Recognising the Impact

Bullying and harassment affect patient care, team performance, and staff health. Seeing the impact makes it easier to decide what to tackle first and to secure time and resources for prevention. ^[1][3][5]

Clinical, operational, and human consequences

• Patient safety: distraction and anxiety increase mental load, leading to missed questions, forgotten safety advice, and poor record keeping. A colleague who feels belittled is less likely to raise a concern or challenge a risky decision. ^[4][5]
• Workforce stability: sickness and presenteeism reduce productivity; high turnover disrupts supervision and continuity; recruitment costs rise. ^[1][7]
• Health and morale: headaches, poor sleep, stomach problems, low mood, and burnout; avoidance behaviours such as skipping huddles or limiting communication weaken teamwork. ^[2][3]

Indicators to monitor in optical practice

• Process signals: more remakes, late referrals, or unfiled attachments; more near-miss reports linked to communication issues. ^[5][4]
• People signals: more sickness absence, exit interviews mentioning culture, staff avoiding certain shifts or rooms. ^[3][1]
• Patient signals: complaints about mixed messages, unfriendly tone at reception, or a sense of disorganisation. ^[5][7]

Bringing impact into governance

Tracking impact is most useful when it is part of normal governance. Review incident data alongside staff survey results on safety, respect, and confidence to speak up. Combine numbers with stories: what behaviours came before the mistake? What did colleagues feel unable to say? ^[6][8]

Where feedback loops exist (e.g., hospital referral outcomes), check whether the information reliably reaches the original clinician. ^[6]

Recognising impact makes culture a visible clinical risk control that deserves senior attention and long-term improvement, not just a “soft” topic.^[6]

References (numbered in text) Why we include references

1. Outcomes of exposure to workplace bullying: A meta-analytic review — Morten Birkeland Nielsen; Ståle Einarsen; Work & Stress (2012) Find (opens in a new tab)
2. Workplace Bullying and Mental Health: A Meta-Analysis on Cross-Sectional and Longitudinal Data — Bart Verkuil; Serpil Atasayi; Marc L. Molendijk; PLoS One (2015) Find (opens in a new tab)
3. Health consequences of bullying in the healthcare workplace: a systematic review — Isabelle Lever; Daniel Dyball; N. Greenberg; Sharon Stevelink; Journal of Advanced Nursing (2019) Find (opens in a new tab)
4. The Impact of Rudeness on Medical Team Performance: A Randomized Trial — Arieh Riskin et al.; Pediatrics (2015) Find (opens in a new tab)
5. The impact of interprofessional incivility on medical performance, service and patient care: a systematic review — Clive Lewis; Future Healthcare Journal (Royal College of Physicians) (2023) Find (opens in a new tab)
6. Review of patient safety across the health and care landscape — Department of Health & Social Care (Published 7 July 2025) Find (opens in a new tab)
7. 7.4 What are the effects of poor workplace behaviour and culture on patient safety, the team and quality of training? — Royal College of Obstetricians and Gynaecologists (RCOG) Workplace Behaviour Toolkit Find (opens in a new tab)
8. Psychological Safety and Learning Behavior in Work Teams — Amy C. Edmondson; Administrative Science Quarterly (1999) Find (opens in a new tab)