Horizontal violence and bullying in healthcare

Horizontal violence and bullying is a significant issue confronting healthcare. The behavior has impacted the health and well being of both the healthcare worker and the patients utilizing healthcare services for decades. Bullying and horizontal violence share a range of behaviors from incivility to sabotage and social isolation that is repetitively targeted toward an individual or group. The intent of the behavior is to produce harm. There are four stakeholders who suffer harm from this negative behavior in healthcare. The organization suffers losses by declining productivity, the expense of recruitment and retention, and the potential of lost revenue as a result of poor patient care. The target or victim suffers the physical symptoms of stress and psychological damage of low self-esteem. Bystanders suffer many of the same reactions as the target as well as guilt for not intervening. The perpetrator or bully suffers as well with depression and fear of discovery. The harm may be physical, psychological or monetary. This paper introduces a multi-focal model with interventional recommendations aimed at harm reduction.