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Preventing Sexual Harassment in the Medical Workplace

Welcome! This article is part of a Medscape Physician Business Academy course, . Visit the Course Page to take the full course and receive a certificate.

The Need for a Cultural Transformation

The most effective way for an employer to prevent sexual harassment is to transform the culture of the workplace into a culture that values everyone, where each staff member understands that sexual harassment is unacceptable, where workers perceive that it is okay to speak up, and where leadership speaks out against harassment.

Changing the culture is not easy. People tend to hold deep-seated stereotypes, values, and beliefs about sexual harassment, and these beliefs may be unconscious and persistent. Even when anti-harassment workshops are introduced, for example, the workshops may actually bring out preexisting gender biases.

A workplace's cultural transformation does not happen overnight. It can take anywhere from several months to a few years. After changes are introduced, the problem may seem to be getting worse. Encouraging people to come forward with sexual harassment complaints often leads to a whole host of new complaints. As the culture is transformed, however, the number of complaints typically will decline.

Your organization will probably have to spend more money to fund high-quality workshops and set up effective investigative processes. Is this money well spent? If the change is not sufficiently supported, it will be less effective.

Leadership Is Key

Whether your organization is a small practice or a large health system, leadership has to champion the cultural transformation. In a large organization, the commitment must extend all the way up to the CEO and the board.

The leaders need to take a visible role in the transformation—in speeches, publications, and public appearances that call for an inclusive workplace that is free of harassment. Leaders should clearly enunciate specific behaviors that are not acceptable in the workplace.

Also, leaders should stay clear of a compliance mindset—for example, offering ineffective workshops that comply with the letter of the law, but fail to effect any change. Workshops must be robust to be effective. In the same vein, trying to keep reports of sexual harassment low makes the organization look good in the short run, but true change only comes by opening the doors and making it easy to report.

Making Policy for the Practice or Organization

Survey the Climate of Sexual Harassment

The first step in changing the workplace culture is to determine the extent of the problem. Leaders of a sprawling institution may be out of touch, but even partners in a small practice may never have looked into sexual harassment, even when it is occurring around them.

Start off by discussing sexual harassment with people at all levels in your organization. Explain to them the different kinds of sexual harassment. Do they think it exists? What kinds of harassment do they see? Is it easy to report it?

A large health system might conduct a climate survey that asks the same questions across the organization. Several kinds of climate surveys exist, including one used by the US military. The surveys can also serve as benchmarks. After you have made changes, you can ask employees to fill out the survey again to determine if the changes have been effective.

Create Policies and Procedures

A key to transformation is having an effective sexual harassment policy and complaint procedures in place for reporting it. Large organizations tend to have such policies, but many small ones do not. One survey found that 12% of medical practices do not have a sexual harassment policy.

Not having policies and procedures gives employees the message that if they engage in sexual harassment, nothing will happen to them, and if they are victims, they won't be able to report it. In fact, every employee has the legal right to report sexual harassment and receive a timely investigation.

Even if you have policies and procedures, they may not be effective. For example, the policy may lack a clear definition and examples, which would make it difficult for employees to identify and report sexual harassment.

Furthermore, it's not enough just to have policies and procedures on file. Employees should know about them and have access to them. Communicate the policies and procedures on a regular basis—particularly the information about how to file a complaint, how to report harassment that one observes, and protections against retaliation.

Elements of Policies and Procedures

Here are some basic elements of sexual harassment policies and procedures.

Overall statement. The policy should begin with a clear statement that sexual harassment will not be tolerated.

Provide a definition. If the policy does not have a clear definition and examples of sexual harassment, employees will be confused and will have a very difficult time reporting it.

Obligations of supervisors. Outline the role of supervisors to be on the lookout for suspected behavior, and immediately respond to complaints in an unbiased manner.

Complaint procedure. The policy should outline a procedure that makes it easy to report a compliant, helps the victim to feel safe from retaliation, and details the steps of the investigation must take.

Rule out retaliation. State that retaliation will not be tolerated, and detail the steps the employer will take to stop retaliation. Examples of retaliation include sabotaging one's work, demotion, or a termination.

Describe the investigation. Assure that the investigation will be prompt, thorough, and impartial. The description should list possible procedures, such as accessing an employee's social media content when warranted, and interviewing witnesses.

Provide for discipline of perpetrators. State that corrective action that will be taken, depending on the seriousness and pervasiveness of the offense.

Describe external complaints. Let employees know that their complaints can also be filed with the Equal Employment Opportunity Commission or the equivalent state agency, and that the complaint may even evolve into a lawsuit against the employer.

Describe training. Inform employees what sorts of training will be offered, the different kinds of training available, how often training will be provided, and to whom the training will be offered.

Sexual Harassment Training

Sexual harassment training should not be a one-shot event. It should be given to all new hires and then continue on a regular basis every 2 years or so.

Even though [sexual harassment policy] training is not a cure-all, some authorities often focus on it because it is easily measurable.

Good training complements the sexual harassment policy. It can help employees understand the policy, get an idea of acceptable behavior, and explain the procedure to file a complaint. Even though training is not a cure-all, some authorities often focus on it because it is easily measurable.

In a recent count, sexual harassment training was required in nine states: California, Connecticut, Delaware, Hawaii, Illinois, Maine, Massachusetts, New York, and North Carolina. The requirement is limited to the size of the employer, which varies by state. Whereas Delaware requires training for companies with 50 or more employees, it's only five or more in California, one or more in Illinois, and all employers in New York and Connecticut.

The type of required training also varies by state. For instance, California requires 1 hour of training for all employees and at least 2 hours of training to supervisors, and this training can be either in person or online. In New York, employees must get training annually, the program must be interactive, and must include information on pursuing remedies.

Problems With Training Programs

Much of the sexual harassment training that employers provide is dull, uninspiring, too short, and too focused on satisfying the law, rather than on changing behavior. Training material tends to reflect the employer's concerns about not being held liable in a lawsuit and doesn't inspire employees to strive for a harassment-free workplace.

In much of the training today, participants are given a passive role. When passive participants are shown uncomfortable aspects of sexual harassment, they often react by making defensive jokes that reinforce gender stereotypes, which can actually lead to more harassment.

Moreover, training sessions may not last long enough or be frequent enough to make a difference. An hour-long session is probably too short, and providing sessions only for new staff at orientation means that behavior will not be reinforced.

Research shows that the most effective sexual harassment training is at least 4 hours long and occurs in-person and in small groups. Training should be interactive and be customized to the worksite.

California mandates that training must be at least 1 hour long for general employees and 2 hours for supervisors. But this is too short to allow enough time for interactive role-playing, review of various scenarios, and other activities that can truly have an impact on participants. The minimum time should be 2 hours for regular employees and 4 hours for supervisors.

Elements of Good Training

Creating effective sexual harassment training takes planning and creativity. Here are some elements of a good program.

Train frequently. Employees should get training every 18-24 months, and the program shouldn't be the same each time. Each session should last at least 4 hours. The follow-up after the initial training session should include knowledge assessment tests and refresher courses.

Program should be varied. Participants should take an active role and become involved in the topic. The training should be interactive and include multiple formats, such as lectures, videos, and role-playing. Sessions should be customized to your particular workplace.

Use role-playing. Simulated encounters can help doctors and staff develop confidence on how to respond to inappropriate behavior by patients, visitors, and coworkers.

Demonstrate professional boundaries. Demonstrate the proper professional boundaries between attending physicians, residents, medical students, nurses, and other staff. Research has shown that poor education on proper boundaries is a common factor in this type of physician sexual misconduct.

Encourage civility. Rather than just focusing on what you can't do, training should show employees what civility is like. Encourage respectful behavior, and point out when behavior crosses the line. Encouraging civility can help create a sense of psychological safety.

Other Types of Training

Bystander Training

Employers are increasingly adopting a form of sexual harassment training that shows employees how to behave when they are bystanders—people who see or know about an incident. This approach is considered to be a potent tool for stopping sexual harassment and encouraging civility in the workplace.

Left to their own devices, bystanders often avoid getting involved in an incident and distance themselves from the target rather than helping out. If bystanders aren't doing anything about a sexual harassment situation, perpetrators get the message that their behavior is normal and natural.

When bystanders realize that they can play an active role and are provided with ways to intervene, they can become a powerful antidote to sexual harassment.

When bystanders realize that they can play an active role and are provided with ways to intervene, they can become a powerful antidote to sexual harassment.

Bystander training helps employees feel responsible for stopping harassment and gives them the confidence and skills to get involved. Bystanders can offer their support to targets of harassment, such as accompanying them when they report the incident to HR or a supervisor. They can even confront the harasser or file their own complaints about the incident.

Training Supervisors

Supervisors should get a separate and longer form of training that reflects their specific responsibilities in responding to sexual harassment.

Supervisors should act as the linchpin of sexual harassment policy. However, there is ample evidence that many of them don't know how to carry out their function. As discussed earlier, some supervisors try to discourage victims from reporting, and some even engage in retaliation against them. They may even falsely assume that their retaliation is helping the organization by controlling dissent.

In addition to covering the basics of sexual harassment, supervisors' training should cover ways to monitor sexual harassment and retaliation, how to receive a complaint from an employee, and the consequences if supervisors themselves commit sexual harassment or retaliation.

In addition to providing training, organizations should hold supervisors accountable if they fail to respond to a report of harassment, fail to stop retaliation against a complainant, or do not make sure an investigation begins promptly. A higher number of complaints indicates either that employees trust their supervisor enough to respond to their complaint, or that the supervisor has failed to prevent the behavior from happening in the first place.

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Welcome! This article is part of a Medscape Physician Business Academy course, . Visit the Course Page to take the full course and receive a certificate.


Susan Strauss, RN, EdD

| Disclosures | January 01, 2020

Authors and Disclosures


Susan Strauss, RN, EdD

Strauss Consulting, Burnsville, Minnesota

Disclosure: Susan Strauss, RN, EdD, has disclosed no relevant financial relationships.