Dr Carly Atkinson’s literature review of bullying and harassment at work won the inaugural Denis D’Auria prize. This is a summary of her conclusions and their practical implications for occupational health (OH) practitioners. This article is a concise summary of a comprehensive review of literature from 2005 to 2009 on bullying and harassment at work, and addresses the limited literature available up to 2005. It offers a critical appraisal of 27 papers. The evidence suggests that the prevalence of bullying was increasing and had physical and mental health effects on individuals. It also had consequences for the employer, such as reduced job satisfaction. However, the association with some outcomes, such as propensity to leave a job, was variable. None of the studies evaluated interventions by OH services, or discussed the role of OH. Only three papers met the criteria for acceptance as type IV evidence in the Health Evidence Bulletin Wales critical appraisal tool for qualitative studies, highlighting the need for better quality research, particularly regarding interventions. The degree of OH involvement is likely to depend upon the nature of the service and the needs of the organisation. The study covered: epidemiology – its prevalence in various occupations;
ways of measurement;
outcomes for the individual in relation to health and home life;
outcomes for employment such as sickness absence, turnover, job satisfaction;
occupational health service involvement.
Bullying: the definition was based on that used by Einarsen, Raknes and Matthiesen (1994): “A person is bullied when he or she feels repeatedly subject to negative acts in the workplace, acts that the victim may find it difficult to defend against.” An added criteria was that the bullying had to be over a period of at least six months. This is used in a substantial proportion of the literature to establish that the process was persistent and not an isolated event. Harassment: the definition used is the one from Acas (2009) which is well established and respected. Critical appraisal
Only one tool – the Health Evidence Bulletin Wales tool (2004) – met all the important criteria for evaluation of cross-sectional studies, and this was, therefore, used in this study. To provide a consistent approach, the Health Evidence Bulletin Wales critical appraisal tool for qualitative studies was also used. Discussion
This review revealed a huge variation in the prevalence of bullying – from 1% (Agervold, 2007) to 97% (Fox and Stallworth, 2005) – depending on the definition of bullying and the approach used to measure it. Studies using an operational approach, eg the Negative Acts Questionnaire (NAQ) or Leymann Inventory of Psychological Terror (LIPT) found prevalence rates of between 4.7% (Agervold, 2007) and 31% (Simons, 2008) for exposure to at least one negative act at least once a week for six months. This is higher than previously documented by Zapf et al (2003), who found the prevalence using this method in European countries to usually be 3%-7%, although they did comment that some studies had higher values. This suggests that bullying is becoming more prevalent. Other studies that were not specific about the number of negative acts over six months to five years had higher prevalence values of between 30% (Cheema and Ahmad, 2005) and 97% (Fox and Stallworth, 2005). Self-reporting of bullying, preceded by a definition, varied in prevalence from 9.4% (Lutgen-Sandvik et al, 2007) to 21% (Simons, 2008) compared with 1%-4% in Zapf et al. Self-reporting of bullying without a definition, ranged from 1% (Agervold, 2007) to 47% (Bilgel et al, 2006) in this review, compared with 10%-25% in Zapf et al. However, no previous studies on the latent class cluster method of measuring bullying were available to enable comparison. Original research
Dr Carly Atkinson won the inaugural Denis D’Auria prize for her dissertation “The role of occupational health in the management of bullying and harassment in the workplace: an evidence based literature review”. This is a concise summary of her review. Her educational supervisor was Dr Michael Glenn.
The majority of studies on bullying examining outcomes relating to health found an association with mental health effects and some physical symptoms. This is similar to previous literature reviews. However, two studies found no significant difference with those that were not bullied. (Pranjic et al, 2006; Sa and Fleming, 2008). It must be stated that while an association has been found in many studies between bullying and health outcomes, it is impossible to say whether bullying has caused the ill effects or contributed to them, or whether there is a different explanation. It may be that someone who is depressed perceives a situation in an alternative way, making them more likely to feel bullied, or that they are less likely to be able to cope with negative situations at work. The association between bullying and employment outcomes appears to be less clear. The findings in this literature review are similar to others in that there does not seem to be conclusive evidence that links it to a propensity to leave one’s job and increased sickness absence (Moayed et al, 2006 and Hoel et al, 2003). However, there appears to be more evidence to support an association with reduced job satisfaction (Moayed et al, 2006). The prevalence of sexual harassment in this study ranged from 35% (Berdahl and Moore, 2006) to 76.5%, (Sims, Drasgow and Fitzgerald, 2005), which compares with 50%-76% in previous studies. In this literature review, sexual harassment was found to be associated with reduced physical and mental health and was also associated with some employment outcomes such as reduced satisfaction with colleagues (Buchanan and Fitzgerald, 2008) and increased turnover (Sims et al, 2005). This is supported by previous literature review findings. Racial harassment was associated with increased stress and reduced satisfaction with colleagues (Buchanan and Fitzgerald, 2008). Again, as with the bullying literature, it must be stressed that studies that show an association between two things cannot actually conclude that one has caused the other. There were no studies identified that looked at evaluating interventions for bullying or harassment. However, there was one that did not meet the inclusion criteria but examined destructive interpersonal conflict in the workplace. While this evaluated some interventions, there was not enough data for conclusions to be drawn (Al-Daraji, 2008). The research report on the Dignity at Work Project was designed to look at strategies that could be used by organisations to combat bullying and harassment at work. It highlighted different types of intervention relating to three zones – the prevention zone (dealing with the negative behaviours), the intervention zone (where the target is enquiring or making a complaint) and the failure zone (where the target wishes to pursue litigation) (Rayner and McIvor, 2009). Bullying prevention
In order to prevent bullying and harassment at work, the antecedents and the culture of an organisation need to be understood. The majority of the literature published on the management of bullying and harassment in the workplace supports the provision and implementation of a policy, provision of information and training of staff, and secondary prevention with mechanisms of support once bullying or harassment has been declared. It is important to have a clear policy on bullying and harassment at work. It has been suggested that it is better to keep these issues together in one policy, with terms having a broad definition, rather than have separate policies for different types of behaviour (Rayner and McIvor, 2009). This is often called a “dignity at work” policy, which then needs to be clearly communicated to all staff. However, seeing as people are often promoted into managerial positions with no formal training or experience in managing staff, dealing with such situations can sometimes be difficult. It is therefore critical that staff, including managers, should have effective training on the policy and should feel confident to address any negative behaviours at an early stage. While issues should be dealt with promptly, another mechanism of giving or receiving feedback is through regular appraisal of staff (Cartwright and Cooper, 2007). Often issues can be dealt with quickly and informally by these methods to the benefit of all concerned. The policy also has to be effectively implemented when a problem has been identified. When a member of staff decides to take formal action, this should involve a meaningful and impartial investigation of the complaint. This process is often difficult for both the alleged victim and bully and, if not managed effectively, can actually add to the stress experienced. Mediation, a voluntary process requiring the willing participation of both parties, can be useful in some situations if it is used early (Lewis, 2006). Adequate support during this process is vital to all parties. Colleagues and family members have an important role to play during this type of situation (Lewis, 2002). Other means of support include counselling services, online information such as Bullyonline and organisations such as the Andrea Adams Trust. XpertHR resources
Line manager briefing: bullying and harassment Policy on investigating bullying claims
Trade Unions such as Unison and the British Medical Association (BMA) are often involved and provide support to their members. Examples of support from the BMA include askBMA, Doctors for Doctors, and the BMA counselling service (British Medical Association, 2009). Involvement of OH services
Occupational health services are sometimes involved. This is usually in an impartial capacity to ensure that the individual receives support and appropriate treatment if necessary, and to provide advice on fitness for work and rehabilitation. In Finland, OH services sometimes provide mediation (Einarsen et al, 2003) although a degree of caution is necessary. Mediation requires skill and appropriate training and impartiality would need to be safeguarded. One way that OH services should be involved is in the prevention of bullying and harassment in the workplace, seeing as this is part of promoting and maintaining the health and wellbeing of staff. The importance of this has been highlighted in the recent Boorman review of health and wellbeing in the NHS (Boorman S, 2009). This could be achieved by helping with the development and review of a dignity at work policy, by assisting or being involved in training of staff on the issues, or by raising the profile of the impact of bullying and harassment through health promotion activities. How involved OH services become in this issue will depend on many factors, including the available resources, training of the professionals, the size of the organisation, whether it is a public- or private-sector organisation and whether OH provision is arranged in-house or outsourced. Limitations There are limitations with this literature review. The scope of bullying and harassment is vast and individual aspects could not be examined in depth. It included papers published from 2005 to 2009 as most other literature reviews included studies prior to this. An alternative would have been to concentrate on one form of behaviour in greater detail. Non-English language papers were not included in this review, which may have limited the results. One of the main strengths of this literature review is the inclusion of critical appraisal of the studies. Only one previous review on bullying did this and there was none on harassment. Preferably, three assessors would have been used rather than two, although there was no disagreement on the quality of the studies reviewed. Conclusion Evidence available to date on bullying and harassment at work does appear to support a wide impact on both the individual and the organisation. However, it should be noted that the literature included came from many different countries and cultures. In addition, various definitions and ways of measurement were used, which makes meaningful conclusions difficult to draw with confidence. Only three of the studies included were accepted as type IV evidence. This has highlighted the need for better quality research into this subject, particularly regarding the methodology of the studies. It seems as though there is a shift in direction to a qualitative approach to the research which may yield better results. OH services provide an important role in supporting both the individual and the organisation in bullying and harassment at work, although the degree of involvement will vary according to the circumstances. Future research
It would be useful to have more research into evaluating the effectiveness of interventions for bullying and harassment at work. While there seems to be plenty of research available on bullying and sexual harassment, there appears to be less on other types of harassment, for example on grounds of disability. A 2009 study also highlighted that more than one-third of people with a long-term health condition were bullied at work (Public and Commercial Services Union Survey Report, 2009). This is an important issue for OH professionals. Research into the wider impact of bullying would be helpful, as it often has a profound effect on those supporting individuals such as family, friends and colleagues. Selected references Acas. “Bullying and harassment at work. A guide for managers and employers” [online]. Cited on 20/07/2009. Agervold M (2007). “Bullying at work: a discussion of definitions and prevalence, based on an empirical study”. Scandinavian Journal of Psychology; 48, pp.161-172. 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