The Silent Epidemic: Workplace Bullying in Healthcare

Workplace Bullying in Healthcare and the Leadership Response

Healthcare is one of the most demanding professional environments on earth. Clinicians make high-stakes decisions under pressure, routinely absorb the grief and trauma of others, and operate within systems stretched well beyond capacity. Most enter the profession with a commitment to care. What many do not expect is that one of the greatest threats to their wellbeing will come not from patients, but from colleagues and institutions.

Workplace bullying in healthcare is a crisis. It is endemic, structurally reinforced, and damaging at scale — to individuals, to teams, and ultimately to the patients those teams exist to serve. The sector can no longer treat it as an uncomfortable outlier. The data demand a different response.

The Scale of the Problem

In Australia, healthcare and social assistance recorded the highest number of serious workers’ compensation claims among all industries in 2021–22, accounting for 18.9% of all serious claims.^[1] A World Health Organization multi-site study found that up to 67% of Australian healthcare workers reported verbal abuse in a single year — the highest rate among the countries surveyed.^[2]

A Monash University survey of nursing and midwifery federation members found nearly 50% had experienced bullying or harassment within the previous twelve months.^[3] A multi-facility study found that over 85% of nursing staff had observed workplace bullying, and more than a third had been direct victims.^[4] A systematic review of radiology workers found 100% had experienced verbal aggression.^[5]

Among medical trainees, the Australian Medical Training Survey — administered annually by the Medical Board of Australia and AHPRA — found that 35% of junior doctors witnessed or experienced bullying, harassment, or discrimination in 2021, up from 34% in 2020 and 33% in 2019.^[6] The problem is considerably worse for Aboriginal and Torres Strait Islander trainees, with 52% experiencing or witnessing these behaviours compared with 35% of junior doctors overall.^[6]

The financial toll compounds the human one. The Australian Productivity Commission estimated the total cost of workplace bullying to the national economy at between $6 billion and $36 billion annually.^[7] At the individual level, research puts the cost per victim at up to $100,000 per year when absenteeism, lost productivity, turnover, and clinical error are factored in.^[7]

How Bullying Manifests in Healthcare Settings

Workplace bullying in healthcare rarely presents as a single dramatic incident. It accumulates. Common forms include persistent public humiliation of junior staff, aggressive questioning during clinical training — sometimes euphemistically described as ‘teaching by pressure’ — social exclusion from decision-making, withholding of information that affects performance, and what researchers describe as ‘undermining behaviours’: subtle, deniable, but corrosive over time.^[8]

Surgical and acute care settings carry particular risk. In 2015, the Royal Australasian College of Surgeons commissioned an independent review that found 49% of surgeons and trainees had experienced discrimination, bullying, or sexual harassment, and that 71% of hospitals reported these behaviours among staff, with senior surgeons identified as the primary perpetrators.^[9]

A 2024 study published in The Lancet Regional Health — Western Pacific identified that fragmented regulation, weak correction processes, conflicts of interest, and fear of retribution for complainants collectively create environments that enable perpetrators while discouraging reporting.^[10] The targets are not random. Research consistently identifies women, new employees, individuals with disabilities, and those from marginalised communities as disproportionately affected.^[4,8]

What the Research Actually Shows About Impact

The consequences of workplace bullying extend well beyond the individual who experiences it — making it a patient safety issue, not merely an HR one. A simulation study found that teams subjected to even mild rudeness shared less information, sought help less often, and produced poorer clinical outcomes for patients.^[11] Incivility alone — below any threshold we might call bullying — degraded team performance in measurable, patient-facing ways.^[11]

The mechanism is psychological safety. Amy Edmondson’s foundational research defines psychological safety as a shared belief that team members can speak up, take risks, and admit mistakes without fear of punishment or humiliation.^[12] In healthcare, this is not merely a team dynamic preference — it is a clinical competency. Research confirms that when leader inclusiveness supports psychological safety, nurses are less likely to remain silent and more likely to report errors.^[13] Bullying cultures suppress exactly the voices most likely to catch the mistakes that harm patients.

Beyond patient safety, bullying drives attrition in a sector that cannot afford it. More than half of nurses who experienced workplace violence seriously considered leaving their role or the profession as a direct result.^[14] Workplace bullying is closely linked to intention to leave, increased absenteeism, reduced job satisfaction, and deteriorating team relationships — all compounding existing workforce pressures.^[4,8]

Why the System Enables It

One of the most important shifts in how researchers now frame workplace bullying in healthcare is the move from individual attribution to systemic analysis. A 2025 paper in Expert Review of Pharmacoeconomics and Outcomes Research is direct: bullying in healthcare is increasingly recognised as a symptom of systemic dysfunction rather than isolated misconduct.^[15] The enabling factors are structural — inadequate governance, poor detection and correction mechanisms, conflicts of interest that protect perpetrators, and cultural norms that frame silence as professionalism and reporting as disloyalty.^[10]

The National Health Practitioner Ombudsman’s 2023 report, Processes for Progress, recommended that the Australian Medical Council work with colleges and stakeholders to develop a clear framework for managing bullying, harassment, racism, and discrimination at accredited specialist training sites — with defined roles, responsibilities, and accountability mechanisms.^[16]

The system’s response, when it comes, is frequently insufficient. Of junior doctors who experienced or witnessed bullying, 66–70% did not report it.^[10] Among nurses, only 47% who experienced violence reported it to management — citing time constraints, insufficient staffing, and perceived inaction.^[4] The 2017 AHPRA-commissioned report found that concerns about vexatious complaints are largely unfounded: no more than 1% of health sector complaints are estimated to be vexatious.^[10]

In my work coaching healthcare leaders and professionals, I see this pattern consistently. Those presenting for coaching after sustained workplace bullying are rarely clinical outliers — they are often among the most committed practitioners in their organisation, whose values make them unwilling simply to absorb the culture and move on. The cost of that refusal, and the resilience required to navigate it, is significant.

The Regulatory Landscape Has Changed

A development that deserves greater attention in healthcare settings is the transformation of Australia’s work health and safety framework. Safe Work Australia’s revised model WHS Regulations and the accompanying Code of Practice: Managing Psychosocial Hazards at Work (2022) now impose a positive duty on employers to proactively identify and manage psychosocial risks — including bullying — rather than respond reactively.^[17]

As of 2024, nearly every Australian state and territory has adopted these changes. NSW went further still: the Work Health and Safety Regulation 2025 now explicitly requires application of the hierarchy of controls to psychosocial risks, including mandatory elimination where reasonably practicable.^[18,19] This is not soft law. A Victorian employer was fined close to $380,000 in late 2023 for failing to identify or assess psychosocial risk adequately.^[18]

Healthcare organisations that treat bullying solely as a conduct or HR matter are not only failing their people — under current Australian law, they are increasingly exposed to serious regulatory risk.

A Leadership Framework for Response

Given the evidence, what does effective organisational response actually look like? Three overlapping areas demand attention: detection, culture, and leadership development.

Detection requires more than policy — it requires systems that staff trust enough to use. Initiatives such as the Ethos programme evaluated across St Vincent’s Hospitals in Australia represent the kind of structural intervention the evidence supports: confidential, accessible, and genuinely acted upon.^[20]

Culture change requires leaders who understand that psychological safety is a performance lever, not a soft concept. Teams with high psychological safety report errors more frequently, allow for earlier intervention, and produce better clinical outcomes.^[12,13] Building that safety requires leaders who model vulnerability, reward candour, and respond visibly to concerns.

The four stages of psychological safety framework — inclusion, learner, contributor, and challenger safety — offers healthcare leaders a practical progression for building environments where speaking up is genuinely possible.^[21] This is a culture project, not a workshop. It requires time, visible senior support, and institutional commitment.

The AMA’s updated Position Statement and its 2022 campaign calling on hospital boards to act directly reinforces this: role modelling from senior clinical leaders is the single most cited lever for cultural change in the research literature.^[22]

The Resilience Dimension

It would be a mistake to frame this issue solely as an organisational problem requiring organisational solutions. The individuals caught within bullying cultures need support that is timely, skilled, and genuine — not a referral to an EAP hotline.

Resilience in this context is not about absorbing more. Properly understood, it is the capacity to navigate adversity without losing the ability to function effectively, maintain connection, and act in accordance with one’s values. For healthcare professionals experiencing or recovering from workplace bullying, that involves processing the psychological impact, rebuilding confidence in professional identity, and determining whether the organisation they are in is capable of changing — or whether their energy is better directed elsewhere.

These conversations require skilled, confidential, independent support. For many healthcare professionals, professional coaching outside the institution provides exactly that space.

What Needs to Change

The evidence on workplace bullying in healthcare is not new. What is new is the growing consensus that framing it as an individual conduct issue has failed. Meaningful change requires:

• Governance reform that closes the regulatory gaps enabling perpetrators to avoid accountability^[10,16]
• Reporting mechanisms that staff actually trust, with visible institutional follow-through — including compliance with Safe Work Australia’s psychosocial hazards framework^[17,18]
• Leadership development that treats psychological safety as a clinical competency, not a compliance checkbox^[12,21]
• Independent support for affected practitioners that goes beyond reactive EAP referrals
• Annual public reporting by specialty colleges on bullying complaints and sanctions imposed, as recommended by the Senate Community Affairs Committee^[23]

Healthcare organisations that fail to address bullying are not simply failing their staff. They are compromising patient safety, driving workforce attrition, and — under Australia’s current WHS laws — taking on significant legal exposure. The evidence is clear. The question is whether leadership has the will to act on it.

Author Bio

Andrew Healey, MBA, Resilience and Leadership Coach, Prospice Consulting

Andrew Healey is a Resilience and Leadership Coach based in Newcastle, NSW, operating through Prospice Consulting. He works with founders, executives, clinicians, and senior leaders across Australia, with a focus on resilience, leadership under pressure, and building psychologically safe team cultures. Credentials include an MBA from Strathclyde Business School, R2 Resilience Expert, PR6 Resilience Practitioner, Solution Focused Brief Therapy (Diamond Level 1), and Authorised Partner with Coaching On the Go (Henley Business School).