2022: Dignity at Work Standards for the Healthservice

Dignity at Work Standards for the Healthservice: Consensus standards developed at Dignity at Work Conference 15 Jan 2022

Priyanka Nageswaran
Imperial College London, UK

Published 2022-03-13


  • Dignity,
  • Incivility,
  • Bullying & Harassment,
  • NHS,
  • Regulators

How to Cite

Chakravorty, I., & Nageswaran, P. (2022). Dignity at Work Standards for the Healthservice: Consensus standards developed at Dignity at Work Conference 15 Jan 2022. Sushruta Journal of Health Policy & Opinion, 1–60. https://doi.org/10.38192/dws22


BAPIO (British Association of Physicians of Indian Origin) as an organisation actively promotes the diversity, equality and inclusion of all healthcare professionals. As an organisation which encompasses a majority of ethnic minority members, we hear the unfortunate experiences of bullying, harassment and discrimination that takes place in numerous healthcare settings within the UK. In response to these lived experiences, a committee was appointed to establish a set of standards, to foster dignity within the workplace, using the large body of literature documents available.

The ambition of this project is to advocate and advertise for an environment that is free from bullying and harassment and to adopt a zero tolerance policy towards bullying or harassment. We aim to do this by developing, implementing, and evaluating our Dignity@Work Standards.

The Standards constitutes of 8 different domains for all healthcare professionals including managerial members to adopt in clinical practice. These domains include:

  • Environment & Culture - ensuring the workplace environment remains a safe place for professionals to raise concerns, be treated fairly and one with dignity for all.
  • Cultural Intelligence - acknowledging and raising awareness of the impacts of culture and diversity on dignity and accounting for intersectionality in the workplace.
  • Organisational Interventions - highlighting the role of the organisation in accommodating the appropriate resources to eradicate behaviours of bullying and harassment.
  • Communication & Interactions - encouraging respectful interactions between staff and creating a safe workplace to communicate any workplace issues.
  • Monitoring & Accountability - adopting a collaborative approach to routinely monitor the standards of behaviour in the workplace and being held accountable for any failures
  • Metrics - collection of data from the workforce to be able to understand the lived experiences of the workplace.
  • Concerns & Grievances - having a transparent process to raise concerns and ensuring the same process is applied to all members of staff.
  • Support - provision of the appropriate support for all staff that are a victim of bullying and harassment.

Our preliminary vision of the Standards is to create a document that defines the gold standard for dignity in the workplace. The Standards incorporates the diversity of the workforce and ensures consideration is given to the intersectionality of already known determinants of bullying and harassment within the workplace.

The COVID-19 pandemic has created increased pressure on the workforce of the National Health Service and with this pressure has come unacceptable working standards, inappropriate behaviour within staff, increasing reports of bullying and harassment and more staff leaving the NHS than ever before. It is therefore crucial to act now in order to eradicate bullying and harassment within the healthcare setting.

We know and appreciate that collaboration is the cornerstone to progress and we encourage working with core leaders within the UK healthcare system to create this change. Together we will deliver.




  1. Keller S, Yule S, Zagarese V, et al. Predictors and triggers of incivility within healthcare teams: a systematic review of the literature. BMJ Open 2020;10:e035471. doi:10.1136/bmjopen-2019-035471
  2. Porath C, Pearson C. The price of incivility. Harv Bus Rev 2013;91:114–21, 146.
  3. NHS Staff Surveys - NHS Staff Survey Results. https://www.nhsstaffsurveys.com/Page/1085/Latest-Results/NHS-Staff-Survey-Results/ (accessed 8 Jul 2020).
  4. Protected characteristics | Equality and Human Rights Commission. https://www.equalityhumanrights.com/en/equality-act/protected-characteristics (accessed 30 Dec 2021).
  5. Carbado DW, Crenshaw KW, Mays VM, et al. INTERSECTIONALITY. Du Bois Rev 2013;10:303–12. doi:10.1017/S1742058X13000349
  6. Guan A, Thomas M, Vittinghoff E, et al. An investigation of quantitative methods for assessing intersectionality in health research: A systematic review. SSM Popul Health 2021;16:100977. doi:10.1016/j.ssmph.2021.100977
  7. Bolton SC. Dimensions and dignity at work: a new model for Europe? International Conference on Sociology, Athens Institute of Education and Research. 2008.https://strathprints.strath.ac.uk/15084/ (accessed 30 Dec 2021).
  8. Carayon P, Wood KE. Patient Safety: The Role of Human Factors and Systems Engineering. Stud Health Technol Inform 2010;153:23–46.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3057365/ (accessed 30 Dec 2021).
  9. Relation between Job Satisfaction and Job Performance in Healthcare Services - ScienceDirect. https://www.sciencedirect.com/science/article/pii/S1877042815012860 (accessed 30 Dec 2021).
  10. High reliability organisations - A review of the literature. ;:34.
  11. Veazie S, Peterson K, Bourne D. Evidence Brief: Implementation of High Reliability Organization Principles. Washington (DC): : Department of Veterans Affairs (US) 2019. http://www.ncbi.nlm.nih.gov/books/NBK542883/ (accessed 27 Dec 2021).
  12. Viotti S, Essenmacher L, Hamblin LE, et al. Testing the reciprocal associations among co-worker incivility, organisational inefficiency, and work-related exhaustion: A one-year, cross-lagged study. Work Stress 2018;32:334–56. doi:10.1080/02678373.2018.1436615
  13. Leape LL, Shore MF, Dienstag JL, et al. Perspective: a culture of respect, part 2: creating a culture of respect. Acad Med 2012;87:853–8. doi:10.1097/ACM.0b013e3182583536
  14. Powell M, Dawson J, Topakas A, et al. Staff satisfaction and organisational performance: evidence from a longitudinal secondary analysis of the NHS staff survey and outcome data. Southampton (UK): : NIHR Journals Library 2014. http://www.ncbi.nlm.nih.gov/books/NBK263759/ (accessed 27 Dec 2021).
  15. Kline R, Lewis D. The price of fear: Estimating the financial cost of bullying and harassment to the NHS in England. Public Money & Management 2019;39:166–74. doi:10.1080/09540962.2018.1535044
  16. Regulation 10: Dignity and respect | Care Quality Commission. https://www.cqc.org.uk/guidance-providers/regulations-enforcement/regulation-10-dignity-respect (accessed 28 Dec 2021).
  17. Dignity at Work Toolkit — NHS Scotland Staff Governance. https://www.staffgovernance.scot.nhs.uk/improving-employee-experience/dignity-at-work-project/dignity-at-work-toolkit/ (accessed 27 Dec 2021).
  18. Policies, Standards, Guidelines & Procedures. https://www.cpni.gov.uk/insider-risks/policies-standards-guidelines-procedures (accessed 28 Dec 2021).
  19. Ariza-Montes A, Muniz NM, Montero-Simó MJ, et al. Workplace bullying among healthcare workers. Int J Environ Res Public Health 2013;10:3121–39. doi:10.3390/ijerph10083121
  20. Carter M, Thompson N, Crampton P, et al. Workplace bullying in the UK NHS: a questionnaire and interview study on prevalence, impact and barriers to reporting. BMJ Open 2013;3:e002628. doi:10.1136/bmjopen-2013-002628
  21. Bergbom B, Vartia M. Ethnicity and Workplace Bullying. In: D’Cruz P, Noronha E, Caponecchia C, et al., eds. Dignity and Inclusion at Work. Singapore: : Springer 2021. 393–432. doi:10.1007/978-981-13-0218-3_14
  22. Bergbom B, Vartia-Vaananen M, Kinnunen U. Immigrants and natives at work: exposure to workplace bullying. Employee Relations 2015;37:158–75. doi:10.1108/ER-09-2014-0101
  23. Gilbert JA, Raffo DM, Sutarso T. Gender, conflict, and workplace bullying: Is civility policy the silver bullet? Journal of Managerial Issues 2013;25:79–98.
  24. Salin D. Workplace Bullying and Gender: An Overview of Empirical Findings. In: D’Cruz P, Noronha E, Caponecchia C, et al., eds. Dignity and Inclusion at Work. Singapore: : Springer 2021. 331–61. doi:10.1007/978-981-13-0218-3_12
  25. Pascoe CJ. Bullying as Social Inequality. The Enemy. 2013.http://theenemyreader.org/bullying-as-social-inequality/ (accessed 28 Dec 2021).
  26. Soylu S, Sheehy-Skeffington J. Asymmetric intergroup bullying: The enactment and maintenance of societal inequality at work. Human Relations 2015;68:1099–129. doi:10.1177/0018726714552001
  27. McCluney CL, Schmitz LL, Hicken MT, et al. Structural racism in the workplace: Does perception matter for health inequalities? Soc Sci Med 2018;199:106–14. doi:10.1016/j.socscimed.2017.05.039
  28. Harnois CE, Bastos JL. Discrimination, Harassment, and Gendered Health Inequalities: Do Perceptions of Workplace Mistreatment Contribute to the Gender Gap in Self-reported Health? J Health Soc Behav 2018;59:283–99. doi:10.1177/0022146518767407
  29. Rosander M, Salin D, Viita L, et al. Gender Matters: Workplace Bullying, Gender, and Mental Health. Front Psychol 2020;11:560178. doi:10.3389/fpsyg.2020.560178
  30. Tsuno K, Kawakami N, Tsutsumi A, et al. Socioeconomic determinants of bullying in the workplace: a national representative sample in Japan. PLoS One 2015;10:e0119435. doi:10.1371/journal.pone.0119435
  31. Hussenoeder FS, Bodendieck E, Conrad I, et al. Burnout and work-life balance among physicians: the role of migration background. J Occup Med Toxicol 2021;16:28. doi:10.1186/s12995-021-00318-y
  32. Doki S, Sasahara S, Matsuzaki I. Stress of working abroad: a systematic review. Int Arch Occup Environ Health 2018;91:767–84. doi:10.1007/s00420-018-1333-4
  33. Garcia LC, Shanafelt TD, West CP, et al. Burnout, Depression, Career Satisfaction, and Work-Life Integration by Physician Race/Ethnicity. JAMA Netw Open 2020;3:e2012762. doi:10.1001/jamanetworkopen.2020.12762
  34. June 2021 RT. Major trust faces bullying concerns from hundreds of senior doctors. Health Service Journal. https://www.hsj.co.uk/university-hospitals-of-north-midlands-nhs-trust/major-trust-faces-bullying-concerns-from-hundreds-of-senior-doctors/7030150.article (accessed 28 Dec 2021).
  35. Keramat SA, Alam K, Rana RH, et al. Age and gender differences in the relationship between obesity and disability with self-perceived employment discrimination: Results from a retrospective study of an Australian national sample. SSM Popul Health 2021;16:100923. doi:10.1016/j.ssmph.2021.100923
  36. Jones AM, Finkelstein R, Koehoorn M. Disability and workplace harassment and discrimination among Canadian federal public service employees. Can J Public Health 2018;109:79–88. doi:10.17269/s41997-018-0022-0
  37. Hauge LJ, Skogstad A, Einarsen S. The relative impact of workplace bullying as a social stressor at work. Scandinavian Journal of Psychology 2010;51:426–33. doi:10.1111/j.1467-9450.2010.00813.x
  38. The NHS Constitution for England. GOV.UK. https://www.gov.uk/government/publications/the-nhs-constitution-for-england/the-nhs-constitution-for-england (accessed 31 Aug 2020).
  39. NHS England » We are the NHS: People Plan for 2020/2021 – action for us all. https://www.england.nhs.uk/ournhspeople/ (accessed 28 Sep 2020).
  40. Shortened-Version-NHSEI -Civility-Respect-Toolkit.pdf. https://www.socialpartnershipforum.org/sites/default/files/2021-10/Shortened-Version-NHSEI%20-Civility-Respect-Toolkit.pdf (accessed 21 Dec 2021).
  41. Dierynck B, Leroy H, Savage GT, et al. The Role of Individual and Collective Mindfulness in Promoting Occupational Safety in Health Care. Med Care Res Rev 2017;74:79–96. doi:10.1177/1077558716629040
  42. Chassin MR, Loeb JM. The Ongoing Quality Improvement Journey: Next Stop, High Reliability. Health Affairs 2011;30:559–68. doi:10.1377/hlthaff.2011.0076
  43. Rowe M. Fostering Constructive Action by Peers and Bystanders in Organizations and Communities: Fostering Constructive Action by Peers and Bystanders. Negotiation Journal 2018;34:137–63. doi:10.1111/nejo.12221
  44. Ng K, Niven K, Hoel H. ‘I could help, but . . .’: A dynamic sensemaking model of workplace bullying bystanders. Human Relations 2020;73:1718–46. doi:10.1177/0018726719884617
  45. Ng K, Niven K, Notelaers G. Does bystander behavior make a difference? How passive and active bystanders in the group moderate the effects of bullying exposure. J Occup Health Psychol Published Online First: 9 August 2021. doi:10.1037/ocp0000296
  46. Wolke D, Lereya ST. Long-term effects of bullying. Arch Dis Child 2015;100:879–85. doi:10.1136/archdischild-2014-306667
  47. Namie G. Home. Workplace Bullying Institute. https://workplacebullying.org/ (accessed 3 Jan 2022).
  48. Sansone RA, Sansone LA. Workplace Bullying: A Tale of Adverse Consequences. Innov Clin Neurosci 2015;12:32–7.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4382139/ (accessed 3 Jan 2022).
  49. Hodgins M, MacCurtain S, Mannix-McNamara P. Workplace bullying and incivility: a systematic review of interventions. International Journal of Workplace Health Management 2014;7:54–72. doi:10.1108/IJWHM-08-2013-0030
  50. Salin D. Organizational Measures Taken against Workplace Bullying: The Case of Finnish Municipalities. Helsinki: : Swedish School of Economics and Business Administration 2006.
  51. The Effect of an Expressive‐Writing Intervention for Employees on Emotional Self‐Efficacy, Emotional Intelligence, Affect, and Workplace Incivility - Kirk - 2011 - Journal of Applied Social Psychology - Wiley Online Library. https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1559-1816.2010.00708.x (accessed 28 Dec 2021).
  52. Hodgins M. Workplace mistreatment: Health, working environment and social and economic factors. Health 2014;6:392–403. doi:10.4236/health.2014.65057
  53. Engeström Y, Virkkunen J, Helle M, et al. THE CHANGE LABORATORY AS A TOOL FOR TRANSFORMING WORK. ;:16.
  54. Chakravorty I. Incivility in Healthcare: Sushruta Journal of Health Policy & Opinion 2019;12:17–9. doi:10.38192/12.1.9
  55. Hopkins B. From Restorative Justice to Restorative Culture. ;:17.
  56. restorativeJusticeAnOverview.pdf. https://fbga.redguitars.co.uk/restorativeJusticeAnOverview.pdf (accessed 21 Dec 2021).
  57. Earley PC, Mosakowski E. Cultural Intelligence. Harvard Business Review 2004.https://hbr.org/2004/10/cultural-intelligence (accessed 21 Dec 2021).
  58. Miller WC. Cultural Consciousness in a Multi-Cultural Society: The Uses of Literature. MELUS 1981;8:29–44. doi:10.2307/467535
  59. Tiwari A, Sharma RR. Dignity at the Workplace: Evolution of the Construct and Development of Workplace Dignity Scale. Frontiers in Psychology 2019;10:2581. doi:10.3389/fpsyg.2019.02581
  60. Quinlan E, Robertson S, Carr T, et al. Workplace Harassment Interventions and Labour Process Theory: A Critical Realist Synthesis of the Literature. Sociological Research Online 2020;25:3–22. doi:10.1177/1360780419846507
  61. Heames J, Harvey M. Workplace bullying: a cross‐level assessment. Management Decision 2006;44:1214–30. doi:10.1108/00251740610707695
  62. Saam NJ. Interventions in workplace bullying: A multilevel approach. European Journal of Work and Organizational Psychology 2010;19:51–75. doi:10.1080/13594320802651403
  63. Caponecchia C, Branch S, Murray JP. Development of a Taxonomy of Workplace Bullying Intervention Types: Informing Research Directions and Supporting Organizational Decision Making. Group & Organization Management 2020;45:103–33. doi:10.1177/1059601118820966
  64. Gillen PA, Sinclair M, Kernohan WG, et al. Interventions for prevention of bullying in the workplace. Cochrane Database Syst Rev 2017;2017:CD009778. doi:10.1002/14651858.CD009778.pub2