Professor of Management at the School, Stephen Wood, presents some of the findings – and methodology – from the National Survey of Staff Morale amongst Mental Health Staff
2013’s Francis report on the failings in the Mid-Staffordshire NHS Trust highlighted bullying as one part of the problem. While the effects of bullying upon an individual’s well-being have been widely researched, its effects on an individual’s behaviour are less well understood. With Karen Niven (Manchester Business School) and Johan Braeken (University of Oslo), I’ve studied the effects of managerial bullying and discrimination by managers on NHS mental health workers. Bullying includes verbal abuse, the withholding of information and gossiping and discrimination can be based on the person’s religion, ethnicity, age or sexual preference. The research is reported in ‘Managerial abuse and the process of absence among mental health staff’ and will be published within Work, Employment and Society.
21% of the 1,472 mental health workers we studied reported that they had been bullied and 8% reported that they had been discriminated against by their managers in the previous year. Of these, 86% had gone sick for, on average, 11 days in total. In contrast, 74% of staff who had not been bullied or discriminated against took, on average, eight days of sick leave. This means that bullying and discrimination is linked to a 37% increase in time off.
How are we to explain these figures? The emphasis in the psychology literature is on the stress caused by abuse. Sociologists instead consider the sense of injustice that abuse generates. We tested stress and justice perceptions and found that both were important explanatory factors. Using the commonplace distinction between voluntary and involuntary absence, we treated stress-based absence as involuntary and justice-based absence as voluntary. People are absent following abuse because they are both unable and unwilling to attend. Sensing that their abuser has violated them, they judge that they both could and should have been treated differently. This sense of ill-will in turn generates a feeling that the abuse reflects badly on the employing organisation.
In previous research, scholars have attempted to capture the distinction between voluntary and involuntary absence by associating the former with the frequency of absence and the latter with the length of absence. Our approach to isolating withdrawal and stress-based absence departs from this convention. We treated the different measures of absence – the total time lost or the total number of separate occasions absent in a specified time period – as reflecting the fact that absence is an ongoing process. Over a period of time, there is first the initial step of going absent (i.e. occurrence), then the extension of absence beyond a day (i.e. duration) and finally there is the process of returning to work followed by either a recurrence or cessation of absence (i.e. frequency).
To capture this process we used the hurdle count regression model. This model enabled us to investigate whether managerial abuse had varying effects across the different absence parameters and whether potential mechanisms, in terms of the psychological strain and organisational justice explanations, are differentially linked to each absence parameter. This, we found, was indeed the case. Depression and distributive justice explain the relationship between managerial abuse and the absence levels of mental health workers. Once absent though, the duration of absence is not further affected by abuse but remains linked to depression and distributive justice. Frequency of absence, for its part, was found to be linked to bullying and depression.
All the 19 Trusts covered by the study had anti-bullying policies. Our findings therefore suggest that NHS policies on abuse and absence were not robust enough to curtail either the abuse or the absence that resulted from it. One implication of our research is that the prevention of abuse may need to be tackled by selection processes, training, appraisal and role-modelling. This was acknowledged in a subsequent report by Lord Francis on the Freedom to Speak Up, a study which emphasised the importance of recrimination not being taken against whistle-blowers. Values-based recruitment is now mandatory within the NHS as a direct result of Lord Francis’ recommendations. The ethical issues considered in the framing of the principles guiding such personnel practices, both in and beyond the NHS, must be as full and inclusive as possible, both for the sake of the organisation and also for the sake of its employees.