12. Bullying, Threats & Intimidation

If patient safety is to improve healthcare needs to change.

The historical top down approach which has hindered improvement requires a transition into one where decisions are driven from the front line.

Those corporations who’ve introduced front line driven frameworks (e.g. Toyota Production System – see here) provide the highest quality in the most efficient way to their customers.

Transitioning to this approach will not happen overnight. It may occur through numerous small steps – hundreds of thousands of individuals taking on leadership roles each having decided to make a specific improvement. The improvement may be something which appears relatively simple – ensuring an emergency drug is readily available at the point of care, ensuring different medications are packaged differently to reduce their inadvertent administration, or suggesting a change to simplify a data entry form.

‘Still too often our leaders model old fashion and outdated concepts of command and control; concepts of ‘my way or the high way’, that contribute to damaging bullying, sexist and discriminatory behaviours.’

‘We need to embrace a new paradigm of organisational leadership, and move towards a leadership culture that emphasises respect, sees difference and diversity as a source of innovation and energy.’

(Italicised quotes with much thanks from ‘Workplace Bullying: An Adaptive Leadership Challenge‘ by Dr Moira Jenkins)

We all have it within us to take on leadership roles to advance patient safety.

Find an issue, but don’t go alone however much you’re encouraged to do so – obtain the feedback and interest of others. Just as the transition from a top down to a front line driven healthcare culture will not happen overnight, it’s unlikely the specific patient safety intervention one is promoting will happen quickly.

Professor Ronald Heifetz, a guru on adaptive change makes a clear distinction between leadership and authority – watch his video presentation here. Keep just the right amount of pressure on and be as prepared as you possibly can be.

‘An adaptive challenge that benefits a whole organisation (and society) will undoubtedly upset the egos of those who have benefited from the old system of doing things. People in positions of power, people with taken for granted privilege will need to examine their role in perpetuating bullying, sexism and workplace discrimination.’

The quickest, most primitive and often most effective way for authority figures to stop change is through bullying, threats and intimidation. The closer one gets to bringing about change the greater the likelihood for this to happen. These untoward practices permeate throughout healthcare and it’s wise to understand they won’t be fixed by tougher laws, increased penalties and regulation.

True leadership requires a deeper understanding, perhaps of oneself, and of developing a position of influence.

Dale Carnegie wrote his book ‘How to Win Friends and Influence People‘ in 1936. It’s stood the test of time and is still as relevant now as it was when first written. There are many tools within it which will help in achieving change. We thoroughly recommend reading it in full and have summarised some points here, of particular note: Don’t criticise, condemn, or complain, be friendly, avoid arguments, be a good listener, talk in terms of the other persons interests, find common ground…..

Remember, everyone in healthcare wants patient safety to improve.

‘The organisations that thrive will be those that signal the intolerance of poor behaviours at all levels of the hierarchy, and reinforce respectful discourse, and a collaborative approach to leadership. Cultural change will be addressed in a transparent way that will clearly indicate to all employees, and stakeholders, (both internal and external) that the organisation is committed to change.’

We would love to hear your stories and will do whatever we can to help advance your patient safety goals.

This is where we’re up to in achieving specific patient safety interventions –  we realise change won’t happen overnight, however we’ll work tirelessly, keeping just the right amount of pressure on until we see these patient safety improvements.

We sincerely thank you for your support.

8 thoughts on “12. Bullying, Threats & Intimidation

  1. Bad bosses, toxic managers, whatever label, have operated with impunity. Their greatest abuse is terminating the nurse on the unit who is outspoken on patient safety, systems issues, etc. I am trying to advance the discussion on a set of standards that a manager has to navigate through when a subordinate is facing leaving under duress or when the manager wants to end employement. It’s taken me years of emails but I think I have two national level nurse executives willing to get the discussion going.


    1. Thanks John, Bullying, threats and intimidation are rife throughout healthcare. Perhaps it’s partly due to the inherent command top down structure.

      I’m recently reading ‘Team of Teams’ by General Stanley McChrystal – it provides great insight into how healthcare safety can progress.

      I wish you all the best and please let me know if I may be of any help.




      1. Ironically, a photo of a Naval officer was on the desk of my last bad boss. That day former SEAL Retired Rear And. Scott Moore had given a talkin the city. One of the things he said was ” a successful team is cohesive and transparent, meaning there are no secrets among its members …trust is paramount.” I became a victim of secrets. Of deceit. Trust is the expectation that someone is going to act in your interest. Boy did I experience something differently.


      2. Thanks again John,

        Our error reporting systems are designed with this command structure where we only see information on a need to know basis. The problem is that those at the top cannot perceive who needs to know what in order to drive change.

        Is it possible if we were to remove current error reporting systems it would make no difference to front line patient safety?

        Perhaps the best thing that could be done for health care safety is to redesign our error reporting systems to make them much more transparent.



    1. The matriarchal top down management style is so entrenched in healthcare its like the proverbial Sword in the Stone. This past week one of the British royalty announced a campaign to support nurses. That’s what we need. It would take somebody like Michelle Obama. Somebody whom the media hangs on every word. Oprah.


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