Workplace bullying in NHS community trust: staff questionnaire survey

British Medical Journal,  Jan 23, 1999  by Lyn Quine

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Abstract

Objectives To determine the prevalence of workplace bullying in an NHS community trust; to examine the association between bullying and occupational health outcomes; and to investigate the relation between support at work and bullying.

Design Questionnaire survey.

Setting NHS community trust in the south east of England.

Subjects Trust employees.

Main outcome measures Measures included a 20 item inventory of bullying behaviours designed for the study, the job induced stress scale, the hospital anxiety and depression scale, the overall job satisfaction scale, the support at work scale, and the propensity to leave scale.

Results 1100 employees returned questionnaires--a response rate of 70%. 421 (38%) employees reported experiencing one or more types of bullying in the previous year. 460 (42%) had witnessed the bullying of others. When bullying occurred it was most likely to be by a manager. Two thirds of the victims of bullying had tried to take action when the bullying occurred, but most were dissatisfied with the outcome. Staff who had been bullied had significantly lower levels of job satisfaction (mean 10.5 (SD 2.7) v 12.2 (2.3), P [is less than] 0.001) and higher levels of job induced stress (mean 22.5 (SD 6.1) v 16.9 (5.8), P [is less than] 0.001), depression (8% (33) v 1% (7), P [is less than] 0.001), anxiety (30% (125) v 9% (60), P [is less than] 0.001), and intention to leave the job (8.5 (2.9) v 7.0 (2.7), P [is less than] 0.001). Support at work seemed to protect people from some of the damaging effects of bullying.

Conclusions Bullying is a serious problem. Setting up systems for supporting staff and for dealing with interpersonal conflict may have benefits for both employers and staff.

Introduction

Bullying in the workplace has been recognised as an important issue by trade unions in Britain for about five years. Several reports have graphically

illustrated the pain, mental distress, physical illness, and career damage suffered by victims of bullying,[1-4] but academic study began only recently.[5-7] The most developed research comes from Scandinavia,[8-12] where there is strong public awareness, government funded research, and established anti-bullying legislation.

Bullying presents considerable methodological problems for researchers. A central difficulty is that of definition as no clear consensus exists on what constitutes adult bullying. Although physical bullying is rarely reported, the workplace presents opportunities for a wide range of intimidating tactics. Rayner and Hoel provide five categories of bullying behaviour.[7] These are threat to professional status (for example, belittling opinion, public professional humiliation, accusation of lack of effort); threat to personal standing (for example, name calling, insults, teasing); isolation (for example, preventing access to opportunities such as training, withholding information); overwork (for example, undue pressure to produce work, impossible deadlines, unnecessary disruptions); and destabilisation (for example, failure to give credit when due, meaningless tasks, removal of responsibility, shifting of goal posts).

Most definitions of workplace bullying share three elements that are influenced by case law definitions in the related areas of racial and sexual harassment. Firstly, bullying is defined in terms of its effect on the recipient not the intention of the bully. Thus it is subject to variations in personal perceptions. Secondly, there must be a negative effect on the victim.[7 8] Lyons and colleagues use the following definition: "persistent, offensive, abusive, intimidating, malicious or insulting behaviour, abuse of power or unfair penal sanctions, which makes the recipient feel upset, threatened, humiliated or vulnerable, which undermines their self-confidence and which may cause them to suffer stress" [13] Thirdly, the bullying behaviour must be persistent.[12]

There have been three main approaches to research into workplace bullying. The first has been qualitative and individualistic in perspective, identifying a role for the individual in terms of vulnerability to bullying or a propensity to bully[5 14 15] and elucidating the dynamics of bully-victim relationships. The second approach is descriptive and epidemiological and is usually based on self report.[6 9 10] These studies document the prevalence of workplace bullying, the types experienced, age and sex differences, who is told, what action is taken, etc. The third approach is influenced by theories and constructs in organisational psychology and has focused on the interaction between the individual and the organisation and how aspects of the organisational structure and climate of the workplace may encourage the development of a bullying culture.[11 12]

This study is a survey of workplace bullying in an NHS community trust. The objectives were to determine the prevalence of workplace bullying in the trust; to examine the association between bullying and occupational health outcomes; and to investigate the relation between support at work and bullying.