Workplace bullying interventions in healthcare: a realist approach

Abstract

Background and Objectives: Workplace bullying is a persistent issue in healthcare, but research and theoretical development on intervention efficacy is limited. Using realist methodology, this research aimed to develop and test programme theories to explain how workplace bullying interventions work, for whom, and in what circumstances. A practitioner framework was also developed to translate theories into evidence-based guidance on developing and implementing bullying interventions.

Methods: Programme theories were developed through a realist synthesis of 46 papers and 17 subject matter expert interviews. Theory testing and refinement was conducted via realist evaluation of three organisational interventions and an updated realist synthesis of 22 papers. These theories informed the development of a practitioner framework to guide the design of workplace bullying interventions. This framework was evaluated through interviews with 17 intervention practitioners.

Results and Conclusion: Five programme theories were developed to explain how workplace bullying interventions work, elucidating key mechanisms, outcomes and overarching contextual factors that influence intervention efficacy. Theories outlined the importance of: 1) theoretical learning on bullying and appropriate strategies to address workplace bullying; 2) active and skills-based learning to enable practice and to develop confidence to apply strategies; 3) group work to increase knowledge, collegial support and confidence; 4) reflection on one’s own behaviour to encourage self-monitoring and behaviour change; and 5) knowledge, strategies and confidence to apply learning in the workplace. However, for an intervention to be effective, there needs to be an organisational culture of psychological safety; leadership support for the intervention and for behaviour change; organisational readiness regarding the availability of, and adherence to, relevant policies and procedures; and a work environment which is not excessively stressful. These programme theories informed practitioner guidance on the planning, design, implementation and evaluation of workplace bullying interventions in healthcare.

Date of Award	28 Mar 2024
Original language	English
Awarding Institution	Northumbria University
Supervisor	Madeline Carter (Supervisor), Neill Thompson (Supervisor) & Laura Longstaff (Supervisor)