Bullying has more manifestations beyond being argumentative or rude, and can include overloading people with work, spreading malicious rumours, denying someone's training or promotion opportunities, and using social media to humiliate, threaten or offend (NHS, 2022). In a midwifery context, the Ockenden (2022) report into maternity services at the Shrewsbury and Telford NHS Trust cites one staff member who commented that ‘the bullying culture from top down breeds bullying. I used to be proud to work there, but that changed from 2006’.
The British Journal of Midwifery has previously drawn attention to bullying. To take two examples, Newman (2019) observed that, far from bullying being healthcare's ‘dirty little secret’, it was a recurring feature of national news. The author cited a survey of 1500 health professionals, of whom 81% had experienced bullying, and noted that ‘in maternity, women never forget the midwife whose stress led them to be unkind or dismissive’ (Newman, 2019). In a survey of UK and Australian midwifery students, Capper et al (2020) reported that age mediates the bullying experience, with younger students exposed to direct verbal attack, and strategic, covert approaches deployed against older students. They found that ‘midwives, specifically mentors, are the most common perpetrators for both younger and older students’ (Capper et al, 2020).
Confirming the insights from Newman (2019), Capper et al (2021) highlighted the perception that bullying student midwives can ‘place women at risk, in uncomfortable situations, damage rapport and undermines their confidence in students and the profession’. Further, a student's confidence in their ability to provide women-centred care can be compromised as they lose confidence ‘in front of the woman and her family when they are bullied by registered midwives’ (Capper et al, 2021).
The corrosive nature of bullying for both patients and staff necessitates an urgent approach to address this challenge. So, what are the benefits of different methods that aim to prevent bullying in the workplace? This question was asked by Gillen at al (2017) in a Cochrane review of the issue. They investigated five studies with 4116 participants that evaluated victims of bullying, those who were bullies, and the consequences of bullying, such as absenteeism. The outcomes were that two studies found a 5% increase in civility, the opposite of bullying, following organisational interventions. One of the studies also showed a reduction in coworker and supervisor incivility, and the average time off work reduced by over one third of a day per month. Although Gillen et al (2017) concluded ‘that organisational and individual interventions may prevent bullying in the workplace’, they noted that ‘the evidence is of very low quality. We need studies that use better ways to measure the effect of all kinds of interventions to prevent bullying’.
It was hardly encouraging to read the analysis by Dixon-Woods (2022) of the Kirkup report into failings in maternity and neonatal services at East Kent Hospitals University NHS Foundation Trust. It was noted that bullying, harassment and discrimination were endemic at East Kent. Further, Dixon-Woods (2022) made clear that bullying and harassment policies at the trust required complainants to speak with the subject of their complaint informally. Dixon-Woods (2022) noted that ‘this was a deeply misguided approach, since the trust comprehensively failed to ensure that it was safe to do so’. On top of evidence of racial abuse cited in the report, it is no surprise that Dixon-Woods (2022) considered that the ‘chillingly recurrent discovery of the same failings in report after report in maternity care and elsewhere represents an unforgivable forgetting of painful lessons’.
Given this dark outlook, are there any signs of light that could illuminate an otherwise bleak landscape? In a Canadian study, Darling et al (2023) sought to understand the factors that contribute to and negatively impact Ontario midwives' mental health, using a mixed-methods approach with 275 midwives that included focus groups, interviews and an online survey. Participants highlighted the importance of having specific and dedicated human resources personnel in clinics to avoid conflicts of interest that might arise, for example, in relation to addressing bullying and harassment issues. Many noted ‘the potential benefits of having an outside party in terms of accountability and to help ensure changes actually happened or were implemented within practices’ (Darling et al, 2023). Five broad recommendations from Darling et al (2023) that could, even obliquely, help to mitigate bullying cultures are the provision of diverse work options for midwives, ensuring that the impacts of trauma on midwives are addressed, promoting healthy midwife-to-midwife relationships, and encouraging improved respect and understanding of midwifery.
Interestingly, the American Medical Association (2021) suggested tactics to generate a positive organisational attitude towards addressing bullying. These include surveying employees discreetly to evaluate their perceptions of the workplace culture and the prevalence of bullying behaviour, demonstrating to employees that their feedback is taken seriously, encouraging open discussions to enable employees to talk freely about problems and/or encounters with bullying behaviour, ensuring prompt interventions to address reports of bullying behaviour, and enforcing consequences for perpetrators of bullying.
The verb ‘bullying’ has been part of the English lexicon since the 18th century; one might hope that it will disappear in the 21st century.