To the Editor: The Garling report,1 reviewed by Van Der Weyden2 and others in the Journal, yet again brings to our attention the problem of bullying within our health care system. New South Wales is not alone in having this problem, as it has been highlighted across many systems throughout Australia and the rest of the world over the past 10 years.3

Garling acknowledges that the current guidelines in NSW are robust and comprehensive, but that there are serious deficiencies in their implementation. His report then goes on to suggest implementing the “Just Culture” program within the NSW health system.1

I would hold that if the policies and procedures already laid down are adequate, there is little point in reinventing the wheel and expending a large amount of time and energy, not to mention fiscal resources, in developing new guidelines, which, in all probability, will not be followed either.

To minimise bullying in the workplace, one must be aware of the root causes of the problem — these include improperly trained managers, financial pressures, and a resultant “survival” culture within stressed environments. Many Australian public hospitals operate in a resources-limited, highly pressurised environment, where the culture is often adversarial — as pressure on the system grows, so does bullying.

Garling correctly suggests that there must be zero tolerance for bullying behaviour within the workforce. This, however, needs to be more than just window dressing and must be rigorously enforced throughout the organisation, from the top down. Positive reinforcement of good interpersonal relationships, rather than the constant negative feedback that health care workers have come to expect, will reap rewards and aid the cultural change required.

Training of people in management roles is essential, and all staff within the organisation must be aware of the expectation that they will work together in a collaborative and respectful relationship for the benefit of the patient.

In the final analysis, in workplaces where a culture of openness and respect is present, bullying is likely to be minimised.

In public hospitals in NSW and in most other Australian states where bullying is an ongoing problem within the workplace, the solution is not to institute yet another program to combat the issue, but to properly implement the policies and procedures that are already in place, and to develop an open, non-adversarial environment in which excellence in health care can flourish.