Sweating the small stuff

It is a stomach-churning reality that the NHS rests on bullying the people who work in it This “endemic culture of bullying” has facilitated a growing crisis of structural discrimination and racism, staff burnout and stress, and with it a risk to patient safety.  Getting a perspective on bulling is difficult because it requires facing up to some hard facts of life - that bullying in the NHS is likely to get worse as the financial crisis deepens and that whatever our role we are all involved in bullying at work.  Understanding bullying Bullying is not an exact science, its something like “the repetitive, intentional hurting of one person or group by another person or group, where the relationship involves an imbalance of power” - underlining the structural inequalities behind bullying cultures and their impact on our health.  Understanding the dynamic nature of bullying - that it has systemic and individual aspects -  can feel like an attack on the victim. You don’t have to be John McDonnell to think that there’s a connection between austerity and bullying but how bullying has taken hold in the NHS needs more investigation.  Psychoanalytic ideas are profoundly helpful in helping us to understand how bullying in a non-judgemental way - defining it as a psychological and social defence against our own feelings of vulnerability, anxiety and aggression. Under this model bullying is understood as an attempt to project our own vulnerability and fear into other people, something that under the right (or wrong) circumstances we are all capable of doing.  This is not to suggest that everyone is actually a bully - rather that bullying at work is painful in part because we are all involved. Whatever our role – the patients that stand by, the staff that turn a blind eye, the politicians that cut budgets and the bullies themselves - we all have a part to play in bullying becoming established.  Despite everything we know about the necessity of team working in health and social care, where bullying exists we generally don’t challenge it, Common survival strategies include withdrawal from colleagues or to strike up alliances with people who offer us protection. This can include establishing gang-like ways of working - such as blaming and exclusion of people with different views or ways of working.  Gangs, unlike functioning teams, offer a mafia-like organisation where accepting the gang rules protects you from attack but demands utter compliance, a dangerous culture in healthcare where our duty of care demands we raise concerns about patient care.  Another important dimension to bullying is what happens in the mind of the victim when the bully launches their attack. One of the reasons why bullies get under our skin is because they enlist our internal bullies - the voice inside our head which actually agrees with the external bully.  Not wishing to look like I’m punching kittens, in the case of health and social care workers, this internal voice can be loud, efficiently disorienting us and undermining our self-confidence.  Understanding the dynamic nature of bullying - that it has systemic and individual aspects - can feel like an attack on the victim but its a risk worth taking because it is by understanding the nature of bullying that we can start to tackle it.   Sweat the small stuff Having the dubious honour of working on bullying at work for some time, I’m going to do something potentially irritating,  which is to give you a checklist. In my defence it is based on what I have learned from you about how to survive bullying and can be summarised as sweat-the-small-stuff before taking on the bullies.  Step 1: find some higher groundBeing bullied feels like drowning so you first need to get to safer ground. This involves getting out of bullying hot spots; anything from avoiding the smoking breaks or those after work drinks that seem to end up with someone calling you fat and ugly. Or it can be going somewhere every day where you feel safe - from your best friend’s sofa, to train stations or allotments.  Stage 2: bullying bookMethodically write down the times, places and what happened every time you were bullied. Not everything is subjective, there are facts about bullying behaviours so write them down. Keep the book at home and only ever open it when you’re in a robust frame of mind and definitely when you are not drunk.  Stage 3: get a witnessIt is essential that you tell someone what is going on. They can be someone that has witnessed the bullying or not, someone you like or not, but someone who you trust to keep their eye on you. Telling someone does a number of things. It forces you out of your bunker and makes you admit what is happening.  Stage 4: phone a friendWhether you are a victim of bullying or trying to help someone who is there’s a huge temptation to withdraw from other people. So this brings us kicking and screaming to a really obvious fact of life. Tackling bullying requires doing something totally counterintuitive - making contact with other people and asking for their help. In a bullying workplace, joining a group can give us a profound sense of place and support to make changes. Trade unions are often good at dealing with bullies – they don’t like em, and reps can be dogged in their devotion to shouting back on our behalf when we can’t summon up the strength to do it ourselves.  If you can regain your humanity by taking some small steps you will then be in a better position to make the bigger decisions about how to raise your concerns at work.  Taking a perspective on bullying involves the pain of no longer being able to sweep things, including our own humanity, under the carpet. As any clinician will know, the work of helping other people involves helping ourselves, and this, old chum, is the stuff of blood n guts. It’s not always dignified, you will sweat more and it’s unlikely to go on your CV but it is the basis of tackling bullying. This turns out to be the hardest part because it requires us to stop being heroes and to ask another human being for their help.  From October 2015 we will be running courses on Bullying at Work at the Tavistock Clinic in London.