How high-pressure health and human services workplaces turn toxic

By Stephen Easton

Friday July 21, 2017

Colleauges gossiping with sad young businesswoman in foreground at a bright office

An allegation of workplace bullying is rarely an open-and-shut case where an objective set of facts can easily be established but a recurring pattern is certainly evidence of cultural issues that need fixing.

How individual managers go about dealing with employees who are not living up to their responsibilities, and how individual employees react to this, often comes into play. The only answer is to make sure everyone in a particular workplace is on the same page, as much as possible, regarding expectations of courtesy and respect.

Melbourne’s Herald Sun recently reported a problem with bullying and harassment in the Victorian Department of Health and Human Services, with 182 allegations over two years and 50 staff terminated for bad behaviour. The public sector union’s state secretary Karen Batt described it as a cultural problem, driven by pressure on managers and frontline staff caused by tight resourcing.

Health and human services agencies seem to be at particularly high risk of forming toxic workplace cultures, perhaps due to the nature of the work being physically, mentally and emotionally draining while the pay is at the lower end of the scale.

This ongoing human resources challenge also appears to have been neglected and an increasingly bitter relationship allowed to grow between frontline staff and management in South Australia’s Adult Community Mental Health Service.

A toxic culture is revealed in a recent report by the state’s former industrial relations commissioner Greg Stevens, who was brought in to conduct a series of interviews with staff and try to sort out the situation.

“The general impression gained was that they spoke openly, honestly and frankly about these experiences,” writes Stevens in the report, which was published by the SA branch of the public sector union.

“Some who had particularly harrowing experiences to relate had difficulty, understandably, in the re-telling of their experiences. Incidents that occurred a few years ago, or even longer, were recalled as if they had recently happened.

“Quite clearly, those staff are still hurting, and particularly so where no acceptable resolution or closure had occurred, which was usually the case.

“Where these incidents involved allegations of bullying, harassment, intimidation and other disrespectful behaviours, staff had little hesitation in naming the alleged perpetrators. Mercifully, the majority of staff had never been subjected to such experiences.

“Many of them, however, have suffered the collateral effect of knowing colleagues treated in this way. Others, who are still working in the system, have been ‘broken down’ by the relentless pressure of unsustainable and uncapped workloads, and of poor treatment by certain managers past and present.”

With bullying, there is usually little to go on other than one person’s word against another’s and those words are typically based on different but equally sincere viewpoints. Accused bullies don’t see themselves that way, and have to be given a fair hearing as much as the person making the allegations.

SA Health deputy chief executive Don Frater told online publication InDaily the department was investigating the “system and workforce matters” raised in the Stevens report, and promised “immediate and appropriate action” in response to bullying claims — if they could be substantiated. That’s always the catch.

Dealing with the problems at an organisational level won’t resolve these individual cases but if leaders take charge and meaningfully address the underlying issues that are frustrating staff who do not have the authority or the levers to fix them, there is a chance of imrpoving things in the long run.

In this regard, a series of workshops are planned for August to address a range of grievances revealed by Stevens that appear to have come to a head at the same time as the cultural issues, such as: the model of care being provided, workloads and roles, workplace wellbeing and culture, and HR issues to do with overtime, selection processes and contracts.

The “process for handling allegations of disrespectful behaviour” is also up for discussion in the workshops, and senior SA Health staff have agreed to take some other actions in response to the Stevens review:

“In addition to the workshops, allegations of disrespectful behaviour, including bullying and lack of respect, accompanied by a lack of confidence in the process of managing formal bullying claims will be addressed. To assist with dealing with these issues, the Workforce Directors in each of the metro [local health networks] have been:

  • Provided with a summary document outlining specific concerns;
  • Requested to meet with Greg Stevens to obtain more detailed information about the issues raised in the interview process;
  • Directed to investigate allegations of bullying and disrespectful behaviour;
  • Required to report back in relation to progress with such investigations.”

Stevens found several common beliefs among the staff: that management is reluctant to follow up bullying allegations with the alleged perpetrators, other than moving staff into different roles, and that some managers are only “paying lip service” to the workplace health and safety policy, and possibly failing to meet their legal responsibilities under the state’s Work Health and Safety Act.

None of the employees Stevens interviewed wanted to make formal allegations of harassment, bullying or generally disrespectful treatment. They apparently have no faith in the process, for reasons the review summarises as:

  • The lack of support and guidance given by HR generally.
  • The anonymity of the HR staff handling the complaint.
  • The length of time taken to resolve the complaint.
  • The complainant does not get to see the perpetrator’s response or the response of any other witnesses.
  • The complainant is never advised the outcome of their complaint. i.e. Upheld in full / Upheld in part / Dismissed / Not proven.
  • The complainant is sometimes offered mediation with the perpetrator in obviously inappropriate circumstances.
  • The complainant is not always told when their complaint has been finalised.

Cultural breakdowns don’t just come out of nowhere. They are driven by underlying issues that are left to fester. In the case of SA’s mental health service, Stevens found the most consistent theme was a lot of staff feel tired, overworked and unappreciated:

“There were never enough hours in the day to complete tasks. Many staff worked for additional hours in their own time. Overtime or time in lieu was rarely applied for, and even more rarely, granted.”

This goes on through a list that shows this is by no means a special case peculiar to SA Health: a feeling that there’s no time or funding for extra training and professional development, older employees with decades of experience getting fed up and retiring early, and pressure from KPIs and legal compliance obligations creating “an environment of friction and stress … which made it difficult for both staff and managers to fulfil their respective roles”.

There’s disagreements over what are seen as unworkable arrangements for claiming overtime and casualisation of the workforce, a lack of “role clarity” and conflict over the “integrated model of care” that is in place, as well as a belief that nepotism is rife among a cabal of managers:

“It appears that the composition of selection panels may be at the heart of this issue. It was alleged that persons who had relationships and/or friendships sat, sometimes together, on selection panels, which then produced what could be seen as inappropriate appointments.

“In other words, they were alleged to have conflicts of interest that should have precluded them from such involvement. There was another selection panel where it was alleged that two members of the panel had endeavoured to coerce the third member of the panel into agreeing with their scoring of the applicants.”

Senior managers and the HR team appeared to pay no attention to this and a list of other common gripes around how the workforce is being managed, Stevens reports.

While the issues covered by the review could emerge in almost any organisation, mental health workers have an unusually tough job and those interviewed generally wanted more “recognition of the vicarious trauma inherent in this work, and their feelings of being unsafe and put at risk” along with more specific training in how to cope.

In his conclusion, Stevens reports some of the employees are “in survival mode” and adds:

“It is quite remarkable that most teams are working as cooperatively and collegially as they seem to be. However even in the best of teams, there may come a “tipping point” or a “breaking point”. If that occurs the survival of the individual will become paramount.”

Perhaps needlessly, he summarises his findings as a “disturbing picture” of a workplace where unacceptable behaviour is allowed to continue because the victims have no faith in the formal allegation process, so they just keep it to themselves and struggle on.

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