Abstract
The negative health effects suffered by victims of workplace bullying have been well described by the literature, and are in the process of being quantified by research. That employers may also bear some penalty, albeit primarily economic, has been suggested by potentially higher rates of employee turnover from socially hostile work environments. This paper will examine the course of economic loss to employers from higher rates of absenteeism, illness, and turnover in victims of workplace bullying, with a focus on health care facilities. Studies have suggested that bullying may be more prevalent in these institutions than others despite its higher cost of employee replacement. While the actual costs of bullying vary too widely by employment category, geographical location, and even institution to make a meaningful generalized calculation of economic impact to employers, the scope of the problem can be defined.
Introduction
The consequences of workplace bullying extend beyond the creation of discomfort for its victims. Exposure to the phenomenon has been associated with both physiological and psychological harm to those with exposure. Several studies have studied the prevalence of bullying. In a large scale study of French workers, Niedhammer, David, and Degioanni (2007) found that 10% of respondents reported exposure to the behavior. There is reason to suspect that in healthcare facilities the rate is much higher. Simmons (2008) found that 31% of nurses responding to an investigation of prevalence reported having been bullied. Of itself, the potential for damage to individual workers is reason to explore mitigating strategies in the work environment; however, employers are often hesitant to examine conditions within their organizations and are often disinclined to implement anti-bullying procedures (conversation with S. Simons).
The reason for the reticence has not been explored by the literature, though some suggest that employers may view hostile interpersonal employee interactions as competitive, relationships that positively influence overall work quality and eliminate the less productive or competent workers. Furthermore, bullying of employees by managers has been described as a management technique tolerated as appropriate by some organizations (Einarsen, Hoel, Zapf, Cooper, 2011). Beale and Hoel (2011) go so far as to suggest that managerial bullying is an integral part of the employer/employee contract used to maintain necessary control of the work environment. As such, reluctance on the part of employers to implement strategies and policies aimed at reducing the prevalence of workplace bullying may be understandable. Yet, as more is learned about the phenomenon, it is becoming accepted that bullying behavior in the workplace is not equivalent to healthy competition between workers, and has economic consequences which bear upon both effected employees and the employer.
The literature is largely silent on quantifying the economic impact that workplace bullying places on employers. Without a pretense of placing dollar amounts on the practice, this paper will attempt to examine the relationship in two ways. First, it will examine specific illnesses shown to correlate with bullying exposure; second, it will consider cost and prevalence of absenteeism associated with these conditions. It is notable that insofar as many American employers bear some costs of health care to employees, medical and psychological conditions caused by or exacerbated by a hostile work environment are also shouldered by the employer.
Further, the cost of increased employee turnover, an indicator of employment dissatisfaction commonly shown to increase among bullied employees, will be examined. The economic impact of turnover varies by institution and employment classification and is modified by the cyclic nature of the labor market. As such that aspect will represent different burdens to the universe of employers. Furthermore, bullying occurring in nursing and healthcare environments generally, has been associated with increased incidences of negative patient care events which have not been quantified by systematic study. While it may not be practical (or possible) to design methods which might tease out instances of health care provider error which would not have occurred but not for bullying, it should be stressed that hostile work environments reduce worker effectiveness regardless of industry. The consequence only adds to an employer burden of decreased worker productivity.
Search Mechanisms
Several relationships are to be explored in the literature. First, information directly related to economic costs of workplace bullying; secondarily, increased risks of specific diseases and employee dissatisfaction related to the phenomenon. For comparative value the economic costs to employers of disease, absenteeism, and turnover rates due to nonspecific cause were investigated. Finally, it an understanding of employer attitudes about the phenomenon was researched.
A review of literature was conducted using Web of Science and Google Scholar using the following search terms as topic search: workplace bullying and (economic costs or employer tolerance or employer attitudes); employee absenteeism and economic costs; workplace bullying and (health or disease), which were further refined to workplace bullying and (heart disease or fibromyalgia or depression).
Impacts of Bullying on Health and Wellness
Exposure to prolonged bullying is known to be associated with negative health outcomes. It is suspected that disruptions to the hypothalmic-pituitary-adrenal (HPA) axis resulting in abnormal cortisol levels may be a root cause (Lazorko, 2009). Typically, an elevated level of cortisol is associated with the human stress response. Long term exposure to abnormally high levels of cortisol may accelerate damage bodily tissues. It is postulated that exposure to chronic stress eventually alters this response to decreases cortisol reactivity, resulting in the flattened response characteristic in victims. A better understanding of the process would require more detailed investigation than has been attempted to date. Yet, agitated levels of the hormone have been implicated in a litany of disease processes and medical conditions. Hypertensive cardiovascular disease (Walker, 2007), type II diabetes (Lundburg, 2007), fibromyalgia (Crofford, et al 1994), insomnia, and depression have been associated with abnormal cortisol profiles. Studies have found increased prevalence of these conditions among victims of bullying.
Kivimaki, Virtanen, et al. (2003) conducted a two year longitudinal study of 5432 hospital employees. While the study found that victims of bullying were more likely to suffer from cardiovascular disease, with odds ratio of 2.3 (95% CI 1.2 to 4.6), the odds ratio fell to 1.6 (95% CI .8 to 3.5) once adjusted for overweight. The study concurrently evaluated depression as a possible outcome, finding a more profound effect with an odds ratio of 4.2 (95% CI 2.0 to 8.6). While Kivimaki et al were unable to conclusively relate victimization to cardiovascular disease, we note that the study excluded departed employees from follow-up inclusion. The study indicated that cardiovascular disease was the most common reason for early departure from employment.
In a similar study of hospital employees, Kivimaki, Leino-Arjas, Virtanen, Elovainio, Keltikangas-Jarvinen, Puttonen, et al (2004) studied the incidence of fibromyalgia among hospital workers as a function of work-related stress of which bullying was a component. It was found that bullying was a significant predictor of developing the gamut of symptoms (joint and muscle pain, headache, insomnia) associated with the syndrome (odds ratio of 3.1, 95% CI from 1.2 to 8.0).
Another longitudinal study by Tuckey, Dollard, Saebel and Berry (2010) of 251 police officers found that adjusted for age, bullying was associated with increased cardiovascular disease with odds ratio of 2.6 (95% CI 1.36 to 3.13). The study also found a significantly increased likelihood of depressive symptoms in those who reported being bullied.
Cost of Absenteeism to Employers
Several studies have compiled statistics of self-reported instances of absences in direct response to bullying (Ortega, Christensen, Hough, Rugulies and Borg, 2011). However bullying exposure is correlated with increased instances of illness which employees might not associate with their exposure to hostility. The true rate of absenteeism caused by exposure to hostile work environments is much higher, as it should include instances of illness initiated by the workplace.
Ortega, et al conducted an examination of 9949 health workers in Denmark, finding that 11.8% had been bullied within the past 12 months. The 1.8% of respondents who reported being frequently bullied had a 92% higher rate of long-term sickness absence than those unaffected. While the study did not use a recognized tool for evaluating bullying, it did have access to a national registry of transfer payments detailing illness and absence from employment.
Evaluating the cost of disease to employers is confounded by the lack of a coherent strategy of record keeping. Nevertheless, there are data which relate the prevalence of conditions which result in employee absence, and gross computations relating their costs to American employers. Goetzal, Long, Ozminkowski, Hawkins, Wang, and Lynch (2004) examined employer records of several large American firms, finding that hypertension, cardiovascular disease, depression and arthritis (muscle and joint pain) were the major causes of medically-related employee absenteeism. They define another loss term, "presenteeism" that represents losses in productivity of workers suffering from ailments who present at the workplace. For conditions previously associated with bullying, the researchers calculate annual costs across the population of all workers of $718.52, representing 66% of the total costs of all illness-related healthcare and absenteeism for employers.
An additional consideration for many healthcare environments that the authors did not factor into their cost analysis is the cost of absent worker replacement. Many healthcare facilities are obliged by regulation to provide specific ratios of care providers to patients. Where existing resources are inadequate to maintain mandated staffing levels, overtime wages, bonuses or expensive temporary staff must be expended to meet requirements.
Employee Turnover
Employee turnover, the voluntary separation of a worker from an institution, represents real economic cost to the employer. These represent not only costs of the recruitment process, but also of the investment in employee training which is made. There is, of course, wide variability among employment positions and geographical location. Yet, retention is often within the ability of the employer. According to Hinkin and Tracey (2000), “poor quality of supervision and working conditions” were the most commonly noted reasons for separation, not that an employee found more agreeable alternative employment. They calculated the cost of turnover for a single front desk worker (hourly wage rate of $20) at a New York City hotel to be between $11,609 and $12, 882.
In arriving at the calculation, the authors model a learning curve of new recruit proficiency (of 80 days for one hotel), and add cofactors of disruption to coworkers and supervisors for varying duration; similar models might be developed to describe operations of a nurse or technician in a hospital. What is common to all industries is the notion that while a new hire is working to develop proficiency, the employer is not able to gain full use of the labor for which they pay. Further, new hires represent an additional load on supervisory staff and tend to reduce the productive output of seasoned employees with whom the work.
Whether an employee severs after many years of service or shortly after recruitment, the expenses of a new hire will be the same assuming the worker needs to be replaced to retain optimum productive capacity. Put in context of turnover rates, Hinkin and Tracey estimate that for a hotel front desk operation of 30 associates a turnover rate of 50% represents a cost of $95,000.
In a two year longitudinal study which followed recent nursing graduates into employment, Hough, Hoel, and Carneiro (2011) found that respondents exposed to frequent bullying were at 3.6 times greater risk of leaving employment than otherwise. It was also noted that at the termination of the study, work-related health problems were cited by 20% of those bullied respondents as reason for leaving. Stevens (2002) notes that nursing retention has been identified as the major factor in international shortages of nurses, and that hostile work environments are often cited as reasons for nurse separation from employment.
Conclusion
While the cost of human dignity to those who are treated with hostility in their daily employment can not be affixed with a price tag, employers are bearing its hidden economic cost. Stevens (2002) notes the experience of a hospital in Australia in which bullying had become insinuated into the institutional culture as an appropriate management practice and by extension to employees, as normal interpersonal relations. The Hospital suffered with 50% nursing turnover rates. Hough, et al., while supporting the hypothesis that bullied workers are more likely to sever employment, also noted increased complaints of illness among that group. It has been shown that illnesses implicated in exposure to bullying are also the most expensive ailments related to absenteeism.
As the phenomenon of bullying has become better understood, research has rightly focused on the often devastating demoralization and health decline of its victims. Employers, the stake holders in the best position to implement interventions which would improve the workplace environment, have been slow to wholeheartedly embrace the role. Some have argued that the very nature of the employer/employee relationship is at play; that intimidation is often reserved as a management tool. However, literature shows that the behavior transcends organizational hierarchical structures, and it is clear that more effective, less damaging methods are available to managers.
Bullying imposes heavy costs onto the workplace, borne by both worker and employer alike. More cost/benefit analyses may be required before institutions finally recognize that self-interest coincides at times with that of its employees.
References
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About Pamela Lazorko
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