Supporting Bystanders and Other Staff Exposed to Negative Workplace Behaviour: Developing and Testing the IMO Intervention Framework in the Clinical Workplace

Abstract

Background

Medical student and health-care staff bullying remain international concerns. Our understanding about what might solve such problems is still developing. A common approach suggested for bystanders to bullying is that they challenge or “stand up” to the bully. At the same time, the considerable risks should they act (eg, verbal rebuke) are rarely acknowledged, and neither is the potential for considerable cognitive dissonance should they choose not to.

Methods

Drawing on a substantial literature review, we developed an interventional program, initially with medical student bullying in mind, that generally employed a discourse for values cultivation. We implemented and evaluated this program through 6 cycles of action research methodology in 6 different departments of one tertiary teaching hospital. Data include individual interviews, discussions with key participants plus freehand comments from wider staff’s workshop evaluations.

Results

Alongside others, an early serendipitous finding was the “IMO” [Indirect, focus on Me, focus on Outcome] framework, intended for bystanders to student bullying. From using this framework, participants reported developing confidence in tackling negative behaviours, that interactions had better outcomes and that the workplace atmosphere felt more relaxed. It’s use also significantly reduced cognitive dissonance. Encouragingly, participants went on to use IMO for staff–staff bullying incidents, and other common negative behaviours. We attribute IMO’s utility to its memorability, simplicity and for catering to the many possible causes of bullying, including values issues, without perpetuating or creating conflict.

Conclusion

The IMO framework is offered as a widely usable framework for all staff in a clinical environment – a useful addition to popular frameworks used in the clinical workplace, ideas from which might also help these be further refined. Further evaluation would establish whether IMO invites long-term change and its utility in other contexts.

Keywords:

• bullying
• bystander
• clinical environment
• framework
• IMO
• intervention
• medical student
• onlooker
• verbal

Abbreviations

CAPLE, Creating A Positive Learning Environment research project; IMO [In My Opinion], a verbal framework for use in situations around negative workplace behaviours; IR, Interventionist-Researcher; AR, Action Research; KSH, Kelby Smith-Han, researcher.

Ethics and Consent Statements

This project was granted ethics approval in its entirety from the University of Otago, Dunedin, NZ. Participants all granted their written consent prior to taking part in the research, to include consent for participation and publication of their anonymised responses gathered during the research. Data and other materials are unavailable for lodging in an accessible repository as ethical approval did not allow for this.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

The authors declare no competing interests around undertaking or reporting this research.

Additional information

Funding

We acknowledge with gratitude funding received from the Division of Health Sciences, University of Otago, Dunedin, NZ. Study design was developed by a research team independent to the funding body.