Rights and Strategies

IF YOU ARE BEING HARASSED: Depending on the nature of the harassment, you might consider taking some of these steps:

• Ask for help. Discuss the situation with the appropriate office within your organization or your provincial human rights office and find out how you can resolve the situation. All discussions are confidential and there is no obligation on you to act.
• Tell the harasser to stop. If you are too upset at the time of the incident, calm down and then ask the harasser to stop the behaviour. If it is too hard to speak to the harasser, try sending a letter or email. Identify the incident(s), state what you found objectionable in the harasser's behaviour and say clearly that you want the harassment to stop. Keep a copy of all correspondence.
• Keep a record. Record dates, times, nature and details of incidents, names of witnesses, if any, and your response at the time. If you know of others who are being harassed by the same person, consider asking them to document their experiences.
• Protect yourself. If possible, avoid being alone with the harasser. If you have contact, written or verbal, stay calm and avoid resorting to behaviour that could lead to charges of harassment against you.
• Get support. Find someone supportive who will respect how you feel and tell them about the harassment. They could make sure you are not left alone with the harasser or be present should you decide to confront the harasser or support you as you decide how to deal with the harassment. See your doctor if you are having health-related problems as a result of the harassment.

IF YOU HAVE WITNESSED HARASSMENT, consider the following courses of action:

• Let the target of harassment know that you witnessed what happened and offer your support as they take action to deal with the harassment.
• If it will not jeopardize the target of the harassment, make the harasser aware that you have witnessed and disapprove of the behaviour.
• Record any incidents of the harassment that you witness.
• Witnessing the harassment can be upsetting.
• Contact the Provincial Human Rights Office and to find out what your options are under the provincial policies.

As A Supervisor, you must do the following:

• Contact Human Rights and Equity Services for advice and guidance.
• Establish and Communicate Clear Expectations. Make it clear that inappropriate behaviour will be subject to discipline just like any other performance issue.
• Communicate the meaning of Harassment and Discrimination and make it clear that they will not be tolerated.
• Be a role model. Ensure that your own behaviour is free of harassing or discriminatory elements.
• Step in if you witness inappropriate behaviour, intervene immediately, but respectfully.
• Document every discussion and step you take.
• Monitor your workplace. Look for inappropriate behaviour and intervene if you see it.

Addressing Issues of Intimidation in a Medical School Unit

One Strategy That Has Proven Effective

The following is a summary of a situation that recently faced a new Chair and of the steps he took to address the situation. It is included here for guidance only but it does show that, with a careful, inclusive and cooperative approach, problems of bullying and intimidation can be addressed in a positive fashion that rebuilds relationships and improves the climate.

The Situation

A Chair was fairly new in his department. He had not even really settled into the position when the Situation came to his attention after a Resident faced a ‘safety’ incident while on-call. A particular specialist had failed to provide adequate support, supervision and guidance and had behaved in an intimidating and abusive fashion. The Resident brought forward a number of major issues with regard to the climate in the unit and the behaviour of certain staff members.

After a brief investigation, the Chair found that a number of issues, both major and minor, had arisen within the unit, involving more than one complainant and more than one respondent:

• Resident safety a concern at one hospital site
• Simultaneous cases after hours
• Some staff providing insufficient support
• Some staff discourteous or unprofessional behaviour
• a ‘Culture of criticism’ had developed which was affecting generalists and residents
• Not conducive to a proper learning environment
• Appropriate evaluation difficult
• Program unable to respond to major issues
• Gossip about "whining residents"
• Inappropriate references to evaluation
• Morale was low
• Rotating clerks get poor image of department

Chair’s response

The Chair’s response was immediate but also well-considered. He first identified that the Program Director was part of the problem and accepted his resignation. The Chair went on to appoint an interim director who then appointed a selection committee to search for a new director.

The Chair then immediately held meetings with the following people to touch base, gather information and start a plan of action:

• The Resident involved in major on-call incident — the Chair issued an apology to the Resident for what had happened
• Another Resident who was currently on a rotation with the specialist who was identified as problematic – Chair checked in with Resident, listened to any concerns
• Members of other identified subspecialty rotation with concerns
• Clinical Chiefs at different hospital sites
• One other concerned faculty member who approached the Chair in response to problems

In planning how to respond to the situation and attempt to move the Department forward, the Chair decided first, a perhaps most importantly, that the allegations were probably true. He recognised that his response to the situation would decide whether or not he and his Department faced continuing real or potential problems in the future:

• Severe damage to program’s reputation
• Complaints through university harassment office
• PAIRO grievances
• Lawsuits

Years of proceedings and conflict

With these concerns in mind, the Chair focused on devising ways to turn conflict into collaboration. He recognised, for example, that the accusers would have difficulty in confronting accused with their allegations, since a real imbalance of power existed. He took into consideration the desire for and right to confidentiality of both the complainants and the respondents in the matter. The Chair was careful to honour the respondents’ desire to confront the complainants’ allegations fully and fairly, in the face of the possibility of damage to personal and professional reputation and their self-esteem. Of course, the Chair also had to deal with the fact that some members of the Department had a genuine desire to acknowledge and address issues while others were less inclined to do so.

The Chair’s key goals from the process were to eliminate the problem behaviours and to re-establish trust between residents and faculty.

Action Plan

The Chair then implemented the following Plan of Action to address the concerns, eliminate the problem behaviours and start the process of rebuilding trust:

1. Meeting of All Residents

A meeting took place involving the Chair and all Residents. The Chair began the meeting by outlining the purpose of the meeting, the Department’s commitment to addressing the problems, its commitment to protect the Residents retaliation, and its hope to empower Residents to take active part in the process.

The Chair then asked the Residents to continue the meeting without him. He asked them to have a discussion of the issues that face the department and to prepare for the Chair a report of some kind that identified the issues the Residents saw as being at play in the Department and that identified the individuals whose behaviours were creating problems. He promised the Residents that, if a single report came from the group, it would go a long way toward ensuring that each individual Resident could not be identified nor targeted afterwards. The Chair appealed to the professionalism of the Residents in presenting their concerns and asked them to be responsible and fair to the Department and the faculty.

The Residents continued the meeting for another 90 minutes without the Chair present. Their discussion covered issues, concerns and methodology. The result was itemized statements of all problems concerning the behaviour of individual members of faculty that had been encountered by at least one Resident. The Residents also performed a survey to give an indication of how many individual Residents had encountered each such problem behaviour.

2. Analysis of Results

The Chair reviewed the Report from the Residents very carefully. He was pleased to find that the majority of the faculty (including the Chair himself) were not the subject of concerns. Several faculty and two subspecialty rotations were identified with major issues, however. The survey gave quite specific details of the kinds of problematic behaviours that were occurring:

• A faculty member uses position of power to intimidate and threatens to place residents’ action "in their file" or "in their FITER".
• Feedback at morning handover and when discussing residents’ patient management is often derogatory and not constructive.
• A faculty member criticizes residents to other healthcare team members.
• A faculty member blames others for poor outcomes.
• A faculty member has stated, "This will result in failing the rotation".
• A faculty member gossips, discusses residents’ personal information with other healthcare team members.
• A faculty member is disrespectful towards residents’ concerns concerning patient care.
• A faculty member is difficult to reach and does not answer pages.
• A faculty member overtly voices prejudices.
• A faculty member does not tolerate being challenged on patient management issues.

The Chair accepted the survey information as a statement of concerns about individuals (not as a formal evaluation) and as a starting point for changing behaviours and the climate.

3. Meetings with Identified Faculty

The Chair then met individually with every identified faculty member to notify them of general issues and each specific concern. The tone of the meeting was serious and sober. The responses from the faculty members varied from a vigorous ‘mea culpa’ or and "How can I change" to a protestation that "That’s just the way I am". The Chair took advantage of the opportunity to advise all faculty members of the Department’s commitment to change and to warn all faculty members of the potential consequences for individuals and the program if the problems were not dealt with before the next Royal College review.

4. Healing Process

In order to begin the healing process. three faculty met directly with all residents as a group seeking to address and correct concerns. A Letter from Chair to all Faculty addressing issues was sent out in order to address the generalized anxiety that quite naturally arose as a result of the process.

A new Program Director was chosen and two faculty members, nominated by the Residents themselves, were appointed as ombudspersons to help address any future concerns that might arise.

The Department planned and held a Faculty/Resident retreat, off site, to be facilitated by representatives of the University’s Harassment and Human Rights Offices. This retreat was called "Communicating and Building Positive Relationships". All Residents and Faculty were invited and 34 of 50 faculty, and 20 of 24 residents attended, including five of the seven faculty members whose behaviours had been identified as problematic.

The Retreat involved the following elements:

• Identification of issues
• Discussion of Scenarios in small mixed groups (5-8)
• Dinner with a motivational speaker on Time management
• MOCOMP credits

The following is a sample scenario discussed in small groups:

Staff person A is repeatedly noted to criticize staff person B behind his/her backand in front of residents. After hearing the criticisms on many occasions theresident is not sure what steps to take.

• How is the resident feeling?
• Is it the resident’s responsibility to take action?
• What was the intention of staff person A?
• What was the impact of staff person A’s actions?
• Was it what he/she intended?
• What could staff person A have done differently?
• What was the most important issue in this situation?

The response to this Retreat was very positive. In fact, the response to the entire program in response to the original complaints was extremely positive and, when the Department was reviewed by the Royal College the following year, it received full approval and was commended for its proactive approach to behavioural issues.