Endemic unprofessional behaviour in health care: the mandate for a change in approach

Johanna Westbrook, Neroli Sunderland, Victoria Atkinson, Catherine Jones and Jeffrey Braithwaite
Med J Aust 2018; 209 (9): . || doi: 10.5694/mja17.01261
Published online: 5 November 2018

Pervasive bullying, discrimination and sexual harassment are increasingly hard to ignore, yet evidence of effective interventions is lacking

Unprofessional behaviour is sufficiently widespread in the Australian health care system that it could be considered endemic. The 2016 survey of the Victorian Public Sector Commission found that 25% of staff in health agencies experienced bullying,1 and in a 2014 survey of the Australian Nursing and Midwifery Federation, 40% of nurses reported bullying or harassment in the previous 12 months.2 In 2015, the Royal Australasian College of Surgeons surveyed 3516 surgical Fellows, trainees and international medical graduates and found that 49% had been subjected to discrimination, bullying, harassment or sexual harassment.3 The Australasian College for Emergency Medicine released in 2017 its survey results: 34% of respondents had experienced bullying, 21.7% discrimination, 16.1% harassment and 6.2% sexual harassment.4 Thus, unsurprisingly, the 2016 Senate inquiry into the medical complaints process concluded that bullying, discrimination and harassment levels remain disconcertingly high despite the apparent “zero tolerance” approach reported by medical administrators and colleges.5

  • 1 Australian Institute of Health Innovation, Macquarie University, Sydney, NSW
  • 2 St Vincent's Health Australia, Melbourne, VIC



The authors are recipients of a National Health and Medical Research Council Partnership Project Grant (1134459) for this work.

Competing interests:

Victoria Atkinson and Catherine Jones are employees of St Vincent’s Health Australia.

  • 1. Victorian Auditor-General. Bullying and harassment in the health sector: Victorian Auditor-General’s report. Melbourne: Victorian Auditor General’s Office; 2016. (viewed Nov 2017).
  • 2. De Cieri H, Shea T, Sheehan C, et al. Leading indicators of OHS performance in the health services: a report on a survey of Australian Nursing and Midwifery Federation (Victorian Branch) members. Melbourne: Monash University; 2015.
  • 3. Royal Australasian College of Surgeons. Expert Advisory Group advising the Royal Australasian College of Surgeons: discrimination, bullying and sexual harassment prevalence survey. Melbourne: RACS, 2015. (viewed Nov 2017).
  • 4. Australasian College for Emergency Medicine. ACEM to tackle bullying and harassment. Melbourne: ACEM; 2017. (viewed Nov 2017).
  • 5. Senate Standing Committee on Community Affairs. Medical complaints process in Australia. Canberra: Parliament of Australia; 2016. (viewed Nov 2017).
  • 6. Hickson BG, Pichert WJ, Webb EL, Gabbe SG. A complementary approach to promoting professionalism: identifying, measuring, and addressing unprofessional behaviors. Acad Med 2007; 82: 1040-1048.
  • 7. Loerbroks A, Weigl M, Li J, et al. Workplace bullying and depressive symptoms: a prospective study among junior physicians in Germany. J Psychosom Res 2015; 78: 168-172.
  • 8. Reknes I, Pallesen S, Magerøy N, et al. Exposure to bullying behaviors as a predictor of mental health problems among Norwegian nurses: results from the prospective SUSSH-survey. Int J Nurs Stud 2014; 51: 479-487.
  • 9. Rosenstein A, O’Daniel M. A survey of the impact of disruptive behaviors and communication defects on patient safety. Jt Comm J Qual Patient Saf 2008; 34: 464-471.
  • 10. Rosenstein AH. Nurse–physician relationships: impact on nurse satisfaction and retention. Am J Nurs 2002; 102: 26-34.
  • 11. Ortega A, Christensen KB, Hogh A, et al. One-year prospective study on the effect of workplace bullying on long-term sickness absence. J Nurs Manag 2011; 19: 752-759.
  • 12. Nielsen MB, Indregard AM, Øverland S. Workplace bullying and sickness absence: a systematic review and meta-analysis of the research literature. Scand J Work Environ Health 2016; 42: 359-370.
  • 13. Hickson GB, Federspiel CF, Pichert JW, et al. Patient complaints and malpractice risk. JAMA 2002; 287: 2951-2957.
  • 14. Hickson GB, Federspiel CF, Blackford J, et al. Patient complaints and malpractice risk in a regional healthcare center. South Med J 2007; 100: 791-796.
  • 15. Rawson JV, Thompson N, Sostre G, et al. The cost of disruptive and unprofessional behaviors in health care. Acad Radiol 2013; 20: 1074-1076.
  • 16. Riskin A, Erez A, Foulk TA, et al. The impact of rudeness on medical team performance: a randomized trial. Pediatrics 2015; 136: 487-495.
  • 17. Cooper WO, Guillamondegui O, Hines OJ, et al. Use of unsolicited patient observations to identify surgeons with increased risk for postoperative complications. JAMA Surg 2017; 152: 522-529.
  • 18. Cruess RL, Cruess SR, Steinert Y. Amending Miller’s pyramid to include professional identity formation. Acad Med 2016; 91: 180-185.
  • 19. Rees CE, Monrouxe LV. Who are you and who do you want to be? Key considerations in developing professional identities in medicine. Med J Aust 2018; 209: 202-203. <MJA full text>
  • 20. Foster K, Roberts C. The heroic and the villainous: a qualitative study characterising the role models that shaped senior doctors’ professional identity. BMC Med Educ 2016; 16: 206.
  • 21. Scott KM, Caldwell PH, Barnes EH, Barrett J. “Teaching by humiliation” and mistreatment of medical students in clinical rotations: a pilot study. Med J Aust 2015; 203: 185. <MJA full text>
  • 22. Gillen PA, Sinclair M, Kernohan WG, et al. Interventions for prevention of bullying in the workplace. Cochrane Database Syst Rev 2017; 1: CD009778.
  • 23. Leiter MP, Laschinger HKS, Day A, Oore DG. The impact of civility interventions on employee social behavior, distress, and attitudes. J Appl Psychol 2011; 96: 1258-1274.
  • 24. Osatuke K, Leiter M, Belton L, et al. Civility, Respect and Engagement at the Workplace (CREW): a national organization development program at the Department of Veterans Affairs. Journal of Management Policies and Practices 2013; 1: 25-34.
  • 25. Webb LE, Dmochowski RR, Moore IN, et al. Using coworker observations to promote accountability for disrespectful and unsafe behaviors by physicians and advanced practice professionals. Jt Comm J Qual Patient Saf 2016; 42: 149-164.
  • 26. Medew J. Royal Melbourne Hospital targets bullying with new Cognitive Institute program. The Age (Melbourne) 2016; 28 May. (viewed Apr 2018).
  • 27. Atkinson V, Jones, C. The St Vincent’s Ethos Program is “redefining normal” with a pragmatic approach to addressing unprofessional behaviour [unpublished presentation]. 34th International Society for Quality in Healthcare Conference. London (United Kingdom), 1-4 Oct 2017. (viewed Apr 2018).
  • 28. Montgomery A, Panagopoulou E, Kehoe I, Valkanos E. Connecting organisational culture and quality of care in the hospital: is job burnout the missing link? J Health Organ Manag 2011; 25: 108-123.


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