Foreword The aim of this report is to identify how workplace bullying can be tracked over time to indicate what measures and metrics can be used to identify change and to provide comparators for other sectors in the UK and internationally Bullying can encompass a range of different behaviours Deciding on a definition of workplace bullying can clarify what is regarded as bullying but it may also narrow the focus and exclude relevant issues of concern For example bullying definitions typically state that negative behaviours should be experienced persistently over a period of time The threshold for behaviours to be defined as bullying could be set to include one or two negative acts per month over the previous six months or more stringently to include only behaviours that occur at least weekly over the previous twelve months Choosing an appropriate threshold for frequency and duration of behaviours raises several questions should occasional negative behaviours be regarded as bullying Would one or two serious episodes of negative behaviour be regarded as bullying Some researchers use the criteria of weekly negative behaviours over six months to identify bullying but others argue that occasional exposure to negative acts can act as a significant stressor at work Zapf et al 2011 We have identified a range of tools and metrics that can be used to track change over time However there are a number of important issues to consider when measuring bullying which may affect the interpretation of the results In particular bullying prevalence rates vary considerably depending on the type of metric and definition of bullying used For example one international review found prevalence rates ranging from less than 1 for weekly bullying in the last six months up to 87 for occasional bullying over a whole career Zapf et al 2011 There are three main types of direct measures of bullying self labelling without a definition self labelling with a definition and the behavioural experience method Self labelling metrics typically ask a respondent to identify themselves as a target of bullying e g Have you been bullied at work with a yes no response or How often have you been bullied at work with a frequency scale such as never occasionally monthly weekly daily This approach is quick and easy to administer but is more subjective as responses will be based on the respondent s interpretation of bullying This approach can be improved with the provision of a definition of bullying and a request to use the definition when responding However following pilot work Fevre et al 2011 argued that respondents tended not to read and digest bullying definitions as they had already decided what bullying meant to them The behavioural experience method offers a more objective approach but is typically longer and more time consuming This method involves respondents rating the frequency with which they have experienced different negative behaviours e g How often has someone humiliated or belittled you in front of others with a frequency scale such as never now and then monthly weekly daily These behavioural inventories may not mention bullying but capture the prevalence of 2 specific negative acts and a total score may be calculated The threshold for the frequency and number of negative acts or a total score required for an experience to be regarded as bullying can be chosen by the researcher Although this enhances the objectivity of the measure it may be that the respondent themselves may not regard their experience as bullying In a meta analysis of bullying studies conducted across 24 countries Nielsen et al 2010 found an overall prevalence rate of 18 1 for self labelling with no definition 11 3 for self labelling with a definition and 14 8 using a behavioural experience checklist For best practice it is recommended that both the self labelling with a definition and the behavioural experience method are used in bullying research Zapf et al 2011 It is also important to be specific about the type of bullying being measured In particular if the measure is designed to capture bullying at work between co workers this should be explicitly stated so that bullying from patients and their relatives is excluded Interpretation of the results may also be somewhat complex Although increases in bullying prevalence should undoubtedly be addressed we need to be mindful that an increase in reported bullying may reflect a change in culture changing expectations of the behaviour of colleagues and managers or a move towards greater openness and willingness to address concerns that were previously ignored or condoned A measure of employees trust in the organisation to respond appropriately to such allegations may act as a positive indicator The perceived and actual anonymity of responses is a critical factor Employees are understandably wary about providing sensitive information on bullying and have voiced concerns regarding being identified and the potential repercussions of reporting bullying Carter et al 2013 There is a considerable discrepancy between the prevalence of bullying as captured in anonymous questionnaires and direct reports of bullying made to the organisation e g to managers or HR Scott Blanshard Child 2008 Protecting the anonymity of respondents and ensuring that individuals cannot be identified will be important factors in the administration of a bullying measure Some metrics are already routinely collected by the NHS and if examined closely could provide useful indicators of change Direct indicators include complaints about bullying and responses to ongoing NHS staff surveys Indirect metrics can be used to capture factors that are associated with bullying such as psychological wellbeing including stress anxiety and depression sickness rates job satisfaction and organisational commitment However factors other than bullying will affect these measures The prevalence of witnessed bullying could also be considered as an important metric A large proportion of NHS staff report that they have witnessed bullying between staff and this is associated with negative outcomes for individuals and teams Carter et al 2013 Comparing the NHS prevalence rates with other sectors in the UK and internationally is complex Ideally comparators would have used the same definition measurement 3 method and reporting period but the definitions and metrics often differ Total populations are the ideal but are rarely provided Single site studies are less generalisable than multi site studies and total samples are preferred over open invitations to unknown populations which may be more likely to attract responses from those who have experienced bullying This report begins with several definitions of bullying describes direct and indirect measures of bullying and compares the prevalence of bullying in the NHS to other sectors in the UK and to the healthcare sector internationally 4 Contents 1 Definitions of workplace bullying 6 2 Direct Measures 6 2 1 Formal complaints about bullying 7 2 2 The Negative Acts Questionnaire Revised NAQ R and Short Negative Acts Questionnaire S NAQ 8 2 3 Bullying Risk Assessment Tool BRAT Hoel and Giga 2006 11 2 4 Quine workplace bullying questionnaire 12 2 5 Obstetrics and Gynaecology questionnaire Adapted from Quine 13 2 6 NHS Staff Survey 14 2 7 General Medical Council GMC National Training Survey NTS 16 2 8 Trade Unions Professional Bodies and Charitable Organisations 20 2 9 Witnessing bullying 22 3 Indirect Measures 23 3 1 General Health Questionnaire GHQ 23 3 2 Sickness and absence levels 24 3 3 HSE Stress Management Standards Indicator Tool 26 3 4 Exit interviews 27 3 5 Other measures 28 3 Workplace bullying in the UK Comparison of Public Private and Voluntary Sectors 29 4 Workplace bullying internationally comparators with UK health service 37 5 Summary and Discussion 41 6 References 44 7 Appendices 49 5
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