12. Bullying, Threats & Intimidation

If patient safety is to improve healthcare needs to change.

The historical top down approach which has hindered improvement requires a transition into one where decisions are driven from the front line.

Those corporations who’ve introduced front line driven frameworks (e.g. Toyota Production System – see here) provide the highest quality in the most efficient way to their customers.

Transitioning to this approach will not happen overnight. It may occur through numerous small steps – hundreds of thousands of individuals taking on leadership roles each having decided to make a specific improvement. The improvement may be something which appears relatively simple – ensuring an emergency drug is readily available at the point of care, ensuring different medications are packaged differently to reduce their inadvertent administration, or suggesting a change to simplify a data entry form.

‘Still too often our leaders model old fashion and outdated concepts of command and control; concepts of ‘my way or the high way’, that contribute to damaging bullying, sexist and discriminatory behaviours.’

‘We need to embrace a new paradigm of organisational leadership, and move towards a leadership culture that emphasises respect, sees difference and diversity as a source of innovation and energy.’

(Italicised quotes with much thanks from ‘Workplace Bullying: An Adaptive Leadership Challenge‘ by Dr Moira Jenkins)

We all have it within us to take on leadership roles to advance patient safety.

Find an issue, but don’t go alone however much you’re encouraged to do so – obtain the feedback and interest of others. Just as the transition from a top down to a front line driven healthcare culture will not happen overnight, it’s unlikely the specific patient safety intervention one is promoting will happen quickly.

Professor Ronald Heifetz, a guru on adaptive change makes a clear distinction between leadership and authority – watch his video presentation here. Keep just the right amount of pressure on and be as prepared as you possibly can be.

‘An adaptive challenge that benefits a whole organisation (and society) will undoubtedly upset the egos of those who have benefited from the old system of doing things. People in positions of power, people with taken for granted privilege will need to examine their role in perpetuating bullying, sexism and workplace discrimination.’

The quickest, most primitive and often most effective way for authority figures to stop change is through bullying, threats and intimidation. The closer one gets to bringing about change the greater the likelihood for this to happen. These untoward practices permeate throughout healthcare and it’s wise to understand they won’t be fixed by tougher laws, increased penalties and regulation.

True leadership requires a deeper understanding, perhaps of oneself, and of developing a position of influence.

Dale Carnegie wrote his book ‘How to Win Friends and Influence People‘ in 1936. It’s stood the test of time and is still as relevant now as it was when first written. There are many tools within it which will help in achieving change. We thoroughly recommend reading it in full and have summarised some points here, of particular note: Don’t criticise, condemn, or complain, be friendly, avoid arguments, be a good listener, talk in terms of the other persons interests, find common ground…..

Remember, everyone in healthcare wants patient safety to improve.

‘The organisations that thrive will be those that signal the intolerance of poor behaviours at all levels of the hierarchy, and reinforce respectful discourse, and a collaborative approach to leadership. Cultural change will be addressed in a transparent way that will clearly indicate to all employees, and stakeholders, (both internal and external) that the organisation is committed to change.’

We would love to hear your stories and will do whatever we can to help advance your patient safety goals.

This is where we’re up to in achieving specific patient safety interventions –  we realise change won’t happen overnight, however we’ll work tirelessly, keeping just the right amount of pressure on until we see these patient safety improvements.

We sincerely thank you for your support.


  1. Any chance you could be cloned. We need more people with the strength to challenge the status quo in the interest of #patientsafety.
    Thank you

  2. Juan Blankevoort

    Well done an courageous effort to challenge orthodoxy !
    Recently I was prescribed an ineffective antibiotic and different doctors followed the original prescription…until I asked for a swab analysis on my wound, results showed I had a gram negative instead of gram negative bug the moral is a patient has to be proactive during his / her treatment.

    • patientsafe@icloud.com

      Thanks for the support Juan. Hope you’re infection cleared up. I’ve little doubt we could create & introduce systems to overcome the error you’ve described. Healthcare will benefit hugely from better designed communication systems to help ensure the correct antibiotic is given for the bacteria. Great to hear from you. Catch up soon. All the best. Rob

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