Dr Madhav Madhusudan Singh
MBBS, MHA (AIIMS) , MBA (Finance), Ph.D. ( Hosp Mx)
Introduction:
The bystander effect is a phenomenon where individuals tend to remain inactive in situations involving high risk and danger when other bystanders are present. This behavior is a type of cognitive bias that can occur in a variety of contexts. The Bystander Effect is a well-known social phenomenon that explains why individuals are less likely to offer help to a victim in the presence of others. This phenomenon can have serious consequences in the healthcare setting, where individuals may fail to intervene in cases of sexual harassment, discrimination, or other forms of inappropriate behavior. The impact of the Bystander Effect on healthcare professionals can be significant and coping strategies must be implemented to ensure a safe and supportive workplace for all.
How to know if I am a victim of the Bystander Effect:
The Bystander Effect can impact individuals in various ways, and victims may not always be aware of the impact. However, there are signs to look out for that may indicate that you are a victim of the Bystander Effect.
Here are 10 signs that you may be a victim of the Bystander Effect:
1. Feeling uncomfortable or uneasy in situations where inappropriate behavior is occurring.
2. Feeling guilty or ashamed for not intervening in situations where inappropriate behavior is occurring.
3. Witnessing inappropriate behavior, but assuming that someone else will intervene.
4. Feeling powerless to intervene due to a sense of helplessness or fear of retaliation.
5. Assuming that the victim is capable of handling the situation on their own.
6. Failing to take action because you are unsure of what to do.
7. Not reporting incidents of inappropriate behavior to a supervisor or human resources department.
8. Not speaking up when you hear someone making inappropriate comments or jokes.
9. Downplaying the severity of the situation, or rationalizing why it is not your responsibility to intervene.
10.Failing to support victims of inappropriate behavior, or minimizing the impact of the behavior on their well-being.
If you recognize any of these signs in yourself, it may be an indication that you are a victim of the Bystander Effect. It is important to take steps to address the impact of the Bystander Effect and prioritize intervention in cases of inappropriate behavior.
Examples of the Bystander Effect in the healthcare setting:
The healthcare setting is not immune to the Bystander Effect, and there are numerous examples of this phenomenon in action.
1. During a meeting, a healthcare professional witnesses a colleague making discriminatory comments towards a patient, but fails to intervene because they are unsure of how to do so.
2. A healthcare professional observes a colleague engaging in inappropriate behavior towards a patient, but fails to speak up because they assume that the victim is capable of handling the situation on their own.
3. A healthcare worker witnesses a colleague engaging in bullying behavior towards a subordinate, but fails to report the incident to their supervisor because they fear retaliation or believe that the situation is not their responsibility.
4. During rounds, a healthcare professional observes a patient experiencing a medical emergency, but fails to intervene because they assume that someone else will take action.
Causes of the Bystander Effect
The Bystander Effect can occur in any organization, including healthcare settings. There are several causes that contribute to this phenomenon. Here are some of the main factors that lead to the Bystander Effect in healthcare organizations, along with examples in a hospital setup:
1. Diffusion of Responsibility: When people are in a group, they may assume that others in the group will take responsibility for intervening in a situation. This can lead to a lack of action on the part of individuals in the group. For example, if a nurse witnesses a patient falling in a crowded hallway, they may assume that someone else will attend to the patient and not take action themselves.
2. Fear of Social Consequences: People may be afraid to speak out or take action in a situation due to fear of social consequences. For example, a healthcare worker may be afraid to report a colleague for inappropriate behavior for fear of being ostracized or retaliated against.
3. Ambiguity of the Situation: When a situation is unclear or ambiguous, people may be unsure of what action to take. This can lead to a lack of action or a delay in responding. For example, if a healthcare worker witnesses a patient experiencing chest pain, they may be unsure if it is a serious medical emergency or not.
4. Bystander Apathy: People may become desensitized to situations and fail to recognize the severity of the situation. For example, if a healthcare worker is exposed to frequent incidents of inappropriate behavior, they may begin to minimize the impact of such behavior and fail to intervene.
5. Pluralistic Ignorance: People may assume that if others are not reacting to a situation, then the situation is not serious. This can lead to a delay in responding or a lack of action. For example, if a healthcare worker observes a patient exhibiting signs of distress, but sees that others are not reacting, they may assume that the situation is not serious.
6. Organizational Culture: The culture of an organization can play a role in the Bystander Effect. If an organization does not prioritize intervention in situations of inappropriate behavior or does not have policies and procedures in place to address such behavior, employees may be less likely to intervene. For example, if a hospital has a culture of prioritizing patient care over employee well-being, employees may be less likely to report incidents of inappropriate behavior.
7. Power Dynamics: Power dynamics within an organization can also contribute to the Bystander Effect. For example, if a senior physician engages in inappropriate behavior towards a junior physician, the junior physician may be less likely to intervene due to fear of retaliation or consequences to their career.
How to cope with the Bystander Effect in healthcare setup
The "Decision Model of Helping" proposed by Latané and Darley (1970) can be a useful model to overcome the bystander effect in healthcare. This model outlines the five decisions that bystanders must make when faced with an emergency or crisis. These decisions can also be applied to healthcare settings to help healthcare providers overcome the bystander effect and offer prompt and effective intervention to patients.
1. Notice the Emergency/Crisis
The first decision that healthcare providers must make is to notice the emergency or crisis. Healthcare providers must be aware of their surroundings and be vigilant for signs of distress in patients. They must pay attention to nonverbal cues, such as changes in breathing, sweating, or facial expressions, that may indicate distress in patients. In addition, healthcare providers must be aware of the context of the situation and understand the potential risks and consequences of not intervening.
2. Interpret the Event as an Emergency
The second decision that healthcare providers must make is to interpret the event as an emergency. This can be challenging in healthcare settings, where patients may be in pain or distress but may not express it explicitly. Healthcare providers must be able to identify the signs and symptoms of an emergency and understand the severity of the situation. They must also consider the potential consequences of not intervening, such as patient harm or deterioration.
3. Take Responsibility
The third decision that healthcare providers must make is to take responsibility for the situation. Healthcare providers must recognize their role in the care of the patient and understand their duty to intervene in emergencies. They must also be aware of the potential barriers to intervention, such as fear of making a mistake, fear of retaliation, or fear of litigation. Healthcare providers must be prepared to take responsibility for their actions and advocate for the patient's well-being.
4. Decide on How to Intervene
The fourth decision that healthcare providers must make is to decide on how to intervene. Healthcare providers must consider their training, experience, and skills when deciding on the appropriate intervention. They must also consider the resources available, such as equipment or personnel, and the potential risks and benefits of different interventions. Healthcare providers must be prepared to adapt their interventions based on the patient's response and the changing circumstances of the situation.
5. Provide Help
The fifth and final decision that healthcare providers must make is to provide help. Healthcare providers must be prepared to take action and provide assistance to the patient. They must be confident in their ability to perform the intervention and must be prepared to follow through with the intervention. Healthcare providers must also be aware of the potential consequences of their intervention and be prepared to take responsibility for their actions.
Conclusion
The Bystander Effect can have a significant impact on healthcare professionals and their ability to intervene in cases of inappropriate behavior. To cope with the Bystander Effect, healthcare professionals must take steps to educate themselves, create a culture where reporting incidents is encouraged, and prioritize their own well-being. By taking these steps, healthcare professionals can work towards creating a safe and supportive work environment for all.
Dr Madhav Madhusudan Singh MBBS, MHA , MBA , Ph.D.
https://twitter.com/madhavsingh1972
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Disclaimer: The views expressed in this text are solely the personal opinions of the author and do not represent the views of any organization or entity with which the author may be affiliated.
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