We've all read about retaliation against whistleblowers at Veterans Administration (VA) hospitals, but what is retaliation?
The behaviors involved in retaliation include freezing out, isolation, public humiliation, contempt, false criticism, malicious disparagement, trumped-up disciplinary charges and unwarranted job termination. But these behaviors are not reserved for retaliation. What if they are done because Alex is jealous of Bob, or Carol just doesn't like Debbie?
Such abusive conduct also can be classified as workplace bullying or psychological harassment and intimidation. Such conduct falls under "behaviors that undermines a culture of safety," as described by The Joint Commission, which sets the standards for hospital accreditation.
In the federal government, the abusive conduct described above is classified as psychological or "non-physical" violence. This perspective is in the Department of Homeland Security (DHS) Interagency Security Committee's (ISC) guide, "Violence in the Federal Workplace" (April 2013). (http://www.dhs.gov/publication/interagency-security-committee-violence-federal-workplace-guide-april-2013) This guide set new "best practices."
Physical Violence
There is physical and psychological violence in VA health care centers, just like other hospitals. Nurses and doctors are targets of physical violence from patients, sometimes from patients' family members and sometimes from co-workers.
VA health care centers, like other hospitals, have gotten frequent guidance on workplace violence from the Joint Commission. A good example of this guidance is the commission's "Quick Safety – Issue Five, August 2014."
The VA recognized the importance of addressing physical violence in its "Workplace Conflict Guide," which states: "Every VA facility has a workplace violence prevention policy." There is thorough, detailed advice on this in the ISC's 2013 guide. All of these address physical violence.
Psychological Violence
Nurses, doctors and administrative staff also are targets of psychological violence (i.e., bullying, harassment and intimidation) from patients, from patients' family members and from other staff members at the site. To get accreditation from the Joint Commission, hospitals – including VA hospitals – are required to have policies to deal with such psychological abuse. An alert from the Joint Commission addressed "behaviors that undermine a culture of safety," and the 2013 ISC guide says: "The continuum of violent acts ranges from the more common non-physical acts such as incivility, bullying, gestures, expressions and verbal threats to the less common physical acts, such as battery, aggravated assault, homicide and acts of terrorism."
The reporting section of the guide notes: "Employees who feel they are victims of bullying, verbal or electronic harassment/cyber bullying (e.g. e-mails, text messages, web-pages); psychological violence; or emotional abuse need to report the problem as these behaviors can negatively impact the victim, work environment and employee productivity."
So, there is good policy and guidance on psychological violence from the Joint Commission (which applies to any accredited hospital) and from the ISC guide for federal workplaces.
This guidance would make a difference if people knew about it and followed it.
Gathering VA Policies
Years before the serious operational problems at the VA were revealed, the Joint Commission understood the behavior that would deter most people from revealing those problems. The commission set standards for accreditation to address this very behavior.
"Intimidating and disruptive behaviors include overt actions such as verbal outbursts and physical threats, as well as passive activities such as refusing to perform assigned tasks or quietly exhibiting uncooperative attitudes during routine activities," said one Joint Commission alert. "Intimidating and disruptive behaviors are often manifested by health care professionals in positions of power. Such behaviors include reluctance or refusal to answer questions, return phone calls or pages; condescending language or voice intonation; and impatience with questions. Overt and passive behaviors undermine team effectiveness and can compromise the safety of patients. All intimidating and disruptive behaviors are unprofessional and should not be tolerated."
The alert added that disruptive behaviors often go unreported – and unaddressed – for a number of reasons. These include fear of retaliation and the stigma associated with ‘blowing the whistle' on a colleague, as well as a general reluctance to confront the aggressor.
It appears that some VA sites are not living up to those required standards. Many VA staff are not aware of Joint Commission standards, and management is not complying with them. Ultimately, this makes a difference in the care of our service men and women.
To get a sense of the policies that could address retaliation against whistleblowers at the VA, I reviewed and collected policies on workplace violence, managing disruptive behavior, harassment and codes of conduct from more than 20 VA sites, many of which were accessible on the Internet.
Edward J. Hines Jr. VA Medical Center
The Edward J. Hines, Jr. VA Medical Center has had a policy since October 2012 titled "Prevention of Workplace Harassment." It addresses harassment under EEO laws and then bullying, separately.
This policy has a good description of bullying. It says: "Bullying in the workplace is psychological violence." It says that workplace bullying is "intended to intimidate, degrade, humiliate or undermine the health or safety of the employee." The policy offers examples of being bullied, which includes:
- Being ridiculed in front of a group
- Unfounded negative statements and comments about an individual
- Hostile or intense staring
- Glaring (non-verbal intimidation)
- Showing hostility
- Employee made to feel defensive or on guardUndeserved or false criticismBlame without factual justificationBeing treated differently than the rest of the group
- Insults
- Yelling and shouting
- Exclusion or social isolation
- Excessive monitoring or micro-managing
- Use of condescending or demeaning language
- Disregarding satisfactory or excellent quality of work.
The same memorandum states: "Bullying and psychological harassment are often characterized through insulting, hurtful, hostile, vindictive, cruel or malicious behaviors which undermine, disrupt or negatively impact another's ability to do his or her job and results in a harmful work environment for the employee(s)."
The behaviors listed in the bullying section of the Hines VA policy should cover the means of retaliation against whistleblowers. According to this policy, retaliation fits the description of workplace bullying. Of course, the policy is only good if the hospital follows it.
Other VA sites have good policies on workplace bullying or "disruptive behavior." The Oklahoma City VA Medical Center has a good staff code of conduct, which states that, "Raised voice, profanity, name-calling, throwing things, abusive treatment of patients or employees, sexual harassment…or behavior that disparages or undermines confidence, credibility, integrity or dignity of the organization or peers are unacceptable behaviors." It does not mention bullying or retaliation, but most of the means and methods of bullying are captured in this code of conduct.
The Ralph H. Johnson VA Medical Center has a strong and thoughtful policy memorandum, "Employee Code of Conduct and Management of Disruptive Behavior" (http://www.charleston.va.gov/Documents/Education/CPM05-12-26.doc). It is worth a look if you are writing a policy.
Retaliation = Bullying = Violence
Anyone following what went on at the VA knows that some medical centers had serious problems in providing services, and that some employees have publicized those problems and have been subject of retaliation for their whistleblowing.
According to the VA's own policies, the means and methods of retaliation are bullying, harassment and intimidation, and that bullying, harassment and intimidation are considered workplace violence under the 2013 Interagency Security Committee's guide, "Violence in the Federal Workplace." Retaliation and bullying could be addressed in workplace violence programs if the VA were in compliance with the ISC guide, but it is not.
The absence of policies, the inconsistency of policies among sites and the staff's lack of knowledge of relevant standards of the Joint Commission and the Interagency Security Committee have created an environment that is favorable to retaliation and other kinds of bullying.
A lot of work needs to be done at the VA and other medical centers. The Joint Commission and the Interagency Security Committee should do more to educate federal agencies and workers about their valuable guides on workplace violence and bullying.
Edward Stern served the U.S. Department of Labor for more than 40 years as a senior economist and policy/program analyst.