Bullying and Harassment

Workplace bullying can be defined as persistent unacceptable ‘offensive, intimidating, malicious, insulting or humiliating behaviour, abuse of power or authority which attempts to undermine an individual or group of employees and which may cause them to suffer stress’.

Harassment can be defined as conduct which is unwanted and offensive and affects the dignity of an individual or group of individuals. Whether the harassment is intentional or not is irrelevant; the key point is that it is offensive.

As both bullying and harassment are linked to an abuse of power there are clear similarities between the two types of behaviour. However, there is an important difference in that harassment springs from discrimination. While harassment is often aimed at individuals on the grounds of their race, gender or sexuality etc., it can also be a form of bullying. As many forms of discrimination are outlawed by specific legislation, it is important that cases of harassment are identified as such (Unison, 2003).

What is bullying and harassment?

Bullying includes the following situations:

• Shouting, swearing and threatening behaviours
• Humiliation - especially in front of other staff and patients
• Belittling and undermining the work of the trainee especially in front of others
• Sexist, racist, or religious remarks intended to humiliate the individual
• Overloading an individual with work, unreasonable duties, or inappropriate tasks
• Insisting on repeated attendance at the job with early starts, late finishes, outside the stated hours of work in the contract
• Persistently preventing access to the normally expected educational programme or other teaching and learning opportunities within the post
• Intimidation of the trainee with respect to trying to prevent the trainee making justifiable comments or complaints about training and education issues, management or clinical care issues, and most importantly, making complaints about bullying and harassment.
• Bullying by email is a more recent addition, with the sending of repeated messages to harass the individual about work in progress, or other comments about performance, and including other remarks such as those described above.
• Putting trainers and other staff under pressure from trainees and their representatives with regard to issues over a trainee's poor performance. This includes attempts to alter assessment grades where a referral rather than a pass grade has been awarded, and pressure on trainers and programme directors after not being appointed to a post, or a particular placement in a rotation, and so on.

What is not bullying and harassment?

• Constructive criticism and feedback on performance
• Pointing out where improvements may be made
• Giving comments on what went wrong and why
• A referral rather than a pass in an assessment

These will be carried out in a constructive and supportive way, preserving a good trainer - trainee relationship, and usually in a private one to one situation. All of this is good educational practice in respect of giving feedback constructively, and good formative appraisal practice.

All complaints must be taken seriously. There must be the opportunity for a private meeting in confidence. Sometimes the individual may feel under great stress in speaking about such a situation, especially to a senior medical person in authority. Please remember the concepts of power relationships here, as however benign and approachable some of us may feel, we may very well be perceived as senior, high status authority figures by the trainee. It may be useful to suggest the trainee comes with a friend or representative for support.

It is essential to clarify the confidential nature of the meeting, to make notes of what is said, to record who is present, the date of the meeting, and what the problem appears to be. It may be useful to dictate a summary of the contents of the meeting and send this to the trainee (under a private and confidential heading) to the trainee, usually at a home address (NOT the hospital!). Remember to ask what action the trainee wants you to do. Is it just for information, or do they wish an investigation to be carried out?

It is essential to get both sides of the story.

While we do see some cases of bullying and harassment, we do also see situations where trainees complain when they have been quite correctly given feedback about serious deficiencies in performance, or have been given an unsatisfactory assessment, and wish to divert the blame onto their trainer. If you need to go further, ask the trainee's permission to pursue the matter. Always get both sides of the story before wading in! Sometimes you may be amazed at what is really going on, and it may be quite different that what you first thought.

Sometimes it may be necessary to act quickly, especially in situations where the safety of patients is at stake, or where the law appears to have been broken.

Resolving the complaint

Remember that a complaint of bullying and harassment is very distressing for the trainee, but it is also very distressing for the trainer to be accused of such a thing. You must give the trainer the right to give their side of the story, to obtain supporting evidence and to make amends if appropriate.

Informal resolution

The Wales Deanery supports an informal process of dealing with such an allegation if at all possible. This will be by discussion and conciliation whenever possible. If the situation is resolved the training may continue in the present post. Often, however, the trainer - trainee relationship has broken down and it may be best to remove the trainee from their present post and place them in another post with another educational supervisor, preferably in the same location. In a general practice setting, it may be best to move the trainee to another training practice. In all cases, there must be a follow up meeting arranged to check on satisfactory progress and ensure that the trainee is satisfied with the new arrangements.

Formal resolution

In some situations, a formal approach may be necessary. For this to be undertaken, written statements need to be made, with details of actual incidents, dates and times, and any witnesses. The Deanery will want to ensure that both parties give their side of the story. It may be necessary, in hospital practice, to hand the information to the LHB's medical director or director of human resources, depending on the Bullying and Harassment Policy in the LHB. In general practice the formal approach will need to be handled by the relevant Associate Dean at Deanery level.

A formal review panel should consist of:

• A postgraduate dean or nominated deputy
• The Professional Support Unit
• Specialty Performance Lead or nominated member of STC
• A trainee representative

If a formal procedure upholds the complaint, this may result in a recommendation for:

• Re-training of the trainer / trainee
• Withdrawal of training status from the trainer (including removal from future recruitment processes)
• Moving the trainee to another post in a different environment
• Referral to the Medical Director of the LHB for further action (in a case of bullying by a senior nurse, hospital manager or other hospital employee for example)
• Referral to the General Medical Council in extreme cases

(If a trainer has his / her training status withdrawn, this may be for up to two years, and the individual concerned will need re-training and re-assessment as a potential trainer before being re-instated as a trainer)

Awareness of the issues of Bullying and Harassment

Within the Performance workshops offered through Postgraduate Centres by the Wales Deanery we will ensure that such issues are raised and all those who have responsibility for trainees are made aware of such issues. We will continue to build up the training of our trainers to even higher levels, to help foster a positive and constructive educational climate in all situations where we place trainees. We distribute ‘Bullying & Harassment Awareness’ Leaflet to all Postgraduate Centres, so all individual trainees and others are aware.