horizontal violence, vertical violence, lateral violence, incivility, bullying, oppression

Bullying in healthcare is finally starting to get the attention it deserves. Numerous studies validate that organizations with a high rate of bullying, have worse patient outcomes. In 2008, the Joint Commission even sent out a sentinel alert mandating that organizations have a policy and process in place to investigate formal complaints of bullying. Many organizations took it a step further and created a code of conduct and a “no tolerance” for bullying – making every employee sign the document in agreement that they “won’t bully.”
BUT HAS BULLYING GOTTEN ANY BETTER?
The answer is no…and I know why.
While intentions are good, anti-bullying programs and codes of conduct don’t work! We saw the same problems with the initial smoking cessation programs. They didn’t work then and neither do our current anti-bullying programs.
SMOKING CESSATION
I’m a former smoker (in my late teens-early 20’s…before my pre-frontal cortex was fully developed!!). When I started nursing school, I knew I needed to quit. However, I couldn’t imagine drinking my morning coffee, driving a car, or having a beer without a cigarette in my hand. Smoking was a habit reinforced by trigger behaviors (driving, coffee, etc).
Then I figured it out. I only focused on NOT smoking but didn’t pay any attention what to do instead.
The same thing is happening with bullying
Most organizations focus on how NOT to behave instead of focusing and teaching people HOW to behave. I’ve seen some of the most robust codes of conduct with specific details regarding inappropriate behaviors (anywhere from cursing to sexual harassment) and the consequences associated with each one.
However, it’s rare that I actually see a code of professional behavior, detailing HOW to behave – assertive communication style (honest and respectful), active listening, managing up, etc.
IF YOU WANT TO ESTABLISH A BULLY FREE WORKPLACE, YOU NEED TO REPLACE BAD BEHAVIOR WITH PROFESSIONAL ONES.
3 STRATEGIES TEACH PEOPLE HOW TO BEHAVE

1.   Create a code of professionalism
You can’t assume everyone agrees or understands professional behavior. So, ask them – what does professional behavior look like to you? Do this as a staff or department meeting and encourage open dialogue among all members of the healthcare team. Get your employees to generate a list of professional behaviors. Create your code of professionalism from that list.

2.   Engage in conversation about professional behavior
The more you talk about professionalism and professional behavior, the more people will start behaving that way. It’s just like the pink elephant exercise. If you tell people NOT to think of a pink elephant – that’s all they will think about. It’s the same thing with talk about professional behavior – if you keep talking about it, they will keep thinking about it and start to behave accordingly.

3.   Debrief when things go bad
Sometimes we aren’t always on our best behavior – especially with the unpredictability of healthcare. We can all get “testy” with each other from time to time. Don’t ignore it but rather have a debrief instead. Whenever someone acts in an unprofessional manner, talk about it, reflect on it and learn from it.
When trying to quit smoking, I thought about alternative activities such as reading an article or chapter in a book while having my coffee, or talking on the phone while driving (maybe not the best activity), the alternative habits gradually took the place of my smoking habit and I’m glad to say that I’ve been smoke free for 30 years! Now if I could just get my daughter to quit!!!
We can do the same thing with bullying – one bad habit at a time!
Thanks for reading. Take care and stay connected