Yahoo! reports that a recent study by the Workplace Bullying Institute showed that bullying — defined as “abusive conduct that is threatening, intimidating, humiliating, work sabotage, or verbal abuse” — is a problem at nearly half of all US workplaces.  They also found that 27% of all adult Americans have directly experienced it, 21% have witnessed it and 56% of perpetrators are bosses.

More discouraging, the study found that employers are doing little to combat bullying. Among employers who had received complaints about bullying, only 12% established policies to combat bullying, and only 6% reported a zero-tolerance approach to eliminating it.  And, the researchers also found that all this bullying has a high cost in employee turnover: 61% of employees who were victims of bullying either quit, were fired or were forced to quit.

Medical practices exist to help patients, and usually most of the employees in a practice were attracted to the field for that reason — so you wouldn’t think that bullying could be a problem in the practice workplace. But bullying is something we often uncover in working with practices, especially when we’re brought in because of high turnover or operating problems that the physician owners are having trouble solving.

Despite being rooted in a caring profession, medical practices often have characteristics that make it possible — even easy — for bullying to take hold.  These include:

  • Physician owners are most often with patients and have little time to observe ordinary interactions between staff
  • Physicians often dislike the management side of their practices and become too trusting of and over-reliant on one or a few key managers — who then have too much power
  • Managers spot the opportunity to seek excess power from uninvolved physicians — becoming expert at managing upward and hiding the true nature of their relationships with staff*
  • Physicians may have experienced very demanding, bullying (or quasi-bullying) environments throughout their medical training — and may adopt the same management style almost automatically, without appreciating the costs

When our analysis of a practice suggests that a manager, supervisor or physician colleague may be creating a threatening environment for staff or employed providers, the physician owners we work with are typically greatly dismayed.  Usually they started their practices with high hopes for a positive culture, and it’s dispiriting to know that they’ve gone off course.  But the impact on the practice can extend beyond an unfulfilled vision.  Bullied employees are often too paralyzed by fear to act autonomously when they should, leading to inefficiencies that hurt the practice and may even harm patients.  For example, we’ve recently worked with practices in which employees too afraid to fill an open, same-day appointment slot to accommodate a patient who needed to be seen quickly or to bring important problems like poorly functioning computers to the manager’s attention for fear of being blamed or harassed. The costs of these behaviors grows silently and steadily, robbing the practice and its patients of efficiency.

Of course, efficiency problems pile on top of the low morale that is created by a bullying atmosphere, and the poor service and turnover that directly result from persistently unhappy employees.

Physician owners are a bit handicapped in spotting and preventing bullying by comparison to other business owners, because they need to dedicate most of their work hours to seeing patients behind closed exam room doors.  But there are a few things physicians can do to become more sensitized to whether or not bullying is happening in their practices, such as:

  • Have regular staff meetings, and watch staff behavior.  Are people afraid to speak up?
  • Monitor turnover.  Has any part of the practice become a ‘revolving door’?
  • Make ‘managing your manager(s)’ a regular practice — hold them accountable for staff morale, career development and turnover
  • Conduct anonymous staff surveys to learn how employees feel
  • Bring in outside help to understand what’s really going on outside the exam room

We often find that managers sometimes become bullies because they incorrectly assume that instilling fear is part of being effective.  Make sure that newly promoted managers are offered training and/or mentoring to help them understand what effective management is — and isn’t. And if a physician partner is creating the impression that “being tough” means frightening or humiliating those on the lower rungs of the ladder in your practice, it’s time to have a frank talk about how all leaders in the practice will be held accountable for their behavior as well.

*Giving managers too much authority and evaluating them only on upward management can also make it easier for embezzlement to occur at your practice.

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