The Next Wave of Workplace Bullying in Health Care.

Abstract

Background and introduction: Workplace bullying and incivility have continued to escalate across health care and pose serious risks to workforce well-being, organizational sustainability, and patient safety. This article builds on a prior four-part article series for this journal and examines emerging dimensions of bullying, including mobbing, gaslighting, cyberbullying, remote and virtual incivility, and the misuse of artificial intelligence. Recent data demonstrate a rising prevalence, disproportionate impacts across gender, race, ethnicity, and sexual minority status, and direct associations with burnout, turnover, medical error, and mortality. The piece also reviews the evolving regulatory, professional, and legislative responses to incivility and highlights an organizational quality-monitoring system that has yielded successful outcomes for health care settings. Practice strategies are also provided to mitigate bullying within the current health care workspaces (e.g., virtual or remote, onsite, or hybrid) and foster psychologically safe, ethical, and high-quality health care environments that heed the Quintuple Aim.

Purpose/objectives: Readers of this article will be able to (1) identify historic and current data regarding workplace bullying and incivility in health care, (2) define common terms associated with workforce bullying and incivility, (3) recognize fresh dimensions of workforce bullying and incivility, and (4) apply knowledge regarding quality monitoring systems to mitigate incivility in the health care workplace.

Primary practice settings: Health care organizations and systems, all touchpoints across the transitions of care.

Findings/conclusions: Findings reveal how workplace bullying and incivility in health care have not diminished despite decades of professional standards, position statements, and accreditation efforts. Bullying has further escalated in prevalence, complexity, and harm over the past several decades creating significant risks for workforce well-being, organizational sustainability, and patient safety. COVID-19 amplified workforce stress, disrupted interprofessional relationships, while also accelerating the availability of remote roles. New role opportunities became impediments to effective workforce collaboration that advanced quality and safety concerns across practice settings. Ongoing awareness of the dimensions and consequences of workforce bullying by case management's interdisciplinary composition continues to be a critical way to inform successful standards of practice by all case managers.

Implications for case management practice: Professionals who hesitate to confront and address incidents of disruptive and oppressive behaviors in the health care workspace contribute to poor quality of care. The Coronavirus (COVID)-19 pandemic brought new challenges to health care settings that contribute to high levels of workforce burnout, increased retention and attrition, and create tensions across critical fault lines of interprofessional interactions. In response, new types of bullying and incivility have appeared, fostering a dangerous culture of silence in the industry. This dynamic disrupts patient safety and quality care delivery. Understanding of these negative behaviors ensures greater promotion of workforce psychological safety, while also protecting patients and their families.