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Posted February 20, 2018

Confront Bullying with Tough Conversations

By Lynne Cunningham, MPA, FACHE

We’ve all been there. We see someone intimidating, belittling or otherwise harassing another person. It’s a stressful situation, and it can be hard to know how to respond – especially for leaders.

There are six reasons we fear or hesitate to have necessary tough conversations:

  1. We don’t have the skills necessary to have the conversation in a professional manner.
  2. The behavior has been going on a long time, and we’ve never said anything previously.
  3. The employee’s annual performance review is coming up, and we think it will just be easier to wait for that opportunity to discuss the offending behavior.
  4. The employee gets emotional anytime you make suggestions for improvement.
  5. The employee’s best friend (neighbor, sister, fellow church member – you get the picture) is a prominent physician, board member or executive team member.
  6. We’re afraid of the employee because they have a reputation for reacting negatively, pouting or taking it out on other employees (or patients) when they are corrected or coached.

That last reason is nothing less than bullying, something we’ve all heard a lot about in recent years.


Hiring for Values and Standards
Many organizations wait until new employee orientation to have associates sign off on the organization’s standards of behavior or values. I think that’s too late. Potential team members should agree to these standards BEFORE they receive a job application. Wouldn’t it be better to find out they were unwilling to sign your organization’s standards of behavior before you invest time in the hiring process?

Once the associate or provider has signed the standards of behavior, it’s critical that they are held accountable to role model them. Yes, you noticed that I included providers. Whether your physicians, dentists or advanced practice professionals are salaried or part of a voluntary medical staff, signing the organizational standards should be part of the credentialing and re-credentialing process.


So, who should be considered a bully?

  • Someone who consistently manages down a co-worker is bullying. This behavior might be in front of others, but it also could be in communications with the individual when no one else is around.
  • Anyone who throws a tantrum – yelling, screaming, throwing things and swearing are all signs of bullying.

After reading my latest book “From Difficult to Doable: Three Models for Having Tough Conversations Successfully,” many have told me they found it interesting that it’s not just physicians who bully others. Bullies also include nurses, pharmacists and other healthcare professionals. Lately, I’m getting more and more requests to cover bullying when I speak to healthcare audiences at Leadership Development Institutes and other engagements. So, who’s bullying today? In addition to the politicians, actors, TV personalities and executives we read about daily, I’m hearing about executives in healthcare organizations who bully colleagues on the executive team, leaders and employees. Then, of course, there are the more traditional clinical professionals such as physicians who feel it is their “right” to bully newer doctors because that’s how they were trained, or nurses who “eat their young.”

The research cited in my recent book includes several excellent books by other authors. One of the best, I think, is “When Nurses Hurt Nurses” by Cheryl Dellasega, who shares some scary statistics. She estimates the incidence of nurse-on-nurse bullying somewhere between 40 and 70 percent. The reason people outside healthcare should be concerned about this is that bullying leads to poor communication, which ultimately compromises teamwork. And that can put patient safety at risk. When asked how common they thought bullying was in the workplace between adult women, 73 percent answered “common” or “very common.” In their opinion 16 percent of the women they worked with were bullies, 27 percent were victims and 39 percent were bystanders. Thirty-five percent of nurses leave their jobs because of verbal abuse and 70 percent have said that abuse from physicians caused errors and reduced productivity. Another study showed a 50 percent higher rate of absence from work among those who had been bullied.

So, what do you do when confronted with a workplace bully? Typically, I think there are three responses:

  1. Join the bully and become another bully.
  2. Get out and leave the employer.
  3. Become a victim. 

We need to have a fourth option. We must develop the ability to have a respectful conversation with the bully, ensuring they hold up the mirror to see the dysfunctional behavior for what it is and change the behavior.

Typically, when we think of having a tough conversation in the workplace, we anticipate addressing tardiness, dress code, use of personal cell phones while on duty, etc. I think the three models I recommend for these types of tough conversations could also be applied to bullying.

The first model is called the Stub Your Toe conversation. This is a “sandwich conversation” in which constructive criticism is “sandwiched” between positive feedback. Use this model when you have seen or heard behavior that is inconsistent with the organization’s standards of behavior or values.

Next, use the Impact Message tough conversations model with colleagues (peer-to-peer), employees or supervisors when a behavior appears to be consistent and is disruptive to the organization. This model gives you an opportunity to explain the “why”– why the behavior needs to change or the impact it’s having on co-workers and patients.

And finally, when initial conversations haven’t been successful in stopping the bullying behavior, the Low Performer Conversation model is needed. A low performer is someone who has consistently been abusing organizational guidelines and needs to hear the message that behavior must change or employment will be terminated. This conversation model should be held between the leader and the employee.

Bullying is harassment. If after talking to the offender, there is no change in behavior, you should report the bullying up your chain of command. Talk to your supervisor or your Human Resources Department.

The hardest part of having a tough conversation is holding the offending party accountable for changing their behavior. In the short term, this will require time and vigilance. In the long term, the offender will either change their behavior or give you sufficient ammunition to take the conversation to the next level, place the individual on a performance improvement plan and prepare to move the offender out of the organization if performance/behavior doesn’t improve.

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