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Avoiding fear in the healthcare workplace [ TheGoodHealthSuite, by Joan Kingsley, 19/11/2015]


Earlier this year, the Good Governance Institute was commissioned to consider and investigate how the NHS carries out reviews of bullying and harassment under the Dignity at Work Policy. This was following allegations of bullying and harassment at Worcestershire Acute Hospitals NHS Trust. The investigation concluded that The Dignity at Work Policy was ‘not fit for purpose’.

The report found “insufficient evidence to conclude that bullying and harassment is endemic at the Trust”. Although the report did find an “inconsistent and confusing” approach to the way staff concerns were addressed. Additionally the report stated that there was confusion about the definition of bullying.

A Culture of Fear

Culture refers to the implicit standards and values that underpin an organization.

However, the culture of many healthcare organizations is permeated with fear. This negatively affects doctors as well as healthcare co-workers at all levels. It is increasingly difficult for doctors to deliver quality care; nerves are frayed and tempers short. Patients feel compromised, anxious, and overlooked; they look to doctors for solutions. In consequence doctors are experiencing unacceptable levels of mental and physical stress.

Fear & the Brain

The Fear-Free Organization book presents Neuroscientific research that shows the damaging effect fear has on the brain.

In common with all mammals, human beings have evolved with eight basic emotions hard-wired into the brain. Fear, anger, disgust, shame and sadness are the flight/fight/fright/freeze emotions related to escape/avoidance; they prepare us to deal with danger. Love/trust and joy/excitement are the two emotions to do attachment and belonging. Surprise can take us in the direction of either escape/avoidance or attachment.

Excessive and persistent levels of fear create changes in the brain. These changes then interfere with the ability to work, to make decisions and to think with clarity and purpose.


Lord Darzi’s 2008 report concluded there that was a ‘pervasive culture of fear in the NHS’ that directly links to bullying and the failure of staff to speak out and report instances of bullying. A 2015 NHS staff survey showed that 24 per cent of staff said that they had been subject to bullying, with 3 per cent of staff saying they had suffered physical violence from managers or colleagues.

According to the British Medical Association (BMA) hospital doctors are worried about being ‘bullied and harassed’ when raising concerns about patient safety. In a study conducted at hospitals throughout Wales 60% reported raising concerns; 60% of those doctors reported instances of bullying or harassment as a direct result of raising concerns; of those 60%, 40% reported that no action had been taken. The report further stated that underpinning the bullying and harassment of doctors were pressures resulting from unfilled staff vacancies; pressure to work longer hours, the drive to meet targets and having to work in inadequate facilities.

What Doctors can do in the face of fear and bullying

A culture of fear is the perfect breeding ground for bullying behaviour. Bullying and harassment cause anguish; they wreck lives, and destroy the fabric of an organization.

The antidote to fear is quite simple – trust. Although building that trust is more difficult, and can only be born from creating and maintaining good relationships. Strong teams working towards a common goal create a defence against fear and encourages everyone to feel like they are ‘in it together’. Good relationships involve honest and open communication and this is particularly important in healthcare when people are being cared for and lives are on the line. However, it is up to leaders to take note, to realise the importance of eradicating fear in the workplace and follow through on stated policies of zero tolerance of bullying to ensure a fear-free organization is produced.