Bullying and incivility are serious issues in healthcare. These behaviors have been associated with distress, anxiety, posttraumatic reactions, medical errors, and even patient death.

There are some effective strategies you can use if you are the target of bullying or incivility. And while they are less widely known, there are also some effective strategies you can use if you witness bullying, incivility, or other inappropriate behaviors directed against others.

When you intervene in these sorts of situations, you are acting as an upstander rather than a bystander. You see the negative behaviors and the harm caused and you choose to support the person being hurt.

The American Psychological Association offers a helpful bystander intervention tip sheet that describes the 5 Ds to Bystander Intervention that were developed by Hollaback! (now known as Right to Be) and have been used in multiple training programs across different practice settings. 

Those 5 Ds are:

1. Distract: Interrupt the problematic behavior by speaking with either party, causing a commotion, or otherwise impeding the flow.

This is a nonconfrontational way to disrupt an incident of bullying. With this technique, you don’t explicitly acknowledge the inappropriate behavior. You simply interrupt the interaction to stop it. Examples might include asking for directions to the hospital cafeteria (from either party in the interaction), inquiring about the time, indicating that you have something you need to discuss, or whatever. What matters is not how you distract, but that you distract.

2. Delegate: Ask for help. Depending on the situation, this may mean enlisting the assistance of another bystander or it may mean needing to call 911. Try to get help from someone in a position of authority when possible.

3. Document: Take notes or make a video of the incident. Assess for safety prior to documenting, and ensure that the targeted person is receiving the support they need.

It’s crucial to note here that you may have been the one who wrote it, filmed it, or summarized the incident afterwards but it is not yours. 

It’s typically best if your documentation of another’s story is offered to that person for them to use (or not) as they choose. It can be harmful if the documentation is shared casually with others, or shared on social media or any electronic (and easily forwarded) means. 

You may have had your own strong emotional reactions to the situation in which you were an upstander. Those feelings are real and valid. They deserve attention. But take care that you seek support for yourself without further victimizing the target of the incident.

4. Delay: Follow up with the individual who was targeted to offer additional support and other assistance as needed.

5. Direct: Speak out directly against the inappropriate behavior if all parties are physically safe. Prioritize helping the targeted individual over challenging the offender.

Systematic Approach for Addressing Violent Encounters (SAAVE) adds a 6th D: Debrief. (Disclosure: this author is one of the principals in that company).

In addition to following up with the affected individual later to offer support (#4 Delay), SAAVE recommends inviting the individual to provide feedback about your upstanding.

By doing so, you allow the individual space to share. You demonstrate authenticity. You have the opportunity to deepen your support in a meaningful way.

As a woman, I think about hearing a misogynistic comment and having a male upstander intervene. Would I feel supported? Or would I feel robbed of my voice and sidelined? I don’t think there’s a single answer here. A lot would depend on context and history.

Is the upstander someone I’ve known to be an advocate or ally in the past?

Are they someone I’ve experienced as paternalizing?

Or maybe I don’t know them that well and I’m not sure how to take their intervention.

Of course, gender identity is far from the only factor that plays into how upstander intervention is perceived and received.

Ideally, we’re not left guessing how our upstanding was received. We’re asking the person for whom we intervened and receiving their feedback with humility and curiosity. We are open to the possibility that our upstanding landed wrong despite our best intentions. 

For some, this may lead to feelings of futility.

Why bother to help if our efforts may be misinterpreted?

I invite you to consider baking a cake. 

You gather the ingredients, follow the directions, and put it in the oven for the recommended time. 

Do you just pull it out at the end of that time?

Or do you first use a toothpick to ensure that it is adequately done?

This is a simplistic example, to be sure. But the overarching message is that we routinely check whether things worked as we meant for them to work. Debriefing after upstanding is an opportunity to refine our processes, not an indicator that it’s useless to try. 

Your willingness to intervene can be a powerful support for a person being targeted.