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Negative behaviours between healthcare workers are unfortunately common, and past research has demonstrated high levels of psychological distress amongst Australian doctors - putting their psychological safety at stake.  Sadly, bad behaviours tend to cascade down the medical hierarchy, even impacting students.

A recent survey by the Australian Health Practitioner Regulation Agency (AHPRA) reveals the ongoing currency of the issue. Over one-third of doctors-in-training throughout Australia had experienced and/or witnessed bullying, harassment and/or discrimination (including racism) in the 12 months preceding the survey, with interns reporting the highest rates. Significantly, senior staff were identified as the most common source of this bad behaviour - and half of those who experienced bullying, harassment and/or discrimination by a staff member reported that the person responsible was someone in their team. Further, despite contemporary initiatives (such as the Royal Australasian College of Surgeons’ Standards for Supervision, which aligns with training competencies), 43% of medical trainees who reported these experiences indicated the person responsible was their supervisor.

This survey is but one example of the ongoing (and pressing) need for deep cultural change in healthcare, in circumstances where ‘evidence linking unprofessional behaviour and risk to patient safety continues to strengthen’.

However, it’s not just behaviours that constitute bullying, harassment and discrimination (and which can be subtle) that negatively impact practitioners, and the safety and quality of care they deliver. Bad behaviour may be as fundamental as incivility, which may be defined as ‘a low intensity deviant behaviour with the ambiguous intent to damage the target, breaking the norm of mutual respect in the workplace. Uncivil behaviours are rude and discourteous, revealing the lack of respect towards the others’. Whilst the manifestations of incivility (such as rudeness) may be more nuanced, such behaviour can significantly impair practitioner wellbeing, teamwork and patient outcomes - for example, by discouraging the open sharing of information, or seeking of help.  

Negative behaviours may also be in the form of ‘abusive conduct’ such as physical or verbal intimidation, including throwing objects - this has been also referred to as ‘disruptive behaviour’.

Bad behaviour, however subtle, may fuel repeated and/or more harmful behaviour, creating a toxic environment - and potentially a culture of fear, which is counterproductive. Bad behaviour should never be accepted as the ‘norm,’ or justified on the basis of career progression through the medical hierarchy.  

How we treat each other is part of our culture. Disruptive behaviours erode a positive safety culture and contribute to error. Rejecting negative behaviours, and embedding positive ones, is crucial to clinical governance - therefore robust leadership must drive inherent cultural change.

Organisational culture must impress that bad behaviour is not tolerated. This means not only taking measures to mitigate negative conduct, but fostering positive behaviour (which includes creating an environment in which staff feel comfortable to speak up). If we truly focus on the patient (or consumer) at the centre of care, then positive behaviours should naturally follow - by inherently acknowledging and respecting the importance of teamwork, collaboration and communication.

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All accessed on 12/2/22:  

 K. Ivory & K. Scott.  ‘Let’s stop the bullying of trainee doctors – for patients’ sake’.  The Conversation, May 26 2015.  Accessed at:  
 https://theconversation.com/lets-stop-the-bullying-of-trainee-doctors-for-patients-sake-42243 

‘Optimised workforce, optimised outcomes.’ AICG, 7 February 2022.  Accessed at:  https://www.aicg.edu.au/resources/optimised-workforce-optimised-outcomes/ 

L. Stone et al.  ‘Hospital hierarchies are fostering sexual harassment against young doctors’.  The Guardian, 10 September 2019.  Accessed at: 
https://www.theguardian.com/commentisfree/2019/sep/10/hospital-hierarchies-are-fostering-sexual-harassment-against-young-doctors 

J. Medew.  ‘Medical students under pressure amid reports of bullying in Australian hospitals’.   Sydney Morning Herald, 24 May 2015.  Accessed at:  
 https://www.smh.com.au/healthcare/medical-students-under-pressure-amid-reports-of-bullying-in-australian-hospitals-20150524-gh8jq5.html 

‘Medical Training Survey National Report 2021’.  Medical Board of Australia and AHPRA, 31 January 2022.  Accessed at:
https://medicaltrainingsurvey.gov.au/Results/Reports-and-results

‘Resources to assist supervisors’.  Royal Australasian College of Surgeons. Accessed at:
https://www.surgeons.org/en/Fellows/for-educators-trainers/supervisor-support-hub/Resources-to-assist-supervisors

‘What we have done’.  Royal Australasian College of Surgeons.  Accessed at:
 https://www.surgeons.org/about-racs/about-respect/what-we-have-done 

S. Bambi et al. ‘Preventing workplace incivility, lateral violence and bullying between nurses A narrative literature review.’ Acta Biomedica, 30 November 2017.  DOI:10.23750/abm.v88i5-S.6838.  Accessed at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6357576/#ref7 

J. Westbrook et al. ‘The prevalence and impact of unprofessional behaviour among hospital workers: a survey in seven Australian hospitals’.  Med J Aust, 23 November 2020.  DOI: 10.5694/mja2.50849.  Accessed at:  The prevalence and impact of unprofessional behaviour among hospital workers: a survey in seven Australian hospitals | The Medical Journal of Australia (mja.com.au)

D. Katz et al.  ‘Exposure to incivility hinders clinical performance in a simulated operative crisis’.  BMJ Quality & Safety, 2019.  Accessed at:
https://qualitysafety.bmj.com/content/28/9/750 

D. Campbell.  ‘NHS ‘culture of fear' stops nurses raising patient safety concerns’.  The Guardian, 23 April 2013.  Accessed at:
https://www.theguardian.com/society/2013/apr/23/nhs-culture-fear-stops-nurses 

‘Doctors with disruptive behaviours’.  Avant Mutual, 19 March 2018.  Accessed at: Avant - Doctors with disruptive behaviours

S. McCredie. ‘Enough is enough: calling out bad behaviour in medicine’.  Insight Plus, 22 March 2021.  Accessed at:
Enough is enough: calling out bad behaviour in medicine | InSight+ (mja.com.au)