by Nick Jacobs

Frontiers of Health Services Management published its summer 2009 report on Bullying in Healthcare recently. In this edition, they took an in-depth look into the problems of bullying in the workplace. As many of you know, I have been pontificating about the devastating impact of bullying for a dozen years now, and between the Joint Commission's stand and features like this one, the topic is finally beginning to get the attention that is needed to address the absolutely horrible outcomes prompted by those individuals in healthcare who have long lived as bullies.

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With 20-plus years in healthcare executive management, I've seen all levels of this practice, from nurses to physicians to top management. It is always disruptive, and usually marks ineffectiveness in communication skills. Most times, it represents true psychiatric disorders like narcissistic personality disorder, depression/bipolar disorder, and even dementia.

One of the major issues that did not seem to be addressed in this comprehensive treatise was that of "the CEO as a hostage." During my tenure as a CEO, we addressed this bullying issue as often as possible, but invariably, there were always one or two physicians, managers, or staff in the untouchable, protected class. No matter how disruptive, how obnoxious, or how horrendous their behavior, their peers and superiors turned a blind eye to their behavior. Hence the hostage scenario.

Being dismissed because of these disruptive individuals is not always a viable option for the CEO. The decision to take on the top protected offenders can represent a no-win decision. Thirty-year bullies who are top admitters, top notch surgeons who are impossible to replace in small and rural hospitals, and board attached friends often represent the most troublesome cases faced by the CEO. I'm proud to say that we were 98 percent effective, but that other 2 percent always came back to haunt us.

In our case, the executive committee of the medical staff took on many of these individuals, confronted them, warned them, helped them, and corrected them. Regardless, the one or two top bullies continued to prevail in their disruptive ways. Unless these problems are taken on every time--100 percent of the time with complete backing by the board of trustees--we will continue to have bullies in the workplace.