Bullying isn’t unique to healthcare, but there are many things about the healthcare environment that proliferate bullying behaviors, such as high-stakes situations, rigid power differentials, and challenging schedule demands. And while bullying is harmful everywhere, it has devastating impacts in healthcare.

According to our study Silence Kills, half of all nurses and four out of five physicians in our survey said they work daily with a colleague who breaks rules, makes mistakes, fails to offer support, or appears critically incompetent. However, only one in ten speak up when facing these kinds of concerns—and far fewer speak up when the concern is with a physician. The most alarming finding is that people’s failure to speak up when they have these concerns is highly related to quality of care, employee morale, productivity, and retention.