Health industry not immune to workplace sexual harassment
Hierarchies in healthcare puts employees at high risk for workplace sexual harassment
A former cafeteria worker is suing the University of Kansas Hospital Authority alleging the HR department did nothing to stop a co-worker's workplace sexual harassment.
The NYC Health & Hospitals Corporation faces a broad discrimination lawsuit including charges of lewd comments by a senior official.
A respiratory therapist in Quebec filed a $360,000 lawsuit against a hospital anesthesiologist for failure to address allegations of sexual harassment.
High-profile celebrity cases sparked the latest wave of debate over sexual harassment at work, but the abuse is pervasive across all workplaces. And several aspects of the industry — large bureaucracies dominated by men in decision-making — make healthcare particularly susceptible to sexual harassment, says David Ballard, assistant executive director for organizational excellence at the American Psychological Association.
“When you see large power differentials, when you see men predominantly in higher level positions or positions of authority, those are organizations where sexual harassment is likely to occur,” he tells Healthcare Dive.
Between 1995 and 2016, 3,085 employees at general medical and surgical hospitals filed claims of sexual harassment with the U.S. Equal Employment Opportunity Commission, according to a BuzzFeed News investigation. Sexual harassment charges crop up in other healthcare sectors as well, including 1,911 in ambulatory care services, 1,530 in nursing care facilities, 382 in physician offices and 314 in home healthcare services.
In all, more than 170,000 sexual harassment claims were filed across multiple industries. Of those, more than eight in 10 were filed by women, while 15% were filed by men.
According to the EEOC, up to 60% of women experience unwanted sexual attention or coercion, sexually crude conduct or sexist comments in the workplace. In healthcare, where women are 80% of the workforce, that adds up to a big problem.
A 2016 JAMA study found close to one-third of women in academic medical facilities reported having experienced sexual harassment in the workplace. They also experienced or perceived more gender bias than men.
Not only can nurses, physicians and other employees face sexual harassment from colleagues and bosses, they can also experience unwanted behavior from patients, Ballard notes. The experience can harm employee performance and patient care.
The impact is broad. Sexual harassment has been linked to increased anxiety, depression, alcohol and substance abuse, higher levels of staff turnover, less productivity and employee engagement. In healthcare, nurses who experience sexual harassment report a decline in emotional support for patients, while nurses, doctors and other healthcare professionals admit to being more distracted on the job and having impaired decision-making.
While there are no hard numbers on the cost of workplace sexual harassment, lost productivity and turnover can exact a toll. Josh Bersin of Deloitte estimates the cost of replacing an employee is one-and-a-half to two times their annual salary.
Organizations can use behavioral costing measures to estimate the cost though, says James Campbell Quick, professor of leadership and management at the University of Texas at Arlington. For example, how many people are dedicated to surveillance and reporting programs? What are the costs of people not showing up for work? Of investigating sexual harassment allegations and settling claims? Some economists attempt to capture the cost in pain and suffering as well, but that’s tough to do, he adds.
The Association of American Medical Colleges has been working to reduce sexual harassment in healthcare for more than a decade, alarmed at the number of reports.
“We have medical students who not only do classroom work, but in their last couple of years are in an apprenticeship model,” says Janis Orlowski, chief healthcare officer at the AAMC. “They’ll rotate on a medicine service or surgical service or OB service with individuals who can influence their grade and their ability to pass.”
AAMC conducts an annual survey of graduating medical students that includes questions on sexual harassment and abuse.
In the 2017 survey, 95.7% of respondents reported never being subjected to unwanted sexual advances, and 99.7% said they had never been asked to exchange sexual favors for other rewards, according to Orlowski. Asked if they are aware that their school has policies regarding mistreatment of medical students, 97% said yes — up from 88.2% in 2013.
“We have been monitoring this for a long time,” Orlowski tells Healthcare Dive. “We also require our medical schools and teaching hospitals to have policies and education directed both at the faculty and students.”
AAMC has also tried to clarify what may be considered offensive behavior so that faculty and students know when a joke, for instance, is OK, or if it crosses a line.
Another way to prevent sexual harassment in the workplace is to push for more women in high-level positions as administrators and physicians. That’s already starting to change. In 2016, the number of women newly enrolled in medical school equaled the number of new male enrollees.
But waiting until 50% of doctors and surgeons are women isn't the answer, says Dan Eaton, an employment attorney and instructor of business at San Diego State University.
“That is both because any delay in addressing such a clear and present problem is unjustifiable and because representation in the profession will not reflect representation in power in the profession,” he told Healthcare Dive via email. “Using income as an inexact proxy for power, even … nursing studies show male nurses tend to earn more than their female counterparts.”
Top-down culture of zero tolerance
So what should healthcare organizations be doing now to prevent and address sexual harassment in the workplace? They need to go beyond the typical check-the-box training, which tends to be ineffective, and make sure employees understand the organization’s policies for sexual harassment, what the laws are and how to file complaints if something occurs, Ballard says.
And they need to ensure that expectations for employee behavior are clearly communicated. Ballard also recommends organizations conduct assessments pre- and post-training to see if employees are actually learning and internalizing the information.
Organizations also need enforcement mechanisms that exact a price for those who violate it, Quick wrote in an email. He suggests organizations also consider a chief psychological officer responsible for monitoring the workplace environment and screening for sexual harassment issues.
When it comes to reporting, organizations should provide multiple avenues for those who believe they’ve been subjected to sexually harassing behavior, at least one of which is anonymous, according to Eaton.
One area of training that’s often neglected is bystander training — teaching employees who may not experience sexual harassment but witness someone else being harassed how to respond and whom to tell.
“Effective and interactive training in sexual harassment should be given to supervisors and support staff alike, including training on how bystanders may intervene when witnessing such behavior,” Eaton says. In healthcare, it’s also important to address how to respond to unwanted patient behaviors, he adds.
Healthcare workplaces need to demonstrate zero tolerance for sexual harassment.
It should be part of an organization’s culture that certain behaviors are not acceptable, according to Ballard. Senior leaders need to model acceptable behavior to create a safe and healthy workplace environment, he added.
With sexual harassment on the national radar right now, it seems a good time for organizations to revisit their policies and procedures around handling complaints and ramp up trainings to prevent abuse.
“I think we are seeing a national catharsis,” Quick wrote. “Everyone has known it’s there. Now it’s on the table and I am optimistic that we will make progress, but not straight-line linear [progress]. There will be setbacks and challenges, but this appears an inflection point.”