Bullying and harassment: NHSScotland PIN policy

1 The power of a dignified workplace

1.1 Introduction: Targeting bullying and harassment in NHSScotland

NHSScotland comprises 22 separate employers employing a combined total of circa 150,000 people in over 100 different job families. Each organisation is striving to be the best at what it does, whether delivering or supporting the delivery of quality healthcare, improving health or reducing inequalities, whilst at the same time driving change and meeting the demands of externally-set efficiency targets, ranging from waiting times through to sickness absence.

Due to the nature of these targets, the number of staff and diversity of roles, as well as the demands facing the organisations, NHSScotland has been described as the type of organisation where one would expect to see 'issues' (such as sickness absence, work related stress and bullying).

Bullying/harassment takes many forms and occurs for a variety of reasons. It can be directed at individuals or groups, but e.g. mobbing). Due to the fact that it is often misunderstood, badly misinterpreted and largely unrecognised in the workplace, it is necessary to have written definitions to appreciate the nature of the behaviour. Whilst the effects may go beyond the words of any written definition, the problems of not identifying such behaviour can have devastating effects on the personal performance and well-being of individuals, as well as the overall effectiveness of the employing organisation and society at large.

Bullying/harassment impacts upon the individual/group being harassed, on their colleagues and on the employing organisation as a whole. Intimidation in any form leads to under-performance at work. If ignored, incidents of bullying/harassment lead to and perpetuate a working environment in which it is unpleasant to work. People cannot contribute their best or work well in teams when they fear bullying/harassment. It may cause much avoidable demoralisation, stress, anxiety and sickness. There may also be hidden psychological and social effects on the person being bullied/harassed, as well as their family and friends.

1.2 Dignity at work - a definition

In recent years, 'dignity at work' has been used as a term to describe a working environment free from bullying and harassment. For the purpose of this policy, we are defining dignity at work as a combination of factors leading to Dignified Workers.

These factors are:

• Dignified Work - interesting and meaningful work with a degree of responsible autonomy and recognised social status; and
• Dignified Workplace - a workplace with structures and practices that offer equality of opportunity, collective and individual voice, safe and healthy working conditions, secure terms of employment and just rewards.

This definition has been developed using parameters suggested by Bolton (2005) ⁶. Clearly such a broad definition of dignity at work encompasses factors way beyond the development and implementation of a bullying and harassment policy. Many of these factors relate to the organisational culture and may be influenced by other organisational systems and processes.

1.3 Focussing on bullying and harassment

Dignity is a term that has been used for many years in NHSScotland to describe the rights of employees to operate in a respectful and safe environment where their personal values are respected. This also extends to ensuring that employees operate in a respectful manner, thus ensuring that their colleagues are able to work in a safe environment where their personal values are respected.

In recent years, 'dignity at work' has been used as a term to describe a working environment free from bullying and harassment. Of late, however, the term has evolved to be used to describe the much broader overall conditions of an employee and an employer. Hence this policy will focus on tackling one essential aspect of a dignified workplace, namely bullying and harassment.

NHSScotland is committed to ensuring that its environment is one where people are respected as individuals and treated with dignity. However, we recognise that people and processes aren't always perfect. This policy document has therefore been developed to provide the required support and direction for when things go wrong. It provides legal information and practical advice to help you put in place a policy that tackles bullying and harassment, helping you deal with staff who have bullied/harassed, and support staff who have been bullied/harassed in the workplace. As such, it represents the minimum standard expected of organisations responding to bullying and harassment across NHSScotland.

There are other factors that underpin dignity at work e.g. organisational culture) which should not be ignored. Information on the broader factors that influence dignity at work, and accompanying guidance and supporting resources are available on the Staff Governance website. This PIN policy, however, focuses upon dealing with bullying and harassment in the workplace as one of the factors that will lead to a more dignified workplace.

Throughout the policy, the terms 'bullying' and 'harassment' will be used together to ensure that all possible perceptions of such actions are covered. However, in general terms, the authors wish to ensure that any incident or behaviour which is not explicitly stated within the definitions contained within Appendix 1, but which is deemed to be comparable with the descriptions given, is dealt with appropriately.

As a large organisation committed to delivering a service to the people of Scotland, NHS Boards and the line managers within them have a responsibility to deliver the performance the people of Scotland deserve. It is within this performance context that this policy seeks to provide protection and support for all employees who may experience bullying or harassment.

Moreover, this policy also seeks to support the expectations placed upon managers to deliver outstanding performance through appropriate management. Whilst bullying and harassment must be tackled wherever it occurs, this policy cannot be seen as an opportunity for poorly performing employees to challenge a manager's responsibility to manage, as long as that management is appropriate and balanced.

1.4 Recommended principles for dealing with complex issues

Given the often complex and sensitive issues that are associated with bullying and harassment, simply adhering to this policy will not ensure that the outcome will be perceived to be successful by all who are involved. However, in using it, organisations can be satisfied that they are adopting best practice principles when dealing with these complex issues.

In addition to the bullying and harassment of, among and by staff, this policy also addresses bullying and harassment by patients, clients, relatives, advocates, contractors and staff from other agencies. It is recognised that the latter area may have significant legal and ethical implications for organisations that may have differing views on how such issues should be dealt with.

Nevertheless, what is clear is that provision must be made within organisations to deal with such issues when they arise and that staff must know the procedure applicable in each one.

1.5 The impact of the new ACAS Code

On 6th April 2009, new legislative measures for dealing with discipline and grievance came into force under the Employment Act 2008⁷. This Act paved the way for the ACAS Code of Practice on Disciplinary and Grievance Procedures⁸. This Code sets out the principles employers should follow when dealing with disputes at work. The new Code has implications for all parties involved in a bullying/harassment scenario; namely, the responsibility to seek a resolution to grievances through INFORMAL means.

This focus on informal procedures has arisen from the perception that too many cases of bullying and harassment were being pursued through formal process. More often than not, utilising informal procedures such as facilitated discussion or mediation would have adequately resolved the issue, thereby increasing the likelihood of sustaining an ongoing working relationship. In line with the new ACAS Code, this policy seeks to emphasise and support employing informal procedures whenever possible.

The Code states that whenever a grievance or disciplinary process is undertaken, the basic standards of fairness should still apply. For example, issues should be raised and dealt with promptly by both employers and employees and employees should be informed of the allegations against them and given the opportunity to put their case in response before decisions are reached.

Although a failure to follow the Code does not make a person or an organisation liable to proceedings, employment tribunals are legally required to take the Code into account when considering relevant cases. The tribunal has the discretion to adjust any awards made to either party by up to 25 per cent for unreasonable failure to comply with any part of the ACAS Code.

1.6 The need for a new Preventing and Dealing with Bullying and Harassment in NHSScotland PIN Policy

Much has changed since 2001 when the first Dignity at Work PIN guidelines were published. NHSScotland operates within a performance culture, putting patients and service users at the heart of decision making, and moving in focus from treatment to prevention as outlined in Better Health Better Care⁹ (2008). This strategy will be delivered through the NHS workforce via its workforce strategy A Force for Improvement¹⁰ (2009), which sets out five key ambitions:

• All staff will be ambassadors for health improvement, safety and quality, using every interaction with individuals, communities, populations, and every patient care episode to maximise their public health and education role;
• NHSScotland will develop and implement multi-disciplinary and multi-agency models of care which are more responsive, more accessible and more joined up to meet the needs of local communities and ensure efficient utilisation of skills and resources;
• NHSScotland will be an employer of choice - acquiring the best talent, motivating employees to improve their performance, keeping them satisfied and loyal, and providing opportunities for them to develop and make greater contributions;
• All staff in NHSScotland will work together to promote the benefits of preventative action and measures of self care for patients and the public across a range of health issues, supporting them in ensuring that they have the knowledge and understanding to undertake this and where appropriate to seek expert advice and treatment; and
• We will work together with universities, further education and the wider education sector to encourage and maximise flexible access to education and training for people already working in NHSScotland and those with aspirations to join, reflecting the changing demography and increasing diversity of Scotland.

For us to deliver on these ambitions, the workforce across NHSScotland must develop a culture of collaboration and an intentional focus on outstanding performance.

Tackling bullying and harassment will be key to creating the workforce environment where employees are able to deliver results in a supportive environment.

Recent legislative changes around discipline and grievance have put the onus upon organisations to seek solutions to disputes through dialogue rather than legal process. This allows NHSScotland to start tackling bullying and harassment far more collaboratively.

The introduction of the first set of PIN guidelines in 2001 produced a range of positive benefits: a more consistent approach to tackling inappropriate workplace behaviour; clear messages around what constitutes inappropriate behaviour; a level of consensus; and mutual understanding.

However, we also recognise that the 2001 PIN guidelines contributed to an over-emphasis on procedure rather than dialogue, a lack of focus on genuine culture change and an emphasis on punishing bad behaviour rather than rewarding good behaviour.

Perhaps most importantly, there is now a recognition that individuals have a responsibility to promote and maintain a dignified workplace. Clearly, if organisations are to foster an inclusive culture, it is ultimately the employees who will define that culture, which is why the new PIN policy aims to empower employees to resolve issues without the need for any kind of process, by developing the confidence to challenge and the awareness to understand what support is available.

The new policy is therefore designed to encourage a formal process only where there is no other alternative. So the focus for all NHSScotland organisations will be upon dispute resolution through informal dialogue, in a structured and safe environment, where the rights of the individual involved, the team and the organisation are fully respected and valued equally.

1.7 The high cost of bullying and harassment

Bullying and harassment cost organisations money. This can be measured in under-performance, high sickness absence rates, costs of recruiting and retraining where staff leave, cost of legal action (where the compensation awards which tribunals can impose are unlimited in some cases) and adverse publicity.

There are two types of costs to an organisation associated with bullying and harassment - direct and indirect costs. Direct costs include issues such as injuries, sickness absence and staff turnover. Indirect costs go further and include lost opportunity, cost of time, lost productivity and reduced quality of life. Indirect costs would also include factors such as the short and long term effects of bullying/harassment on victims and bystanders, including lost wages and costs associated with psychological and physical distress.

The costs of bullying and harassment in the workplace can be significant for both individuals and organisations. It is estimated that in the UK in 2007, 33.5 million days were lost in organisations due to bullying-related absenteeism and the total cost of bullying-related absenteeism was £13.75 billion, of which £3.06 billion stemmed from absenteeism, £1.55 billion from employee turnover and £9.75 billion from lost productivity. ¹¹

NHSScotland employers are legally responsible for the health and safety of their employees as well as the patients within their care. The onus is, therefore, on the good employer to foresee the potential for bullying and harassment and to take reasonable steps to reduce the risk and to take immediate action where such incidents come to their attention.

All of those involved in the workplace must recognise their own responsibilities, be it as employer, employee, trade union/professional organisation representative, patient, relative, advocate, representative of another organisation or contractor, to be alert to bullying/harassment when it occurs. Unacceptable behaviour must not occur and, when it does, must not be allowed to continue unchecked. Inaction is not an option.

This policy contains best practice principles to help organisations within the NHS to review current policies and procedures to ensure that the arrangements that they have in place are based on sound practice.

It must be emphasised that the behaviours that are displayed within the workplace may be derived from the overall culture of the organisation itself. Therefore, if attitudes and behaviours need to change, the most effective way to achieve this is by developing processes to deal with bullying and harassment in a fully inclusive manner.

Organisations are, therefore, encouraged to use this document as a starting point for this process and to involve staff, trade union/professional organisation representatives and managers in developing procedures to deal with these issues. However, the mere implementation of a policy or procedure without an active development process runs the risk of ignoring the wider organisational development issues that are crucial to eliminating bullying and harassment in the workplace.