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The New Age of Bullying and Violence in Health Care

Part 4

Managing Organizational Cultures and Beyond

Fink-Samnick, Ellen, MSW, ACSW, LCSW, CCM, CRP

doi: 10.1097/NCM.0000000000000324

Disrespect among the health and behavioral health workforce may have reached the point of no return. The industry is on heightened alert, as the disruptive behaviors of bullying and lateral violence, plus escalating incidents of workforce harassment and workplace violence incidents, impact every practice setting. These behaviors contribute to concerns around client and professional safety, quality-of-care processes, as well as workforce retention and mental health.

Purpose/Objectives: This article:

  1. Defines a hostile workplace;
  2. Identifies types of toxic employees;
  3. Discusses types of workplace harassment;
  4. Reviews the impact of organizational culture on these disrupters; and
  5. Explores strategies and legislation to manage workplace violence across practice domains.

Primary Practice Setting(s): Applicable to all health and behavioral health settings where case management is practiced.

Findings/Conclusions: Despite glaring improvements in how care is rendered and an enhanced focus on quality delivery of care, organizations must address cultures that support as opposed to negate disruptive workplace behaviors. The emerging regulatory and organizational initiatives to reframe the delivery of care will become meaningless without consistent attention to enforcement of regulatory, policy, and prevention actions.

Implications for Case Management Practice: Professionals who hesitate to confront and address incidents of disruptive and oppressive behavior in the health care workplace potentially practice unethically. Bullying has fostered a dangerous culture of silence in the industry, one which impacts client safety, quality care delivery, plus has longer term behavioral health implications for the professionals striving to render care. Add the escalating numbers specific to workplace violence and the trends speak to an atmosphere of safety and quality in the health care workplace that puts clients and professionals at risk.

Ellen Fink-Samnick, MSW, ACSW, LCSW, CCM, CRP, is an award-winning industry thought leader who empowers health care's transdisciplinary workforce through professional speaking, writing, mentoring, and consultation. A subject matter expert on ethics, Ellen is an esteemed author with more than 100 publications to her credit. She has authored content for many of the industry's knowledge projects for case managers, including chapters on the Ethical Use of Case Management Technology, Workplace Bullying, Collaborative Care, and the Social Determinants of Health. Her contributions to professional case management, ethics, and clinical social work transverse professional associations and credentialing organizations, including roles as subject matter expert, examination item writer, and leadership positions. She is a vibrant professional voice.

Address correspondence to Ellen Fink-Samnick, MSW, ACSW, LCSW, CCM, CRP, EFS Supervision Strategies, LLC (

The author reports no conflicts of interest.

Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.