Working Toward Bully-Free Workplaces; an Innovative Approach addressing workplace violence in Nova Scotia Health Care

Susan J. Coldwell, MTS, MTh., Nova Scotia Government and General Employees Union (NSGEU) Catherine Janet Fortune-Woodworth, RN, M.Ed., Public Health Services, Capital District Health Authority (CDHA) Key words: Culture, Perceived injustice, Bully-free workplaces, Restorative practices, Union Background The Nova Scotia Government and General Employees (NSGEU) believes in the responsibility of the union to address the problem of workplace bullying as a form of violence. The International Labour Organization (ILO, 1999) report on workplace violence emphasized that physical and emotional violence is one of the most serious problems facing the workplace in the new millennium.i This definition of workplace violence includes bullying as any incident in which a person is abused, threatened, or assaulted in circumstances relating to their work. These behaviours would originate from customers, or co-workers at any level of the organization. This definition would include all forms or harassment, bullying, intimidation, physical threats, assaults, robbery, and other intrusive behaviours.ii This is underscored by Nova Scotias Occupational Health and Safety Actiii which states, Every employer has a duty to provide a safe and healthy workplace. The NSGEU, Nova Scotias largest union, developed and implemented a Bully-Free Workplaces Program. This uniquely member driven program launched its Bully Free Workplace initiative in September 2010 with the objective to deliver a two hour awareness seminar or a six hour interactive workshop. Union membership of over 30,000 includes approximately 12,000 health care workers. Health care representation in development and delivery of the program included public health nurses, a community based rehabilitation counsellor and social workers. A province wide pilot, integrating quantitative and qualitative evaluation data confirmed the overwhelming positive acceptance of the program by both employees and their employers. Participant feedback, notably from within health care settings, quickly determined the need to advance the program beyond education in defining and naming the problem, to introducing intervention strategies. In addition to eliminating bullying behaviors through policy, appropriate investigation and sanction, is the emerging field of restorative practices. This offers a common thread uniting theory, research and practice in seemingly disparate fields, such as nursing, education, counselling, criminal justice, social work and organizational management. A restorative practice framework offers a range of approaches that give those most affected by conflict the tools and principles needed to resolve problems and build relationships. To date over 7000 participant evaluations demonstrate that intervention must include appropriate identification of the situation, address both workplace policy and culture, and move us beyond the rigidity and unenforceability of zero tolerance. Participants have an introduction to using restorative practices in creating a healthy workplace culture. In this successful undertaking the scope of the program continues to evolve to examine policy, remediation and restoration. With the stretching of current resources in health care and no new monies this is an approach that employers can adopt, utilize and transfer into all arenas of work. Method The facilitator led workshops deliver motivating, participant focused sessions employing PowerPoint, flip charts and group activities and written evaluation is strongly encouraged. The two hour awareness sessions explores the effects of bullying on the individual, co-workers, family and the

workplace. The six-hour interactive workshop explores issues in greater depth using a variety of adult learning strategies to engage participants and help in understanding problems and solutions to workplace bullying. Topics addressed include defining workplace bullying, as well as bullying behaviours and characteristics, who gets targeted, incivility, common behaviours of a bully, organizational effects and recognizing the whole person health impact. Lastly the facilitator moves to address situations by offering tips and tools. This allows introduction of restorative practices which looks at repairing harm as an alternative to traditional disciplinary and often punitive approaches. For this conference our workshop objective is to provide participants with the opportunity to experience how a peer to peer approach is an effective and beneficial method to address workplace bullying as well as offer a solution focused format. Approximately forty five minutes will be interactive with attendees participating in a real session as presently delivered. An introduction and closing will highlight the initiative undertaken, the design and evolving approaches we are adopting from our experience and feedback. Time will be allotted for questions, comments and evaluation of the session. Activities incorporated into the session provide opportunity to self-reflect and respond to attendees own work/life experience whether one has been a target, bystander or a person who engages in bullying behaviour. This paper focuses on a comparison between two provincial health districts in Nova Scotia where the Working Toward Bully-Free Workplaces Workshops were implemented, between May 2011 and May 2012. Nova Scotia comprises nine health districts, the largest being the Capital District Health Authority, with the NSGEU representing approximately 12,000 members who work within health care. In addition our workshops have included members of the Nova Scotia Nurses Union (NSNU) and the College of Licensed Practical Nurses (LPNs). The following table highlights the range of health care settings where the program has been delivered. Discussion will focus on these two settings. Table 1. Working Toward Bully-Free Workplaces Program Delivery Within Nova Scotia Health Care South Shore District Approximately 31 x 2 hour session Approximately 1,100 Health Authority Capital District Health Approximately x 6 hour workshops Approximately 111 Authority, Public Health (13 did not attend) Capital District Health Pharmacology Authority Microbiology lab technology Physiotherapy Rheumatology Addictions and Mental Health Occupational Health Allied Health throughout Nova Long Term care Scotia where program has Home Care been delivered Acute Care Student nurses Regional Residential Services Society (may be licensed through Community Services) Nursing Homes Physician Services VON Health Educators Examples: Braeside Nursing Home Mountain Lea Lodge Extended care Seaview Manor Shannex Extended care Northwoodcare Inc Twin Oaks Hospital

Community Hospitals (rural) Emergency Health Services (EHS) IWK Childrens Hospital

The South Shore District Health Authority committed to have all 1,100 employees participate in the two hour awareness sessions preliminary to launching a respectful workplace initiative. The Capital District Health Authority required 120 Public Health employees to undertake the six hour workshop as part of a grievance settlement. While both programs were mandatory versus voluntary the respective undertakings yielded different outcomes. Discussion Quantitative data gathered in the evaluation process to capture satisfaction with the program 3.52/4, relevance 3.59/4 and facilitator knowledge 3.74/4 was consistent across the two groups. However some weeks following the PHS sessions, there was an expressed perception that bullying at work had actually increased. This prompted further analysis of the experience of the two health care districts. SSDH made the sessions mandatory and allowed time during the work day or time in lieu for those attending. It was made known that all levels of the organization would be attending including the CEO, management and physicians, creating a sense of inclusiveness. The sessions were timed to precede the launch of a respectful workplace initiative, directed at changing culture. Public Health Services (PHS) as part of CDHA made the sessions mandatory as one outcome of a prolonged grievance; therefore it may have been viewed as a punitive action. It was found that not all managers attended, and certainly not upper management within the PHS organization, and with no connection to the larger CDHA organization which has publicized its transformational work as world leading. Once the sessions were completed within Public Health no further follow-up occurred with the employer. This served to demonstrate incongruency between what was talked about and the reality. From a program delivery position the commitment to accountability and transparency principles that CDHA publically espouses was not apparent. We believe this did not foster a constructive cultural shift which was the original intent but rather served to heighten a sense of perceived injustice. The challenge for workplaces is to ensure justice in the whole undertaking to address and remediate workplace bullying. Perceptions of justice have been identified as a core value in most organizations and workplaces with significant negative consequences in employee behaviour, attitiudes and health when there is a perception of a lack of fairness or justice. Facets of Justice Include: Distributive justice, concerns the fairness of the outcome or the decision made following a complaint process; Procedural Justice, concerns the fairness of the process, that there was a lack of bias in the investigation process of bullying and equal representation for the parties involved. Interactional Justice, concerns the personal interactions between the parties and includes; o Interpersonal factors, such as did the parties conduct themselves with honesty, respect and goodwill? o Informational justice, were explanations provided of how and why around decision making and outcomes. In addition to eliminating bullying behaviors through policy, appropriate investigation, and sanction is the emerging field of restorative practices. This model offers a common thread to tie together theory, research and practice in seemingly disparate fields, such as nursing, education,

counselling, criminal justice, social work and organizational management. A restorative practice framework offers a range of approaches that give those most affected by conflict the tools and principles needed to resolve problems and build healthy relationships. The underlying premise of restorative practices is that people are happier, more cooperative, more productive and more likely to make positive changes when those in authority do things with them rather than to them or for them. Additionally, a restorative practice framework helps to explain human motivation and social behavior not only within families, classrooms, and communities, but within the social construct of the workplace including health care settings. Using a restorative (workplace) practice can contribute to resolving conflict, repairing harm, and creating an overall healthy workplace culture. This practice is also consistent with changes to the Nova Scotias Human Rights legislation in 2012. As a voluntary process, the guiding principles of restorative justice provide a different response to bullying versus a traditional one. Rather than approaching a solution based on definitions of bullying or measures of frequency and intensity as a guide to sanctions; the focus is on understanding the harm that is done and how it can be repaired. Wrongdoers, in this context people who use bullying behaviours in the workplace, need to be held accountable and answerable. Moreover, the needs of the person who has been harmed (target) are often overlooked even when perpetrators are sanctioned. Overlooking the needs of those who have been harmed can leave them continuing to feel invisible in the process. Formal discipline and sanctions may be a necessary aspect to repair harm and reintegrate individuals into communities of work; as resolving the harm done can serve to prevent it from happening again. A restorative practice model is an appropriate and beneficial tool to employ. Summation NSGEUs interest in the phenomenon of bullying and defining bullying as a form of workplace violence emerged from stories by workers about how they were being treated on the job. At the same time the definition and legislation dealing with psychological harassment in the workplace, and the release of respectful workplace policies was gaining momentum. The NSGEU made a significant commitment to its membership to address workplace bullying and publicly launched its Bully Free Workplace initiative in September 2010. Member facilitators trained to deliver sessions are from various regions in the province. The Nova Scotia Occupational Health and Safety Activ which states, Every employer has a duty to provide a safe and healthy workplace is an anchor to our program. Research and development of this program followed a Grounded Theory Approach. Following the first year of a province wide pilot and evaluation, integrating quantitative and qualitative evaluation data confirmed the overwhelming positive acceptance of the program by both employees and their employers. Participant feedback quickly determined the need to advance the program beyond education in defining and naming the problem, to introducing intervention strategies Several questions have been considered such as: What are the dynamics of making the program mandatory, as part of an Occupational Health and Safety Program rather than as optional training? Additional results from the pilot to the present using collected data highlight positive, unexpected and potential future developments and long range possibilities. For example an on-line course through a virtual campus or delivery via a local college site is under consideration. One of the provinces largest long term care and homecare agency plan to trial a train the trainer model in 2012 based on a cost saving determination. The NSGEU Bully-Free Workplaces Program emphasizes quality assurance through research, development, evaluation and peer-to-peer facilitation. See Quality Assurance Table Appendix 1. Examining two particular Nova Scotia health districts which received the NSGEU Program different outcomes were experienced. This led us to understand the role of perceived injustice. We also

briefly considered a restorative workplace practice framework as an alternative to address issues of workplace bullying. A restorative practice can serve to change perceptions of injustice, thereby promoting healing. We believe in offering a bully free workplace educational session including the two suggested approaches makes the experience more comprehensive as discussed in this paper. There are added benefits and direct measurables. Reduced costs to the employers through retaining and recruiting dedicated staff and reducing the health effects that bullying causes to staff, bystanders and the organization are only two but important ones to consider. We hold to the mission to be a leader in advancing the right to dignity on the job through delivery of programs to promote Bully-Free Workplaces and Restorative Practices.

REFERENCES 1http://safety-council.org/workplace-safety/bullying-in-the-workplace/ 2 http://www.workplace-violence.info 3 ns.ca/lae/healthandsafety/pubs.asp 4 ns.ca/lae/healthandsafety/pubs.asp

Appendix 1. Quality Assurance Table