described the “mob effect,” in which coworkers socially isolate a target from the rest of the group. “They may even side with the bully, exacerbating the situation and affecting the workflow. Or they could retreat in fear of being bullied themselves. [Either] way it causes problems down the line.”
Examples include an individual’s work contributions being purposely ignored or important information being withheld from them, Karolewski said. But the opposite also could happen.
A target could be given “too much attention” he said, where a supervisor assigns unreasonable amounts of work or unrealistic deadlines. Micromanaging and undue criticism also play a role in bullying.
“It is almost a silent epidemic,” Karolewski said. “People are afraid to speak up. What happens when you go to the regional manager to complain about the officer manager, but do not get support from above? Now you are in a bad situation, and I think that can be paralyzing.”
Methods of resolution
There are ways for targets to combat bullying, sources agreed. The first step is to recognize it.
Before taking action, Karolewski said to be certain it was not an isolated incident or a case of a manager being strict in an effort to produce better results.
“But when you can label it, you have to look in the mirror and realize you are not the problem,” he said. “Bullying is about control; it is a power thing. Sometimes the hardest part is realizing it is not personal.”
Once the target identifies a pattern, Karolewski suggested they address the bully. “The first thing I would do is look at confronting them directly. This is one time I can say that silence is not golden.”
Though it may be uncomfortable, he said it is important to keep the lines of communication open.
Requesting a private conversation may be an option. Here, a target should be direct, discuss how they are being impacted and set expectations of how they would like to be treated moving forward.
If a private conversation is not an option, experts suggested targets point out immediately the next time they feel attacked. This will send a clear message to the office that the behavior is not acceptable.
While addressing the bully should be a priority, Karolewski advised targets to be calm, sensible and professional, and to avoid actions that could place one’s job or safety in jeopardy.
Employees targeted by bullying also should document each bullying occurrence.
“You could keep a diary,” Karolewski said, “dates, times, places — everything. If anybody else witnessed it, try to have them document also.”
Employees should keep record of inappropriate emails, comments and other related incidents, with as much detail as possible. Karolewski said this will be crucial should it need to be reported to upper management.
Mattear added targets should confide in a coworker or direct supervisor. “Make sure you get someone involved. Even if you are just a witness, get your supervisor involved,” he said.
“We hear so much about how [someone] did not report an incident and something more drastic happens afterward. It is not that you are tattle-telling, but [bullying] is unacceptable behavior.”
If the bully is a manager, Karolewski suggested going directly to human resources. Employees can report the behavior, present collected evidence and inquire about a company code of conduct. They also can contact an outside agency or conflict resolution committee, he said.
On the management side, an open-door policy is important, according to Perrone.
“You [need] to have a good relationship with your staff. If somebody is feeling intimidated or bullied, they need to know that they can tell you at any point,” she said.
Mattear echoed this idea, adding that management should aim to make employees feel comfortable and take an active role in their work.
“I suggest spending as much time in their workplace as possible,” he said, “even if it is just a walk through the lab. You could pick up on things, get early detection if there is adverse behavior and promptly do [what is] necessary in terms of counseling and re-education.”
If a bullying situation occurs, he said a private, brief meeting should be held with the individual to specify what needs to improve, what services are available and the outcome if the behavior is not rectified.
“I follow the human resources playbook — bring the employees in, transcribe their stories and put them into a personnel chart. This is something that needs to be addressed and a path forward needs to be implemented,” he said.
“Management needs to take it seriously,” Perrone added. “I have seen over and over again where complaints get filed and nothing happens. In those cases, [the workplace] becomes wide open for anyone to behave unprofessionally. If nothing happens when an employee files a complaint, they will not come to you with concerns in the future. They may just continue to work and manifest depression or being disgruntled, they may leave or they may even file legal action as a result.”
Managers can create an office code of conduct that defines disruptive behavior and procedures to address it. Perrone suggests holding regular training for managers and employees to reinforce company policy.
Setting the tone
Perrone said ultimately, education and leadership will set the tone of the company, and that tone should be one of mutual respect and collaboration.
“We have to put up with all kinds of things from the outside world, but when you come through the work doors, it is an environment that we should make positive not only for ourselves, but for our patients,” she said. “We train for decades on how to make an AFO or how to fit the latest prosthetic knee out there. We also need the soft sciences — training on listening skills and communication skills. Developing that is not always easy; it takes practice, but at the end of the day, it is no different than learning how to fit a leg.” – by Shawn M. Carter
- Workplace Bullying Institute. Available at www.workplacebullying.org. Accessed April 1, 2016.
Disclosures: Karolewski, Mattear, Oros and Perrone report no relevant financial disclosures.