Sexual harassment in the healthcare workforce: what next?

The recent publications^1–3 on sexual harassment, sexual assault, and rape among healthcare workforces in the National Health Service (NHS) make shocking reading, and show that the initial reporting^4–8 of an unhealthy culture, both in the NHS and internationally, has been validated. What is needed now is a discussion about how such widespread embedded cultures can be changed. This short report describes the 18-month development and evaluation of a prototype to educate and stimulate open discussions which may offer a potential mechanism for cultural change.

In January 2022, the senior author brought a multiprofessional working group together to discuss how to empower and educate people to speak out when sexual harassment is witnessed in the workplace. The aim was to create an educational tool to facilitate cultural change. Early discussions led to the conclusion that any intervention could not just be offered to doctors in training, or to perpetrators, who would be unlikely to attend training. The solution lay within the wider team, as they are the observers of inappropriate behaviour. Cultural change, to allow and promote a culture in which all team members feel empowered to speak out, requires the education and empowerment of all participants in that culture. Finally, any intervention needed to demonstrate how subtle this behaviour can seem, the common grooming and isolation of victims involved, the power imbalance that often exists, and that all members of the team have a role in stopping such behaviours.

Through iterative discussions, a working hypothesis evolved that uncomfortable emotions may need to be evoked to enable facilitated discussion around these topics to allow true behavioural change that would be carried forward into the workplace. A two-phase design was proposed to test this hypothesis. Phase 1 was to design, produce, and evaluate an immersive experience of workplace sexual grooming and harassment. Phase 2 was to develop a facilitated session, to discuss these behaviours, and then allow interventions to stop unacceptable workplace behaviour to be discussed and rehearsed.

Both phases were to be delivered face to face. Participants were qualified healthcare professionals, actively working in hospitals or postgraduate healthcare education, of mixed gender with a wide spread of seniorities and professional experience. Participants volunteered to participate through an optional sign-up process. Both phases used an iterative process. The aims (Table 1) were sent to participants before the session, with details of the session and support material. Informed consent was sought. Local, regional, and national psychological support signposting was given before, during, and after each session.