Bullying and Harassment in the Health Sector

Tabled: 23 March 2016

5 Sector-wide collaboration and support

At a glance

Background

A systemic response may be more effective when inappropriate workplace behaviour presents as a persistent risk across the health sector.

Conclusion

There is insufficient guidance to support the health sector to adopt consistent better practice in managing the risk of bullying and harassment. There is poor collaboration between the key sector-wide agencies—the Department of Health & Human Services, WorkSafe and the Victorian Public Sector Commission—which is needed to tackle the pervasive challenge of bullying and harassment behaviour in the health sector.

Findings

  • Detailed, tailored guidance on dealing with bullying and harassment in the health sector is absent, superficial, not known or inaccessible to the audited agencies.
  • There is poor collaboration between the key sector-wide agencies, despite each having good data and a role to play in reducing the risk of inappropriate behaviour including bullying and harassment.

Recommendations

That WorkSafe, the Victorian Public Sector Commission and the Department of Health & Human Services:

  • share existing and new data and knowledge to better identify the risk of inappropriate behaviour including bullying and harassment and provide support to health sector agencies with poor safety cultures
  • develop, in collaboration with health sector agencies and relevant parties such as specialist colleges, an effective sector-wide policy framework, principles and approach to building positive workplace culture and respectful relationships
  • support the boards of health sector agencies to understand their responsibilities and requirements for managing bullying and harassment
  • developand promote a set of indicators for health sector boards to benchmark positive culture and reduce behaviours related to bullying and harassment.

5.1 Introduction

With bullying and harassment presenting as a persistent risk across the health sector, a systemic response may be more effective and efficient than responses at the level of individual agencies. Collaboration between key sector-wide agencies could drive improvements and provide detailed guidance and programs that support the development of a safety culture in health settings. Together, the Department of Health & Human Services (DHHS), as the health system manager, and WorkSafe, as the occupational health and safety (OHS) regulator, can draw on work by the Victorian Public Sector Commission (VPSC) to better influence health and safety for workers in the health sector.

5.2 Conclusion

The health sector has insufficient guidance and support to develop consistent better practice in managing the risk of bullying and harassment. There is poor collaboration between the key sector-wide agencies—DHHS, WorkSafe and VPSC—which is needed to tackle the pervasive challenge of inappropriate behaviour including bullying and harassment in the health sector. A limited exchange of valuable information and poor pooling of knowledge represents a missed opportunity to support health leadership—board and executive teams—in need of assistance to reduce this risk in their organisations.

There is an urgent need for stronger sector-wide collaboration to develop evidence‑based best-practice guidance and programs tailored to the health sector.

5.3 Poor sector-wide collaboration

Collaboration remains poor between key sector-wide agencies that have a role in supporting the safety culture of the health sector. VAGO's 2013 report Occupational Health and Safety Risk in Public Hospitals found that collaboration between the former Department of Health and WorkSafe had been poor for a number of years. Although the boards of health services and Ambulance Victoria hold primary responsibility for providing a safe workplace, this audit has shown the need for greater guidance and support to reduce the risk of inappropriate behaviour including bullying and harassment across the health sector. Better sector-wide collaboration is also needed in relation to sharing existing and new data to benchmark, identify and support health sector agencies at risk of poor safety performance.

There have been a number of missed opportunities to date. For example, VPSC has undertaken significant research on bullying and harassment, such as the longstanding People Matter survey, and has prepared a range of guides related to bullying and harassment, building positive culture and better management practice. These documents provide rich information for management to use—however, management teams at audited agencies were not aware of this material. There is an opportunity and need for DHHS to:

  • promote such information to the health service CEOs and board chairs at regular meetings or at appropriate events, to build knowledge of the importance of best practice approaches to addressing this risk
  • work in partnership with WorkSafe and VPSCto develop more detailed best practice guidance for preventing and responding to bullying in the health sector, adapted from VPSC'sresources and underpinned by health-sector-specific analysis of data from the People Matter survey.

As a result of the 2013 VAGO audit, both DHHS and WorkSafe acknowledged the need for greater collaboration, particularly in sharing sector-wide OHS information and responding to emerging OHS risks. However, this has not occurred in relation to bullying and harassment across the health sector—for instance, DHHS and WorkSafe have not worked together to collectively build board capability to help them understand and respond to OHS risks, including bullying and harassment, despite implementing strategies aimed at building the governance capability of boards.

Additionally, WorkSafe does not share de-identified bullying and harassment claims and related complaints data with DHHS, the health system manager. This data could assist DHHS to identify emerging trends and individual health services with potentially poor safety cultures.

VPSC has only recently shared with DHHS limited health sector results from the People Matter survey, including those related to bullying and harassment. This is primarily to inform DHHS's monitoring of patient safety cultures within health services. This information sharing is belated given its importance to identifying health services at risk.

Further, DHHS and WorkSafe have not drawn on the extensive body of evidence and research that VPSC has undertaken on trends in bullying or building positive workplace cultures. Better collaboration between the VPSC, DHHS and WorkSafe could help identify the factors and indicators that assess the strength of a health service's governance, culture and leadership—for instance, VPSC has identified strong correlations between perceptions that the an organisation is not tolerant of bullying with indicators of positive culture and leadership.

5.4 Insufficient guidance and support

There is insufficient guidance and assistance to support the health sector to adopt an appropriate risk management approach to bullying and harassment. Guidance that is available is either fragmented or not sufficiently tailored to the health sector and the unique challenges a hospital environment can pose. Specifically:

  • DHHS provides no guidance on managing workplace inappropriate behaviour or bullying and harassment
  • WorkSafe'sguidance on workplace bullying and harassment does not provide sufficient detail to adequately inform health services.

WorkSafe's guidance is fragmented across different documents and does not reflect the knowledge base that WorkSafe has built through its role as the OHS regulator. It includes minimal instruction in some of the areas in which we identified significant inadequacies. For example, WorkSafe's guidance does not provide information on the use and importance of a risk management framework for managing bullying and harassment, nor does it outline the types of data that can be used to understand bullying and harassment. It provides limited focus on prevention, such as the importance of building strong, respectful workplace relationships and a positive culture.

VPSC provides sufficient guidance to health services through its People Matter survey results. It also provides extensive research and guidance material in relation to bullying, culture, management, capability, codes and standards for the public sector. However, awareness of these resources is low—they are under-utilised and not sufficiently tailored or accessible to health sector management. VPSC produces a number of resources that could provide valuable insight to the health sector:

  • People Matter survey for monitoring employees' perceptions of experiencing or witnessing bullying. Conducted since 2008, the People Matter survey can be disaggregated by sector. According to the survey, the perception that an organisationdoes not tolerate bullying is associated with four key indicators:
    • avenues of redress
    • perceptions of senior leaders
    • perceptions of integrity and support provided by work group
    • perceptions that managers communicate well and are respectful in their treatment of employees.
  • Tackling Bullying guide for responding to immediate incidents of reported or observed bullying. It supports response and prevention by providing guidance on how to accept a duty of care to take action, how to be a supportive manager, how to assess the workplace culture of your team and how to decide what action to take if someone experiences, witnesses or is accused of bullying.
  • Developing Conflict Resilient Workplaces guide for better managing workplace disputes and developing more positive approaches to conflict in the workplace. This guide is designed to assist Victorian public sector leaders and managers to create a working environment in which conflict is managed well and not allowed to escalate. It suggests ways to build commitment to change, review current practice, identify areas for improvement, present options for change and evaluate success.
  • Feedback Matters report provides guidance on the potential effects and benefits of giving informal and formal feedback. Those receiving informal feedback are less likely to report having experienced bullying.The provision of feedback, particularly negative feedback, is one of the most difficult areas for managers, which contributes to its association with allegations of bullying.
  • Managing Poor Behaviour in the Workplace and Talking Performance guides provide guidance on improving processes for managing poor performance and building managers' skills in having conversations about performance with employees, which is seen as a necessary aspect of building a positive culture and preventing inappropriate behaviour and bullying and harassment.

5.5 Building board capability

Neither DHHS nor WorkSafe have developed guidance or provided adequate support to health service leadership—the board and executive—to assist them in acquitting their responsibility to manage the risk of bullying and harassment, despite implementing initiatives focused on improving the governance capability of boards.

DHHS supports improved board capability through the Building Board Capability framework, which it uses to deliver workshops and information sessions. However, board members are encouraged, but not required, to attend.

WorkSafe, as a result of the recommendations in our 2013 audit, has presented to health service boards on their accountability and required approach to managing OHS risks. This presentation does not mention bullying and harassment as an OHS risk, nor does it provide any guidance about prevention and response.

Both these mechanisms could be enhanced to provide greater guidance and information about boards' responsibilities in relation to bullying and harassment risk and other OHS risks.

The national research in Safe Work Australia's 2012 Australian Workplace Barometer, adopted by the Australian Public Service, identified organisational features that predict poor workplace cultures and increase the risk of bullying and harassment. These lead indicators include workplace demands, worker influence over their work and the leadership and management priority given to protecting workers' psychological health and wellbeing. Adoption of these indicators points to a shift toward risk prevention through identifying organisational causes. Indicators such as these could enable boards to better understand, monitor and predict the risk of inappropriate workplace behaviour including bullying and harassment.

Boards reported, as outlined in Part 2, that they require greater support to understand how to monitor and respond to bullying and harassment, including meaningful performance indicators. Leadership is required from DHHS, WorkSafe and VPSC to develop and promote predictive indicators that provide a consistent way for the health sector to monitor and benchmark workplace culture, including the risk of bullying and harassment.

Recommendations

That WorkSafe, the Victoria Public Sector Commission and the Department of Health & Human Services:

  1. share existing and new data and knowledge to better identify the risk of inappropriate behaviour including bullying and harassment and provide support to health sector agencies with poor safety cultures
  2. develop, in collaboration with health sector agencies and relevant parties such as specialist colleges, an effective sector-wide policy framework, principles and approaches to building positive workplace culture and respectful relationships
  3. support the boards of health sector agencies to understand their responsibilities and requirements for managing inappropriate behaviour including bullying and harassment under the Occupational Health and Safety Act 2004, so that public health sector staff receive the highest practicable level of protection
  4. develop and promote a set of indicators that can collectively be used by the boards of health sector agencies to benchmark positive culture and monitor and reduce the risk of inappropriate behaviour, including bullying and harassment.

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