16/10/2011 15:36 BST | Updated 13/12/2011 05:12 GMT

Medical Mobbing

Mobbing is a kind of group behaviour first described amongst birds and other animals by Konrad Lorenz [1903-1989] in his book "On Aggression". Lorenz associated the phenomenon with Darwinian theories on survival.

Mobbing is a kind of group behaviour first described amongst birds and other animals by Konrad Lorenz [1903-1989] in his book "On Aggression". Lorenz associated the phenomenon with Darwinian theories on survival.

Amongst humans, mobbing was first described and investigated by Heinz Leyman in Sweden in the early 1980s. Leyman's documentation is available via his website and also The Mobbing Portal. It has since become the subject of much scrutiny, and was succinctly defined by Kenneth Westues in "At the Mercy of Mob" (OHS 2002) as, "an impassioned, collective campaign by co-workers to exclude, punish, and humiliate a targeted worker."

In the Swiss weekly die Weltwoche of 25 July 1996, Alain Zucker set out a number of distinctive variations on the basic theme (1) mobbing by employees against a colleage, (2) by employees against a subordinate, and (3) by employees against a superior. A little later that same year, in the 25 October and 1 November editions of the New Law Journal, Roderick Ramage also drew attention to the horizontal, downward and upward varieties of mobbing.

The behaviour involved may include social conflicts such as defaming a person, isolating them, instigating rumours that progress into major conflicts e.g. preventing employment, lack of promotion and even threats of physical violence. It may be deliberately coordinated, or may develop through the influence of a copycat atmosphere in the workplace. Ramage says that, "Therefore it is often insidious, difficult to detect and harder to prevent once discovered and potentially incurable." Speaking of the impact upon the unfortunate victim, Ruth Swartz et al who wrote "As a result, the individual experiences increasing distress, illness, and social misery...Resignation, termination, or early retirement--the negotiated voluntary or involuntary expulsion from the workplace--follows. For the victim, death--through illness or suicide--may be the final chapter in the mobbing story." ( Mobbing: Emotional Abuse in the American Workplace [2004]).

In medicine, mobbing has been recognised as "Sham Peer Review". US neurologist Lawrence R. Huntoon defines it as "an official corrective action done in bad faith, disguised to look like legitimate peer review. Hospitals use it to rid themselves of physicians who advocate too often or too vociferously for quality patient care and patient safety, and economic competitors frequently use it to eliminate unwanted competition". Kenneth Westhues, University of Waterloo, 2006, 2009 said that, "'sham peer review' is defined by a particular technique of punishing, discrediting, and humiliating the target: the quasi-judicial procedure of "peer review," whereby in response to one or more complaints, a hospital committee formally deems the target deficient or incompetent in some way, and decides on a penalty (like retraining, suspension, or dismissal)". In his editorial "The Psychology of Sham Peer Review" [2007] Lawrence R. Huntoon goes onto say "The psychology of the attackers is a combination of the psychology of bullies and that of the lynch mob. The attacks are typically led by one or a few bullies who have gained positions of power over others and who enjoy exercising and abusing that power to attack and harm the vulnerable. Although there is always some improper motive that precipitates the attack, the attack itself often serves to distract attention from the bully's own underlying shortcomings, deficiencies, insecurities, and cowardice".

In 2009, the Health Service Journal reported that, "Although less recognised in the UK, the problem is on the rise, and the NHS managers' union Managers in Partnership has now produced guidance for employers and employees, following their handling of a number of mobbing cases". Elements of the mobbing phenomenon have been described in various papers related to whistleblowing. According to Dr Steve Bolsin, of the Bristol Inquiry, "This pattern of behaviour has been described in many cases but I will reference the following the Winnepeg Paediatric Cardiac Surgery Scandal, Canada, The Bristol Paediatric Cardiac Surgery Scandal, UK, The Olivieri Scandal, US, The Dr Patel Bundaberg Affair, Australia, The Canberra Neurosurgery Problem, Australia".

Other groups in which mobbing is commonplace may include medical students. In 2005, the British Medical Association survey revealed that 35% of medical students experienced bullying. More generally, nearly 1 in 12 staff working in the NHS has experienced bullying or harassment by their manager, according to government figures in 2008. Moreover, racial discrimination is rife in the NHS as established by various studies. Dr Sam Everington told the BBC "The highly pressurised target ethos in the health service only adds to the survival of the fittest culture where bullying is often seen as a way of motivating staff."

It doesn't motivate them, of course. According to the Department of Health, the estimated cost to the NHS of bullying and harassment is approximately £325 million per annum. Imagine how much more motivated, efficient and cost-effective the NHS would be if it could weed out all those bullies - perhaps some kind of national campaign might be in order!