Taking Decisive Action to Address Sexual Harassment in Healthcare

Laura M. Cascella, MA

Sexual harassment in the workplace is not a new problem — yet, in the past couple of years, it has received renewed attention as a result of the #MeToo movement and countless numbers of women and men coming forward with accounts of being victimized. These reports indicate that harassment is an ongoing and serious issue across all types of industries and organizations, and healthcare certainly isn’t immune.

Numerous media stories have highlighted allegations of sexual misconduct against healthcare providers and personnel as well as institutional failures to prevent these incidents and protect employees and patients. The consequences of sexual harassment are wide ranging and include various types of physical and emotional harm for victims, financial losses (e.g., legal expenses, fines, settlements, and public relations costs), loss of reputation, a toxic or demoralized workplace culture, and more.

To proactively confront these issues, healthcare organizations of all sizes and types — solo practices, multi-group practices, hospitals, health systems, long-term care and senior care facilities, etc. — need to take decisive action to prevent sexual harassment and address all reports of inappropriate behavior.

Assess Policies

Although many healthcare organizations likely have sexual harassment policies in place, organizational leaders and human resources personnel (if applicable) need to ensure those policies are sufficiently comprehensive and appropriately enforced.

A recent article in the Harvard Business Review cautions organizations about sexual harassment policies devised for "symbolic compliance" only, noting that "nearly every healthcare organization has a policy, but whether that policy is merely a checkbox or actually functions well in practice is a distinguishing feature of organizations that are serious about the problem."¹

Because of the elevated awareness of sexual harassment and the increased scrutiny facing institutions that have lax prevention efforts, now is the time for healthcare organizations to proactively assess their policies and procedures.

Questions to Consider²

• Does your organization have a professional code of conduct that explicitly establishes standards for professionalism, respect, and dignity?
• Does your organization have a policy that prohibits discrimination, intimidation, and harassment, including sexual harassment?
• Does your organization's policy comply with federal and state laws, accreditation standards, and professional guidance related to discrimination and harassment?
• Does your organization's policy define sexual harassment? Do definitions include the two types of sexual harassment that the Supreme Court has ruled are covered by the Civil Rights Act of 1964: quid pro quo and hostile work environment?
• Does your organization's policy provide examples of what is considered sexual harassment, such as unwanted touching, requests for sexual favors, offensive gender-related statements, unwelcome or unreciprocated romantic overtures, gender slurs, and repeated inappropriate comments?
• Are consequences for violating the organization's harassment policy clearly defined, including possible termination?
• Does the organization provide adequate information about its code of conduct and harassment policy in employment arrangements, partnership agreements, and business contracts?
• Have the organization's code of conduct and harassment policy been reviewed by legal counsel? Are these policies periodically reviewed (e.g., annually) to identify potential gaps?

Develop Incident-Response Protocols

The goal of every institution should be to prevent all instances of sexual harassment, discrimination, and other misconduct; however, experience shows that completely eradicating these behaviors is unrealistic.

Although rigorous policies related to professional conduct and discrimination/harassment help establish the expectations for appropriate behavior, organizations also need protocols for managing incidents when they occur. Responding to allegations in a way that appears inadequate, remiss, or indifferent can result in loss of employee trust and increased vulnerability for victims and the organization.

Questions to Consider³

• Has your organization devised clear, easy-to-follow protocols for reporting sexual harassment and other misconduct?
• Are multiple channels for reporting available, including an anonymous option?
• Are reporting methods well-publicized within the organization to increase awareness?
• Are employees encouraged to document all incidents of harassment, including the date, time, who was involved, what happened, how the employee being harassed responded, and any witnesses?
• Does the reporting process include submission of a written statement and any evidence acquired?
• After a report is made, is a written record established that contains materials related to the complaint? Is the record updated when investigative actions occur and outcomes are determined?
• Are protocols in place for timely and consistent investigation of all reports of sexual harassment and other misconduct?
• Are individuals who are responsible for facilitating investigations of incidents aware of their duties, responsibilities, and expected timeframes for action?
• Is a mechanism in place to allow individuals to dispute allegations of sexual harassment or other misconduct?
• Are disciplinary actions applied consistently and commensurate with the offense?
• Is a process in place for monitoring and evaluating performance following disciplinary interventions that do not result in termination?

Secure Leadership Support

A report from the National Academies of Sciences, Engineering, and Medicine notes that the "most potent predictor of sexual harassment is organizational climate—the degree to which those in the organization perceive that sexual harassment is or is not tolerated."⁴

More often than not, organizational leaders set the tone for a workplace's climate and perceived level of tolerance. For this reason, having strong leadership support for policies and initiatives that seek to prevent sexual harassment is essential. In the absence of such support, those who harass may feel emboldened to do so, victims of harassment might be hesitant to report incidents, and workplace productivity and morale may suffer.

Questions to Consider⁵

• Are organizational leaders engaged in the development and assessment of the organization's code of conduct and harassment policy and procedures?
• Do leaders clearly demonstrate and communicate their commitment to upholding the organization's policies and supporting a zero-tolerance environment for sexual harassment and other types of inappropriate behavior?
• Are leaders aware of their responsibilities for enforcing the organization's harassment policy as well as the implications for employer liability if federal and state laws are violated?
• Are women equally represented in leadership roles within the organization? Research shows that sexual harassment is more prevalent in environments where leadership is male-dominated.⁶
• Are leaders held to the same ethical and professional standards as the rest of the organization's workforce? Do they lead by example?
• Are leaders prepared to manage allegations of sexual harassment? Are they aware of their roles and responsibilities in investigative and disciplinary processes?
• Do human resource representatives and healthcare leaders screen employees during the hiring process for potential warning signs of problematic behavior (e.g., reluctant references, previous investigations of misconduct, prior disciplinary actions, etc.)?

Engage Employees

Engaging healthcare providers and staff members in efforts to prevent sexual harassment is an essential component of each organization's anti-harassment strategy. Efforts to create a culture of safety and well-being will encourage individuals to support organizational policies and report instances of harassing, discriminatory, unprofessional, or unethical behavior.

A culture of safety and well-being goes beyond just having policies in place and periodically reminding employees about these policies. Rather, the organization should engage employees in training and feedback regardless of their professional roles or career stages. Every employee, from a new hire to a veteran clinician, can benefit from this approach.

Questions to Consider⁷

• Does your organization support a culture in which employees feel empowered to raise concerns without fear of punitive actions or retaliation?
• Are employees made aware of their ethical responsibility to report discriminatory and harassing behavior that is directed at them or that they witness?
• Are employee representatives included in the development of new, or the revision of existing, codes of conduct and harassment policies?
• Do new hires receive education about the organization's code of conduct and harassment policies during orientation? Are these policies reviewed in detail, and is the concept of zero tolerance emphasized?
• Do employees receive education at least annually that reviews the organization's code of conduct and harassment policies? Are changes or updates acknowledged and explained?
• Are employees educated about the procedures for reporting sexual harassment and other misconduct as well as the investigative process and follow-through steps they can anticipate?
• Are support programs and services available to employees who report incidents of harassment? Are these services offered through an independent, external resource?
• Are all instances of employee education and training well-documented in their personnel files?
• Are employees asked to acknowledge their understanding of the organization's conduct and harassment policies in writing?
• Are employees anonymously surveyed with regularity to gauge their perceptions of:
  • The organization's culture and commitment to a safe working environment?
  • The success of leaders in modeling expected behaviors and supporting employee well-being?
  • The adequacy of the organization's policies related to professional conduct, discrimination, and harassment?
  • The seriousness with which reports of harassment are taken?
  • The timeliness and thoroughness of investigations?
  • The appropriateness of consequences and disciplinary actions?
• Are employee survey data used to inform decision-making and prioritize quality improvement initiatives?

In Summary

Although sexual harassment has long been acknowledged as a pernicious problem in various industries, a surge in reports of this type of behavior as a result of high-profile media stories and corresponding social activism has propelled many organizations to take action.

In healthcare (and beyond), research shows that sexual harassment and other types of misconduct are detrimental to a culture of safety and well-being. Healthcare organizations should take these issues seriously and go beyond minimum legal requirements for addressing sexual harassment. Rather, organizations should develop comprehensive policies, protocols, and education; cultivate strong leadership support; and engage employees through meaningful feedback and training. Demonstrating a strong commitment to preventing harassment will reinforce a safe environment and contribute to employee satisfaction.

Endnotes

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¹ van Dis, J., Stadum, L., & Choo, E. (2018, November 1). Sexual harassment is rampant in health care. Here's how to stop it. Harvard Business Review. Retrieved from https://hbr.org/2018/11/sexual-harassment-is-rampant-in-health-care-heres-how-to-stop-it

² Ibid; U.S. Equal Employment Opportunity Commission. (n.d.). Harassment. Retrieved from www.eeoc.gov/laws/types/harassment.cfm; U.S. Equal Employment Opportunity Commission. (n.d.). Promising practices for preventing harassment. Retrieved from https://www.eeoc.gov/eeoc/publications/promising-practices.cfm; Compass Clinical Consulting. (2018, March 28). Sexual harassment in healthcare — How to prevent? Retrieved from www.compass-clinical.com/how-to-prevent-sexual-harassment-in-healthcare/; Ladika, S. (2018, January 30). Sexual harassment: Health care, it is #YouToo. Managed Care. Retrieved from www.managedcaremag.com/archives/2018/2/sexual-harassment-health-care-it-youtoo ; Lockwood, W. (2017, September). Sexual harassment in healthcare. RN.org. Retrieved from http://www.rn.org/courses/coursematerial-236.pdf; Bryant, M. (2018, January 31). Healthcare industry not immune to workplace sexual harassment. Healthcare Dive. Retrieved from www.healthcaredive.com/news/from-med-school-to-practice-sexual-harassment-in-healthcare/515061/; National Academies of Sciences, Engineering, and Medicine. (2018). Sexual harassment of women: Climate, culture, and consequences in academic sciences, engineering, and medicine. Washington, DC: The National Academies Press. https://doi.org/10.17226/24994

³ van Dis, et al., Sexual harassment is rampant in health care; U.S. Equal Employment Opportunity Commission, Promising practices for preventing harassment; Kohn, A. H., Odell, F. L., & Kennedy Park, J. (2018, March 7). Sexual harassment in today's workplace. Harvard Law School Forum on Corporate Governance and Financial Regulation. Retrieved from https://corpgov.law.harvard.edu/2018/03/07/sexual-harassment-in-todays-workplace/; Ladika, Sexual harassment: Health care, it is #YouToo; Lockwood, Sexual harassment in healthcare; Bryant, Healthcare industry not immune to workplace sexual harassment; National Academies of Sciences, Engineering, and Medicine, Sexual harassment of women.

⁴ National Academies of Sciences, Engineering, and Medicine, Sexual harassment of women.

⁵ van Dis, et al., Sexual harassment is rampant in health care; Kohn, et al., Sexual harassment in today’s workplace; U.S. Equal Employment Opportunity Commission, Promising practices for preventing harassment; Bryant, Healthcare industry not immune to workplace sexual harassment; Frye, K. (2012, November 15). Healthcare employers liable for harassment by patients, not just employees. Becker’s Hospital Review. Retrieved from www.beckershospitalreview.com/legal-regulatory-issues/healthcare-employers-liable-for-harassment-by-patients-not-just-employees.html; National Academies of Sciences, Engineering, and Medicine, Sexual harassment of women.

⁶ National Academies of Sciences, Engineering, and Medicine, Sexual harassment of women.

⁷ U.S. Equal Employment Opportunity Commission. (n.d.). Promising practices for preventing harassment; van Dis, et al., Sexual harassment is rampant in health care; Kohn, et al., Sexual harassment in today’s workplace; Compass Clinical Consulting. (2018, April 2). Sexual harassment: Taking on the imbalance of power in the healthcare setting. Retrieved from www.compass-clinical.com/sexual-harassment-taking-on-the-imbalance-of-power-in-the-healthcare-setting/?et_fb=1; Lockwood, Sexual harassment in healthcare; Bryant, Healthcare industry not immune to workplace sexual harassment; National Academies of Sciences, Engineering, and Medicine, Sexual harassment of women.

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