We know that bullying and incivility take place across all medical specialties, but those working in emergency departments are particularly vulnerable.
Emergency medicine is a diagnostic practice where referral to and interaction with workers from other specialties are a key part of the job. Doctors and nurses of all levels of seniority report often having their skills and experience questioned and undermined by other specialists.
Working conditions in emergency departments (EDs) also coincide with factors that drive bullying and harassment, for example: poor job design; an existence of a particular culture; an over-competitive environment and rigid style of management. We also know that those working in emergency medicine report significantly higher levels of burnout or “moral injury” than colleagues from other specialties.
At the end of October, the Royal College of Emergency Medicine (RCEM) launched its campaign, RespectED, an anti-bullying campaign that aims to raise awareness and address toxic behaviours such as bullying, harassment and incivility between workers in EDs. These negative behaviours can create a toxic working environment, affect staff morale and the delivery of safe patient care.
Jayne Hidderley is chair of the Anti-bullying task and finish group and chair of the Lay advisory group at RCEM. She is a lawyer specialising in pensions and employment law and has researched and advised on whistleblowing and speaking up campaigns. Jayne and RCEM were keen to collaborate with Chris Turner.
Chris was one of the co-founders of Civility Saves Lives, a grassroots campaign designed to raise awareness of the impact of behaviour on the performance of individuals, teams and departments/organisations in healthcare. He came to this after many years of working as a governance lead and the realisation that when the circumstances are poor, patients and workers suffer. For Chris, this is an evidence-based area, and he draws on the ever-increasing body of work that shows negative behaviours result in poorer care and poorer working environments. Conversely, when organisations are seen as being at the more civil end of the spectrum, they have an increase in worker satisfaction, retention and engagement.
The campaign launched with a short video. The message is designed to reach across all ED workers and be easily accessible. The video gives helpful tips on what to do if:
- You are the problem?
- You are the clinical lead in the ED?
- You are a bystander?
- You are a recipient of bullying?
We wanted workers to start having conversations, to think about their working culture and to decide what they wish it to be. Jayne said she felt too often there was a disconnect between what workers reported from their experiences and senior consultants who said, “there is no bullying in my department”. From Chris’ experience, just knowing that behaviour matters (and that poor behaviours frequently lead to poor outcomes) is a good starting place.
The video encourages all workers to complete the National Guardian’s Office Freedom to Speak Up eLearning Speak Up and Listen Up courses and to try different ways of addressing these behaviours. These include using a safe word when a worker sees or hears bullying behaviour, or to try reverse mentoring – when a junior member of staff mentors a senior member of staff. This type of coaching has been used with positive results in the legal sector. We also want EDs to work more closely with their Freedom to Speak Up Guardian.
We launched the campaign at the start of one of the most difficult and challenging times for our EDs, to encourage workers to talk openly and demonstrate support for all colleagues. The feedback we have received has been very positive. Feedback from workers is that they like the video and are referring to it at shift handovers, in training sessions and promoting it at conferences.
The key challenge is keeping it at the forefront of everybody’s mind when there are so many other competing pressures. The aim of the RCEM is to empower every member of our EDs to be able to speak up if they spot these behaviours to make a lasting change.