Bullying and Harassment in the Health Sector

Tabled: 23 March 2016

4 Responding to bullying and harassment

At a glance

Background

WorkSafe, the occupational health and safety regulator emphasises two key controls for effectively responding to inappropriate behaviour including bullying and harassment—early intervention, which involves self-managing inappropriate behaviour or seeking line management support to resolve issues, and robust formal complaints processes.

Conclusion

No audited agency could demonstrate that either early intervention or the formal complaints process was effective for their staff. This means that both early intervention and formal complaints of bullying and harassment are not receiving the priority or attention they demand.

Findings

  • Despite its importance being widely acknowledged, it is not possible for the audited agencies to determine the effectiveness of early intervention because they do not collect data or have mechanisms to ensure that managers are effectively resolving issues informally.
  • Focus groups and interviews identified that early intervention is inadequate.
  • An in-depth review of 33 formal complaints files found that there were extensive deficiencies at each step in the process.

Recommendations

That health sector agencies:

  • record issues related to inappropriate behaviour resolved through early intervention
  • with staff feedback, develop strategies to address reporting barriers and implement and monitor these strategies
  • establish and deliver a robust formal complaints process
  • review and strengthen the capacity and capability of their human resourcesdepartments to deliver a consistent organisational approach to preventing and responding to inappropriate behaviour including bullying and harassment.

4.1 Introduction

WorkSafe, the occupational health and safety regulator, emphasises two key controls for effectively responding to inappropriate behaviour including bullying and harassment:

  • early intervention, which involves self-managing inappropriate behaviour or seeking line management support to resolve issues
  • robust formal complaints processes.

4.2 Conclusion

No audited agency could demonstrate that either of the key controls—early intervention or the formal complaints process—are operating effectively. No assurance mechanisms were in place to ensure managers are responding to issues brought to them effectively, or at all. The effectiveness of the formal complaints process is undermined by:

  • high levels of known under-reporting
  • inadequate complaints management systems and practices, including inconsistent or absent record keeping and documentation.

4.3 Ineffective early intervention

Early intervention is widely acknowledged as preferable to undergoing a formal complaints process, as it prevents escalation and reduces the impact of the issue or incident. Despite this, no data, mechanism or process exists in any audited agency to determine whether early intervention is effective or routinely implemented as a first step across the organisation. It is encouraging to see that two audited agencies have recently introduced a requirement to log all incidents they respond to—not just the formal complaints—as a mechanism to better understand the size of the problem in their agencies.

However, the majority of focus groups with line managers, staff, and junior doctors and paramedics (12 of 17 focus groups) indicate a perception that early intervention is largely ineffective and, as a result, there is little trust in this process. This also highlights the inadequacy of human resources departments to support line managers to fulfil this necessary function. The focus groups expressed a number of concerns:

  • Line managers may be sympathetic but do not take action or are ineffective—which sometimes results in escalation of the inappropriate behaviour, including counter allegations of bullying.
  • For some participants, there is reluctance to go outside the ward or team, as this may highlight internal team problems.
  • If the line manager was complicit in the inappropriate behaviour, it was not possible to raise the issue with another line manager because of a perception that 'all managers are friends'.
  • There was little knowledge of independent avenues of support—this was particularly the case for junior doctors and paramedics.
  • There is fear of the repercussions that may result from raising an issue, such as:
    • damage to an individual's reputation
    • unfavourable performance reviews
    • unreasonable rostering
    • transfer to another work site
    • non-renewal of contract.

These issues are particularly relevant for certain groups of staff—for instance, shift workers such as nursing staff and those working in an organisation with a devolved regional structure such as Ambulance Victoria.

Line manager focus groups reported that, at times, they were prevented from taking action when issues were raised with them because the person raising the issue requested confidentiality and that no action be taken. This is another indication of fear of potential repercussions. Line managers reporting this experience felt that they were bound to keep the person's confidence, but expressed frustration at being unable to act.

The capability of line managers to effectively respond early to inappropriate behaviour was reported as a significant issue across all audited agencies. Five of six focus groups with line managers reported that they did not feel confident to handle complaints about inappropriate behaviour including bullying and harassment brought to their attention. In addition, focus groups at all levels and interviews with senior managers stated that line managers were not equipped to effectively manage such behaviour. This belief was reported in:

  • 11 interviews with senior management from the audited agencies (including board members, chief executive officers, executive team members, human resources managers and senior clinical staff )
  • five of six focus groups with line managers
  • five of seven focus groups with staff
  • three of four focus groups with junior doctors and paramedics.

4.4 Inadequate management of formal complaints

No audited agency could demonstrate that it systematically responds effectively to formal bullying and harassment complaints. Significant inadequacies in the formal complaints process were identified. These inadequacies confirmed the negative perceptions of the complaints process reported by focus groups from all levels of the organisations, as detailed in Parts 2 and 3 of this report.

An in-depth review of 33 formal complaints files from four audited agencies found that there were extensive deficiencies at each step in the process, indicating that serious formal complaints of bullying and harassment are not receiving the priority or attention they demand. Documentation was generally poor or absent, meaning that it was impossible to understand trends related to bullying and harassment. It was clear that policy and procedures are consistently being breached. Shortcomings are detailed in Figure 4A and include:

  • incomplete documentation and record keeping including missing witness statements, interview records, investigation reports, outcomes of formal complaints and documentation authorising staff termination
  • key complaints file information not being logged into a system that would enable analysis, monitoring or identification of trends
  • investigation practices that are inconsistent, incomplete and lacking any justification or transparency
  • no effort to address the underlying organisational factors that may have contributed to the behaviour
  • failure to communicate key information, such as the right of both parties to seek a review of the decision.

Figure 4A

Limitations of complaint management practices identified through review of complaints documentation

Issue

Comments

Incomplete documentation and record keeping

All four audited agencies had significant gaps in documentation and record keeping.

  • Witness statements—10 of 33 files reviewed did not include witness statements.
  • Investigation reports—nine of 33 files reviewed had no investigation report or rationale for the result. This included two complaints with no documentation authorising staff termination.

Logs of complaints not maintained

Only one audited agency could provide a log of complaints when requested. The other three audited agencies did not maintain a log of complaints to track key information.

  • Two audited agencies were able to develop a log, with significant manual effort, when requested.
  • One audited agency was not able to provide a complaints log at all and admitted being unable to provide a reliable calculation of the extent of bullying and harassment due to inconsistent and absent coding of bullying and harassment incidents, and separate unlinked files for different stages of the same complaint.
  • One audited agency has had no complaints and, therefore, has no data management systems, despite a prolonged bullying situation over many years—absence of complaints can highlight risk.

Timeliness of the response

  • 44 per cent of complaints listed in the logs did not include complaints receipt or closing dates.
  • For the remainder, time taken to resolve complaints was longer than specified in policies—between two and six months.

Investigation practices

  • There was no mention of how investigative teams were formed, or the appropriateness or skills of the investigators. Only one audited agency specified that investigators must be trained in bullying and harassment policy.
  • 27 per cent did not provide a rationale or evidence for the investigation outcome, with two audited agencies not providing this information in four of six of the files we reviewed.
  • 30 per cent of files did not have witness statements or meeting records, with three audited agencies failing to have these documents in between 33 and 50 per cent of their files.

Actions taken in response to substantiated complaints

  • Only three of 33 complaints files reviewed resulted in responses that were not confined to the individuals immediately involved. These three responses included team coaching and values workshops. Other responses focused on disciplinary measures such as counselling, warnings, training, and suspension. Inadequacies with the complaint management system prevent recognition of trends and underpinning organisational factors that have contributed to the complaint.

Actions taken in response to unsubstantiated complaints

  • Only two of five audited agencies included in their policies that action may be taken in response to unsubstantiated complaints. Focus groups across all audited agencies consistently perceived that no action occurs as a result of raising an issue either informally or formally.

Parties not told of mechanisms for review of the decision

  • None of the complaints files reviewed advised complainants or respondents that the result of the investigation could be reviewed.
  • In one case, the complainant requested options for review but was told that mediation was the only avenue. This suggests a failure to provide adequate information regarding the external avenues of review which are required to ensure natural justice.

Source: Victorian Auditor-General's Office.

These inadequacies are consistent with the experiences reported by participants in the focus groups and the public submissions. Issues identified through this process included:

  • lack of trust in the capability and authority of human resources departments to respond effectively to complaints
  • lack of trust in the independence and impartiality of the process
  • lack of trust in the transparency and confidentiality of the complaints process, including the adequacy of the investigation process
  • inadequate timeliness of the response
  • failure to provide opportunity to seek review or to have a right of reply
  • lack of support for complainants and respondents during and after the process
  • insufficient action and poor redress, including failure to notify the complainant of the response to formal complaints.
  • Shortcomings with the formal complaints process are also consistent with key themes emerging from the Royal Australasian College of Surgeons (RACS) survey, as shown in Figure 4B.

Figure 4B

Summary of the inadequacies of the complaints process

Issue

Reported in focus groups

Reported in public submissions

Lack of trust in the capability and authority of human resources departments to respond effectively to complaints

8 of 17 focus groups:

  • 2 of 6 line manager groups
  • 4 of 7 staff groups
  • 2 of 4 junior doctor/paramedic groups

Interviews with senior management in four audited agencies

30%

(24 responses)

Lack of independence, transparency and confidentiality of the complaints process

12 of 17 focus groups:

  • 3 of 6 line manager groups
  • 6 of 7 staff groups
  • 3 of 4 junior doctor/paramedic groups

37%

(30 responses)

Lack of support to complainants and respondents during and after process

8 of 17 focus groups:

  • 5 of 6 line manager groups
  • 3 of 4 junior doctor/paramedic groups

23%

(19 responses)

Insufficient action and poor redress

13 of 17 focus groups:

  • 6 of 6 line manager groups
  • 5 of 7 staff groups
  • 2 of 4 junior doctor/paramedic groups

40%

(32 responses)

Source: Victorian Auditor-General's Office and RACS survey (2015).

Interviews with senior management in four audited agencies confirmed a lack of trust in the capability and independence of human resources departments.

The Royal Australasian College of Surgeons Confidential Draft Research Report (RACS Report) identified a similar range of inadequacies in complaints management processes. Respondents expressed a sense of futility in initiating any complaints process with either hospital management or RACS and reported:

  • lack of procedural fairness, transparency and confidentiality
  • belief that complaints are ignored
  • lack of clarity about the process
  • dissatisfaction with the length of time taken
  • perception that senior surgeons collude or, at best, fail to act.

In one audited agency, there was a total failure to provide any support to complainants throughout a protracted and known bullying situation. A small rural health service had no human resources officer, independent employer assistance or OHS representative during a period of entrenched and persistent bullying. The temporary human resources staff employed during this period broke the confidentiality of staff by relaying information to the senior manager who was alleged to be the main bully.

Recommendations

That health sector agencies:

  1. record issues related to inappropriate behaviour resolved through early intervention
  2. with staff feedback, develop strategies to address reporting barriers, and implement and monitor these strategies
  3. establish and deliver a robust formal complaints process
  4. review and strengthen the capacity and capability of their human resources departments to deliver a consistent organisational approach to preventing and responding to inappropriate behaviour including bullying and harassment.

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