How aggression and bullying drain hospital capability

A new study reveals the health cost at an organisational level

In October last year, the College of Intensive Care Medicine of Australia and New Zealand revoked the training accreditation of Westmead Hospital's intensive care unit following allegations of bullying and harassment by senior medical staff of trainee doctors.

It was an indictment of the way the principal referral hospital for western Sydney was allegedly treating its junior staff.

A week later, the cardiothoracic surgery department at Sydney's Royal Prince Alfred Hospital lost its right to train doctors after it, too, was accused of bullying junior staff. This time, it was the Royal Australasian College of Surgeons that decided to withhold training accreditation for one of the city's major hospitals.

NSW Health Minister Brad Hazzard says medical specialists have to understand "that this is the 21st century and there is absolutely not one millimetre of room for a culture of bullying or failure to provide respect to every staff member in the area of service".

Bullying can happen in any workplace and there is plenty of empirical research looking at how it affects an individual staff member's health, wellbeing and job performance. But there are almost no studies showing how workplace aggression affects an organisation's overall effectiveness.

New research by academics at UNSW and the University of Sydney could change all that.

'Employee engagement means something very different for individuals than it does for organisations as a whole'


Percentage increase

Markus Groth, a professor in the school of management at UNSW Business School, and Les White, an emeritus professor in UNSW's School of Women's and Children's Health, together with University of Sydney Business School's Anya Johnson and Helena Nguyen, argue that the prevalence of workplace aggression in organisations leads to lower levels of employee engagement, which in turn reduces an organisation's effectiveness.

Their paper, 'Workplace aggression and organisational effectiveness: The mediating role of employee engagement', uses 2011 data from 101 hospitals in NSW about the rates of hospital-acquired infections (HAIs) as a measure of organisational effectiveness.

HAIs are infections acquired by patients during a hospital stay that are not related to the patient's medical condition. A hospital's ability to prevent patients acquiring new infections during their hospital stay is a key performance indicator in the healthcare sector.

This data was cross-referenced with a 2011 NSW Health workplace survey of employees from public hospitals and healthcare facilities regarding workplace aggression (defined as abuse, assault, repeated behaviour that is offensive, intimidating, or which is intended to humiliate or threaten a staff member).

After controlling for community violence, hospital size and survey response rate, the report's authors found that for every percentage increase of staff reporting violence and aggression, there was an average HAI increase of 2.78%.

Together, the two data sets provided the researchers with a rare chance to use organisational-level data to link the prevalence of workplace aggression to an objective measure of organisational effectiveness, says Groth, who has extensively researched issues such as employee engagement and work practices.

"There are very few studies in this area of research looking at the organisation as a unit of analysis," he says. "The fact that we had that data, limited as it was, meant we could do this kind of analysis.

"A lot of the time, we just draw conclusions that, because something happens at the individual level, it must also occur within an organisation; we extrapolate. But employee engagement means something very different for individuals than it does for organisations as a whole."

Emotionally charged

According to Groth, not all employees are affected in the same way by violence and aggression in the workplace. Some may deploy effective coping mechanisms while others may be quite disabled by aggressive behaviour and fear punishment if they speak out about it.

"That is why we thought it was important to look at things at an organisational level," he says.

There are alarming statistics in Australia and around the world about the levels of workplace aggression. In this research, the source of the aggression was not limited to managers or co-workers.

Hospitals are emotionally charged workplaces where patients and their friends and family frequently act aggressively towards staff. When bullying by co-workers or management is thrown into the mix, staff labour under a weight of issues that can detract from their performance.

The authors argue that organisations that fail to foster a work environment free from harm or risk will have employees who feel unsafe and disengaged, which in turn reduces an organisation's overall effectiveness.

"For example, there may be higher levels of sick leave and turnover, as employees withdraw from the workplace temporarily or permanently. Levels of customer complaints may increase as levels of service decline," they write.

"However, while we can assume that these individual consequences will collectively affect an organisation's effectiveness, there have been almost no studies that have provided evidence that workplace aggression affects organisational-level consequences, such as an organisation's overall effectiveness, or the process by which workplace aggression might affect organisational outcomes."

'It’s about how much energy the employee has left in the tank to do their job'


Afraid to speak up

The authors considered a number of things to explain the link between workplace aggression, employee engagement and organisational effectiveness, such as staff's emotional energy and their psychological safety. 

For example, Groth explains that people only have so much emotional energy in the day to do their job.

"Coping with violence takes up some of that energy and often contributes to a drop in performance [by employees]. It's about how much energy the employee has left in the tank to do their job," he says.

If the source of the workplace aggression is management itself, or if management has been reluctant in the past to confront aggression in the workplace, no matter what its source, staff may be afraid to speak up about it.

"If they feel they have to be careful about what they say, that can really drain staff of energy," says Groth.

Not only will employees decide not to report negative behaviour in the workplace, they may also withhold positive comments about how to improve processes or systems in the workplace that the entire organisation could benefit from, he adds.

"Staff will also be less likely to go the extra mile [for their employers], less likely to go above and beyond what they are generally expected to do at the workplace."

The research found that though it is vital proper procedures are in place and all hospital staff are trained to minimise the spread of infections, those efforts will be damaged, to a varying degree, if hospital employees are disengaged because of aggression in the workplace.

"It is another factor to consider. You don't want to detract from any of the other things done to reduce the spread of HAIs but this is another factor that seems to be a predictor of efficiency in an organisation," says Groth.

The report's authors are cautious about assuming their conclusions can be applied across the board, and to both government and private sector organisations.

"We certainly need more research," say Groth. "It is difficult to get the sort of data you need for this research but we are moving into a time when there is more big data available." 


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