'Shadow' side of healthcare: an exploration of workplace bullying and the paradox of trauma-informed care using thematic synthesis and interpretative phenomenological analysis

Abstract

This thesis portfolio aimed to shed light on the current climate in healthcare, paying particular attention to workplace bullying (WBP), a significant issue with serious implications for all stakeholders. This researcher was interested in exploring how WPB has persisted at a time when healthcare is undergoing a paradigm shift towards trauma-informed care (TIC) and placing greater emphasis on staff wellbeing. This raises questions about how such divergent and ostensibly incompatible cultures as that of WPB and TIC have emerged and been able to co-exist, as well as the possible implications of the polarisation in contemporary healthcare.

The first chapter details a qualitative evidence synthesis (QES), which used thematic synthesis to analyse qualitative research available on early career healthcare professionals’(ECHCPs’) experiences of WPB in the UK. Three analytical themes were identified which highlighted that WPB is a significant and pervasive issue, with serious implications for all stakeholders, including staff wellbeing and patient care. The Jungian concept of ‘the shadow’ was applied to make sense of the findings, as WPB represents a toxic side to the healthcare profession that is less well-known and often is maintained through silence, fear, and oppression. A cultural overhaul is needed to address WPB, including greater accountability for perpetrators, support for victims, and a strong anti-bullying stance and awareness raising campaign across the organisation. There is an appetite for change among ECHCP, and strategies to facilitate the shift towards a more trauma-informed, compassionate workplace for all were discussed.

The findings of this review highlighted a need for more research on the implementation of TIC. The second chapter details an empirical study which explored psychological practitioners’ experiences of the roll-out of TIC in adult mental health and substance use services in an NHS Scotland health-board. Seven participants took part in semi-structured interviews, the transcripts from which were analysed using interpretive phenomenological analysis (IPA). The findings revealed the many ways in which the implementation of TIC has felt paradoxical, as well as the mixed responses from different HCPs across the MDT. Participants felt that the shift towards TIC involves a much-needed re-humanisation of the healthcare system as a whole, both in terms of staff wellbeing and the quality of patient care. There has been increasing deprivation of humanity in healthcare, which can be seen in the prioritisation of target-driven agenda that are leaving staff overwhelmed and burnt out, with less time to form trusting relationships with patients and deliver person-centred care. This can also be seen in the discord among the workforce, with issues such as WPB, problematic power dynamics, and staff generally feeling under-valued at work. Findings are discussed in relation to clinical implications and future research.