Kendall L. Stewart, MD, MBA, DFAPA October 31, 2009

1. Workplace BullyingAn Overview of an Unacceptable Occupational HazardA Presentation for the 2009 SOMC Surgical Services Seminar Kendall L. Stewart, MD, MBA, DFAPA October 31, 2009 1I hope to offer some practical coping strategies you can use tomorrow. 2Please let me know whether I succeeded on your evaluation forms.

2. Why is this important? • Bullying is a common problem on the playground—and in the workplace. • A large number of employees report that they have been affected by workplace bullying—repeated, unreasonable actions intended to intimidate. • Bullying may cost organizations $1.2M per 1,000 employees.2 • Bullying results in stress, increased absenteeism, turnover and a variety of emotional and physical problems. • After mastering the information in this presentation, you will be able to • Describe the extent of the problem, • Give three examples of bullying behavior, • Identify three of the consequences of workplace bullying, • Name three things you can do if you become a victim, and • Specify three steps leaders can take to contain and decrease this unacceptable occupational hazard. 1Rayner and Keashly (2004) 2The bullying of aspiring physicians begins early in medical school. 3The President of MGO was bullying my classmate. “Would you like me to cut this suture . . .”

3. What are some examples of workplace bullying? • Blaming others without justification • Criticizing others inappropriately • Treating others differently • Talking down to others • Exhibiting favoritism • Spreading malicious gossip • Swearing at colleagues • Avoiding or shunning others • Shouting at others • Humiliating others • Being rude or belligerent • Making others the butts of unwelcomed practical jokes • Hovering over others unnecessarily • And so on1,2,3 1The perception of bullying is not a black and white issue. 2My chairman often “bullied” me, but I never felt bullied. 3I asked him to evaluate a patient with conversion hoarseness.

4. What are some of the consequences of workplace bullying? • Stress • Frustration • Resentment • Depression • Anxiety • Mistakes • Demoralization • Dread • Feelings of hopelessness, helplessness and worthlessness • Turnover • Shame1,2 1Bullying regularly occurs in all groups—including church. 2An evangelist told all the “saved” people to turn around and face the rear.

5. How big is this problem?1 1Fisher-Blando (2007)

6. Have you ever been bullied in the workplace at SOMC? 1SOMC Surgical Services Informal Survey, 2009

7. Have you ever witnessed workplace bullying at SOMC? 1SOMC Surgical Services Informal Survey, 2009

8. Why do bullies do it?(Not that it matters!) • They feel inadequate. • Bullying others makes them feel special. • They have observed others doing it.1,2 • They have embraced a pathological work culture. • They have often been bullied themselves. • They feel entitled to do it. • They can get away with it. • They are crippled by maladaptive attitudes and behaviors. • They have a character flaw. • They are not honorable people. 1A fellow student complained to me about being bullied in surgery. 2When he became a surgical resident, his students complained to me about his bullying them.

9. Why do victims take it?(Not that it matters!) • They are not appropriately assertive. • They feel helpless. • They feel inferior. • They feel others will not like them if they stand up for themselves. • They feel pushing back will only make matters worse. • They are fearful they will overreact. • They believe they are supposed to turn the other cheek. • They are used to being treated this way. • They do not believe their superiors will support them. 1A passive patient finally stood up to his wife. 2 “Who is going to dress me in my finest suit for a night on the town?”

10. Why do leaders tolerate it?(Not that it matters!) • They may not know it is happening. • They may not be able to document it. • They may accept it as a normal part of the work environment. • They may be bullies themselves. • They may be weak and inadequate leaders.1,2 1Many years ago I decided to stand up to a fellow executive. 2My colleagues said they were behind me—way behind me.

11. What process should victims follow? • Immediately write down exactly how you feel—but don’t share it. • Write a “police report,” just the facts, with all emotion out of it and place it in your private files. • Ask someone you can trust to tell you the truth whether you are being too sensitive or overreacting. • Accept a genuine apology for an atypical transgression. • Do not accept an apology for a repeating behavioral pattern. • Consider confronting the bully directly. • Go to your supervisor beforehand—unless that supervisor is the bully. • In any event, go to a trusted manager. • Summarize what happened. • Go over your options. • Invite suggestions. • Choose the best option. • Deploy that option. • Develop realistic expectations.1,2 1Very few of the people I’ve fired will speak to me, ever like me or agree that they were in any way to blame. 2After all, I’ve been sued for saying, “Good morning!”

12. What process should leaders follow? • Admit the problem. • Admit that any person with relative power will be tempted to bully others. • If you have power, admit that you are tempted to abuse it.1 • Recognize that bullies will likely behave when they are around you—so you will rare get to observe bullies in action. • Don’t be a bully! • Stand up to those who try to bully you. • Make it clear that disruptive bullying behavior is inappropriate and will trigger unpleasant consequences. • Take a stand. • Encourage fellow leaders to take a stand and then support them when they do. • Tell real stories. • Invite careful documentation. • Conduct an investigation. • Attach consequences to bullying behavior. • Discharge persistent bullies. 1I watched a seminar leader berate an understudy.

13. What have we learned? • Bullies are a common problem in the workplace—and they are a problem at SOMC. • Whether on the playground or in the boardroom, only one thing works. • You have to stand up to them. • This is not easy, but it is much easier for some than for others. • The bully-resistant folks must look after the little kids.1 1This actually happened in our ICU.

14. Where can you learn more?1 • Read Judith Lynn Fisher-Blando’s doctoral research dissertation entitled, Workplace Bullying: Aggressive Behavior and its Effect On Job Satisfaction and Productivity, at http://www.workplaceviolence911.com/docs/20081215.pdf. • Read Burned by Bullying in the American Workplace: • Prevalence, Perception, Degree, and Impact, by Pamela Lutgen-Sandvik at http://healthyworkplacebill.org/pdf/Burned.pdf. • Review a large number of books on bullying in the workplace at http://www.amazon.com/s/ref=nb_ss_2_12?url=search-alias%3Daps&field-keywords=bullying+at+work&sprefix=bullying+at+. • Read the Wikipedia entry on Workplace Bullying at http://en.wikipedia.org/wiki/Workplace_bullying. 1Please visit www.KendallLStewartMD.comto download related white papers and presentations.

15. Are there other questions? www.somc.org SafetyQualityServiceRelationshipsPerformance 