Health care organizations are steeped in power. While there are positive ways to use the power dynamic within each practice setting, misused power has become a far more prevalent dynamic. Staff struggle to deal with constant stressors, as managing complex client and family dynamics or keeping pace with chronic regulatory challenges. They are pressured from all directions to demonstrate successful outcomes, with managers equally pressured to perform and meet department goals. What results is a cycle where misused power begets bullying. It is a concerning dynamic that deeply roots itself in the organization and becomes the cultural norm. Misused power, and thus bullying become intertwined in a dysfunctional dance, making them a fierce combination to reconcile.
Power is defined as the possession of control, authority, or influence over others (Merriam-Webster, 2018). This dynamic manifests across the industry with voracity and intensity. Experts view bullying in health care environments as a direct reflection of the power which stems from the traditional hierarchical stratification that invades many organizations (Fink-Samnick, 2015; Nesbitt, 2012). Those individuals at the top of the hierarchy have the power to bully those below them, solely by virtue of their position. From top to bottom are:
· C-Suite leadership, Department leadership, Physicians
· Clinical professionals
· Paraprofessionals, then
· Non-clinical staff
Those who have walked the halls of a health and behavioral health organization are aware of this pecking order. Most have directly experienced or witnessed bullying from this dynamic in some form; over 75% of the workforce (Comaford, 2016).
Types of Power
The literature identifies distinct types of power in the workplace, each used with keen intent and purpose (Forsythe, 2010; Giang, 2013). Negative manifestations that speak to bullying behaviors are presented with each power type:
· Coercive: A person has power to control punishments for the staff. The staff have less than optimal outcomes for the quarter. Rather than define the reason for this occurance, staff are no longer allowed to flex their time.
· Connection: Staff attain influence by gaining favor or acquaintance with a powerful person. A staff member seeks to have her vacation request prioritized. She brings a muffin daily to the supervisor responsible for making the vacation schedule, feeling that this is the only way to get time off approved.
· Expert: Power derived from having special knowledge and/or skills that a person has and other staff need (or are viewed to need). A well-known industry thought leader who has published extensive articles on patient engagement is hired as the new director of case management. While the new director’s knowledge is initially embraced by the team, there is a downside. Within weeks of being hired the director publicly dismisses the practice of longtime staff, and devalues their knowledge in team meetings.
· Legitimate or Positional: By virtue of position, a person has control over those in lower positions in the organization. A practitioner approaches the physician to clarify a treatment order. The physician yells at the practitioner to ‘never question him/her again’.
· Reward: Use of power to control tangible rewards for staff. The clinical director informs the treatment team that those who provide a clinical report that ‘doesn’t embarrass’ the department, will be receive their primary vacation request. Vacation requests have traditionally been approved based on the date of submission and seniority at the facility.
Promoting Positive Power
Is it that difficult for power to be used with positive as opposed to negative intent? I believe we all know the answer, and it is a resounding, NO. Yet, bullies don’t usually realize they are engaging in bullying behavior to begin with. Nobody likes to think of themselves as the villain in their own story!However, understanding the types of power and how they can manifest in organizations become a forceful weapon to combat workplace bullying. This knowledge leverages a bullying victim’s ability to identify, manage, and potentially call out disruptive behaviors.
Being aware of misused power leads to opportunities to promote positive power; an anti-bullying opportunity. Consider the department director who excels in legitimate or positional power to advocate for increased staff lines or salaries. Expert power may be used by the program director to obtain approval for a needed intervention or additional treatment sessions. Connection power is beneficial when a supervisor problem-solves with an agency that has been reluctant to accept referrals for clients, rather than blaming staff for discharge delays. Reward power becomes incentive for staff to engage in their professional associations and/or attain specialty certifications when the supervisor offers to pay membership dues or professional fees annually for everyone. Serious food for thought!
Until next time...Stay Resilient #Stopbullying #MustDoBetter
Comaford, C. (2016) 75% of workers are affected by Bullying--- What to do about it, August 27, 2016, Forbes
Forsyth, D. R. (2010, 2006). Group Dynamics. Belmont: Wadsworth, Cengage Learning.
Fink-Samnick, E. (2016) The New Age of Bullying and Violence in Health Care: Part 2, Advancing Professional Education, Practice Culture, and Advocacy. Professional Case Management, May/June 2016, 21(3) p. 114-124
Giang, V. (2013) The 7 types of Power that Shape the Workplace, Business Insider July 31, 2013; Retrieved May 12, 2017
Merriam-Webster (2018) Power, Retrieved May 20, 2018
Nesbitt, W (2012) Workplace Bullying in the Healthcare Setting, SMSI Online Newsletter: The Hospital Reporter,Friday, December 12, 2014, Security Management Services International and The Hospital Reporter