Summit outcomes: the Door Directory:

Options for reporting sexual harassment in medicine

This section is drawn from the Sexual Harassment in Medicine Summit in October 2023 and is still under review. Any comments or suggestions on its contents are welcome, and should be directed to louise.stone@anu.edu.au

The Door Directory was initially developed in collaboration with leaders across medicine at the Summit. It aims to map the various doors and the pathways that lie behind them, for doctors who have been sexually harassed by other doctors in Australia. This is a living document, and we welcome feedback through comments under each Door so that we can continually improve and refine this map.

In order for survivors to seek the most appropriate care, they need to understand the various options available to them. At present, there are multiple options for a survivor, including workplaces, Colleges, Medical Defence Organisations, regulatory authorities, and doctors’ health services. Some survivors may seek individual therapy, or may seek no help at all.

Respect@Work provides comprehensive guidance about the range of options available to workers in Australia to address workplace sexual harassment. This includes:

• police (criminal conduct)
• human rights/equal opportunity commissions
• workplace relations bodies (e.g. industrial relations, Fair Work Australia)
• work health and safety regulators
• worker’s compensation bodies

However, there are some doors in medicine that are unique.

Things to consider when choosing a door

Only 18% of Australians who experienced workplace sexual harassment in the past 5 years made a formal report or complaint to a designated person in their workplace or an external agency (Australian Human Rights Commission, 2022, p. 130). Survivors must weigh up the costs and potential benefits of any pathway before they choose to lodge a report. This may involve asking questions such as the following:

Is this door locked to me?

Some paths are only open to specific people in specific positions, or work in different ways for different people in different positions. For example, a locum with limited access to the hospital’s system might find themselves struggling to open that door.

Some doors may shut after a while. For example, individuals at the end of a rotation may have trouble applying to the Fair Work Commission for a “stop sexual harassment” order, as this requires that the behaviour is likely to affect the complainant in connection to that workplace in the future. Over a fifth (22%) of Australians who made a formal report about workplace sexual harassment did so more than a month after the incident (AHRC, 2022, p. 136).

Some doors are linked, so that opening one shuts or locks the other. For example, if a complaint has already been pursued with a state anti-discrimination body, it may not be possible to make a complaint about the same conduct to the federal body AHRC.

Why am I opening a door?

At the summit, participants talked about different things people might want to gain by opening doors, including justice, healing, and protection for others. Discussions also addressed that while vexatious complaints are very rare, they will happen for various reasons and that this possibility should be acknowledged.

What kind of workplace does this door lead to? Is it safer than the place I’m in now?

• did the harassment stop after the report? If it did not, the report did not lead to a safer workplace for the survivor or for any employees within that workplace, or for patients, families, or carers accessing healthcare through that workplace. 28% of Australians who formally reported experiencing workplace sexual harassment said the harassment stopped after their report was lodged (AHRC, 2022, p. 142).
• Organisations might attempt to address sexually harassing behaviours by pursuing their performance management pathways at the level appropriate for the behaviours (and patterns of behaviour, if any) reported. Ideally, this would enable top-down intervention to identify individuals at high risk of repeated, escalating sexual harassment, and either to support and encourage them to adjust their behaviours and/or attitudes, or to protect others in the workplace from those behaviours ultimately by removing them if remediation is not fruitful.
• Organisations might develop new policies, change existing policies practices or procedures, and/or implement new training or education on workplace sexual harassment after incidents come to light. This could potentially improve the safety of the workplace and protect the wellbeing of the workforce beyond the survivor. This can address all three of the central desires summit attendees identified as driving reporting behaviours: justice, healing, and protection for others.
• Survivors may voice concern for the welfare of patients or strain on the overall health system if the alleged perpetrator’s current medical work or practices are interrupted or disrupted. Some doors may offer access to levers to manage alleged perpetrators’ practice and employment conditions in ways that promote safety for everyone in the workplace including the survivor without exacerbating health system strains.

will this door lead to justice or healing?

• Some types of incidents can cause kinds of injury to an individual and to a working relationship that are reparable through conciliation processes or remedial education or training. Organisations can use these levers to improve workplace safety and support repairing working relationships, but face challenges to ensuring that these processes are appropriately responsive to the needs of the situation. In particular, there is a positive relationship between offence or intimidation felt due to sexually harassing behaviour, and likelihood of reporting that behaviour; that is, individuals are increasingly likely to pursue formal reporting the more harm they experienced (AHRC, 2022, p. 150-151). This harm can act as a barrier to openness to processes or genuine reconciliation, as conciliation requires vulnerability. Conciliation processes thus high risks of secondary harm, while also offering possibilities for de-escalation in specific situations.
• Perpetrators might apologise, or pay compensation, to survivors. This can be an act of justice and of healing.
• Employers might encourage the survivor for reporting, and/or might apologise to the reporter. This can support repairing the relationship between the survivor and the employing organisation, which is important for avoiding working relationship dynamics that lead to toxic workplace cultures and individual burnout.
• Organisations might also facilitate access to wellbeing support for survivors after reporting. This can support healing, but not necessarily justice or protection.

Will this door lead to resources I need?

• Material support, such as worker’s compensation, can be important for survivors with complex trauma to access the care they need to heal and, if appropriate, eventually undertake a safe return to work.
• Supporting survivors to adjust employment conditions, such as changing shifts or working areas or taking time off, can be helpful while reporting processes are ongoing to lower risk of retraumatisation or retaliation through continuing with unsafe co-working arrangements with the perpetrator. This can also be a helpful element of planning the survivor’s rehabilitation into the workplace if they took absence, to develop prevention and management planning around potentially re-traumatising aspects of the work itself. These kinds of adjustments can be challenging to action in medical workplaces where flexibility is highly constrained by a number of factors including limited workforce.
• Because medicine has a unique structure and landscape, survivors may benefit from accessing trauma-informed support services that offer guidance and advocacy while survivors undergo reporting journeys, which integrate supports relevant fro all workplace sexual harassment survivors (such as wellbeing and legal support) with supports tailored to medical workforces (such as career considerations and planning). This is particularly important for doctors in working arrangements that are layered or unique in medicine, such as IMGs, doctors working in ACCHOs, or doctors working in rural and remote areas.

What could this path cost?

How long will I have to walk this path? How far might I have to walk?

47% of Australians who formally reported experiencing workplace sexual harassment had to wait more than 4 months for their report to be finalised (AHRC, 2022, p. 141). At the summit, some doors opened onto corridors that could take anything between 3 months to 3 years to reach the end. This can lead to challenging situations for doctors making a decision of whether the cost to their wellbeing and safety of continuing to work with and alongside their perpetrator is a cost they can bear.

Are there cameras behind the door? Pitfalls?

Survivors may have concerns about whether their privacy will be preserved and protected once the door opens. This may include:

• concern for, or experienced, ostracism, victimisation, bullying, or “harmful gossip” by others in the workplace once their identity and report become known
• risk of retaliation by the perpetrator
• negative employment or career outcomes linked to perception of the survivor as a “troublemaker”, including access to opportunities for training and career progression. This can extend as far as direct or diffuse pressure on the survivor to leave work to safeguard their workplace and overall wellbeing and safety.

Will this door lead to a dead end, or a dark corridor?

Of the Australians who formally report experiencing workplace sexual harassment, 73% had their most recent complaint finalised, but fewer than half (47%) stated any workplace complaint process or investigation process had occurred as a result of their formal complaint or report (AHRC, 2022, p. 137-8). Experiencing, or not knowing about, the outcome of a report can harm the relationship between workers and organisations by damaging their faith in the organisation’s reporting process or, by extension, the organisation’s commitment to its values; if the reporting process was onerous or re-traumatising, the betrayal in a lack of outcome can cause additional injury. Having no justice, healing, or protection outcomes from reporting may leave the survivor feeling they have no choice but to leave work if they are to safeguard their workplace and overall wellbeing and safety.

Reporters may also experience negative employment outcomes as a result of their report that are not intended as “retaliation” – particularly in medicine, changing shifts or transferring to other work areas can also mean reducing opportunities for training or promotion or career progression, even if the intent was to secure the safety of the reporter while allegations are investigated.

Will anyone else suffer because I opened this door?

• Negative career consequences for perpetrators can be perceived as risky where the perpetrator has specialist expertise that is unique or in short supply in the healthcare system. Some survivors may feel reluctant to pursue reporting for fear of furthering strain on the healthcare system and impairing patient outcomes as a consequence.
• Conversely, survivors may fear that a reporting pathway that leads only to informal “speaking to” perpetrators or no consequences at all, will fail to protect colleagues and patients from future escalation of behaviours by the perpetrator. Survivors may anticipate that reporting can be a burdensome and exhausting process, and may feel responsible to ensure that their energy is directed only through a door that will result in this protection.
• Survivors can also hold compassion and concern for perpetrators as fellow humans and colleagues, and may be concerned that a door will lead to disproportionate personal harm to the perpetrator (e.g. if they believe a behaviour needs correction but may be “over-punished” by formal reporting systems).

Keeping all these considerations in mind, choose a door….