Does radiology have a bullying problem?

LIVERPOOL - Bullying and harassment are serious endemic problems in some radiology departments, and urgent action is required to promote teamwork and ensure patient care does not suffer, delegates were told on 11 September at the U.K. Royal College of Radiologists (RCR) annual congress.

Dr. Paul McCoubrie, human factors advisor at the RCR and consultant radiologist at Southmead Hospital National Health Service (NHS) Trust in Bristol, U.K., presented the findings of the RCR's pilot study conducted between April and June 2018. He admitted to being deeply shocked and moved by some of the responses.

Bullying can have a horrific impact on individuals, McCoubrie said.

"The stories of the horrific impact on certain individuals was the big surprise," he said in an interview with AuntMinnieEurope.com. "People described how they got very depressed and had to switch jobs, cope with marriage break-ups, and enter prolonged grievance disputes."

Dysfunctional teams are everyone's concern and represent an active threat to patient care, according to McCoubrie, who added that bullying has a negative impact on team effectiveness, cohesion, and harms patient safety, health, and training. It costs the U.K. NHS an estimated 13.75 billion pounds (15.42 billion euros) and contributes to 70% of errors and 30% of perioperative deaths, the Royal College of Surgeons of Edinburgh found.

He and his fellow members of the working party wanted to find out the extent of bullying. They developed a four-page, 30-question paper questionnaire from the 2016 survey on the same topic conducted by the Royal College of Obstetricians and Gynaecologists.

Using purposive (or targeted) sampling, they sent the questionnaire to 280 individuals in 15 U.K. hospitals. All replies were anonymous and the response rate was around 70% (215/280).

Who are the bullies?

The key findings were the following:

• A total of 57 respondents (27%) said they experienced persistent episodes of bullying or undermining behavior in the NHS.
• Of these 57 people, 31 (54%) were men, 25 (43%) were women, and one did not specify their gender; 44 (77%) had qualified in the U.K. and 50 (88%) had trained as a radiologist in the U.K. Also, 21 (39%) were between the ages of 35 to 44, 26 (45%) were 45 to 54 years old, and only 10 (18%) were either younger or older.
• The length of time this behavior had been going on was 12 months in three cases (5%), one to two years in 16 cases (28%), three to five years in 11 cases (19%), and more than five years in 24 cases (42%). Three respondents didn't state duration and eight specifically stated it was either in a previous job or several years ago and not now an active problem.
• The bullying was done by a single person in 24 cases (42%), more than one person in 15 cases (28%), and a group of people in 18 cases (28%).
• A total of 31 respondents said the bullying was done mostly by men (54%), while nine said the culprits were mostly women (16%). Seventeen said they were both men and women equally (30%).
• The three most common types of behavior were persistent attempts to belittle and undermine an individual's work; persistent, unjustified criticism and monitoring of the person's work; and undermining of personal integrity (see table).

"The overwhelming indication is that bullying and harassment is largely from fellow consultant radiologists," McCoubrie said. "Senior consultants were mentioned by 36 (63%) of respondents. Administrators and managers (medical and nonmedical) were also commonly mentioned. Other doctors were cited less commonly, only by nine individuals (16%)."

Impact on the victims

The survey also found the effect on the individual was major (change jobs, sickness) in six cases, moderate (stress that needed help) in 15 cases, minor (demoralization) in 18 cases, and coping (head down) in six cases.

Of those people who had been bullied, 29 (51%) reported it and only four (15%) said it had been addressed and stopped. Of those who decided not to report the bullying, 13 thought it might make things worse, 11 said they were worried about the impact on their career, and eight felt they would not be supported.

Furthermore, a total of 84 respondents (39%) said they had witnessed others being bullied, but only 31 (37%) had reported it. Only 73 (34%) had received any training on how to address bullying.

Overall, the survey identified a concern about the lack of change as well as ineffective, difficult, and hazardous mechanisms and persistent bullies who think they are "untouchable," McCoubrie said, who noted much depends on the culture of the radiology department. On the plus side, radiology fared considerably better than some other disciplines, particularly surgery and ob/gyn, in which a bullying rate of around 40% has been found, he added.

Definitions and the way ahead

A major difficulty, however, is that many definitions of bullying exist, and bullying and harassment are not interchangeable terms, McCoubrie explained. The U.K. General Medical Council (GMC), for instance, states: "Bullying is behavior that hurts or frightens someone who is less powerful, often forcing them to do something they do not want to do."

According to the U.K. Equality Act of 2010, harassment is the "unwanted conduct related to a relevant protected characteristic (age, disability, gender reassignment, race, religion or belief, sex and sexual orientation, marriage or civil partnership, pregnancy or maternity), which has the purpose or effect of violating an individual's dignity or creating an intimidating, hostile, degrading, humiliating, or offensive environment for that individual."

The way forward is to take a zero-tolerance approach, promote teamworking and support radiologists to eradicate bullying, he said. Little hard evidence and clear guidelines currently exist, so there is a real need for more research and further recommendations. In the U.K., this should come from organizations like the Academy of Medical Royal Colleges (AoRMC), GMC, and the British Medical Association.

It's also essential to find out more about what makes some radiologists undermine their colleagues and to help stop bullying happen in the first place, McCoubrie concluded.