Bullying in surgery: senior surgeons' views on systemic drivers across governance, culture and resources in Australia and Aotearoa New Zealand

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Abstract
Purpose: This study explores how governance, cultural norms and resources contribute to workplace bullying in surgical teams across Australia and Aotearoa New Zealand. It draws on Systems Theory and the Resource Dependence Theory (RDT) to examine how these constructs interact to shape both the persistence of bullying and the conditions for reform. Design/methodology/approach: Qualitative data were collected through semi-structured interviews with 31 senior surgeons across diverse specialties and institutional contexts. Thematic analysis was conducted using NVivo, with findings mapped to Systems Theory and RDT. Findings: Bullying behaviours were linked to rigid hierarchies, fragmented governance and exclusionary norms. In public hospitals, resource volatility and team instability heightened strain and reduced accountability. In private settings, continuity was greater but oversight inconsistent. Weak feedback loops, disengaged leadership and informal power structures enabled harmful conduct. Intersectional factors, particularly gender, training background and career stage, disproportionately affected women and international medical graduates. Participants identified governance reform, inclusive leadership and structural accountability as critical levers for change. Practical implications: Reducing bullying requires attention to feedback systems, resourcing stability and organisational culture. Structural redesign, inclusive leadership and equity-focused governance may enhance psychological safety across surgical settings. Originality/value: By applying the Systems Theory and RDT, this study offers a structural account of bullying as a product of governance gaps, resource asymmetries and cultural norms rather than individual misconduct. It shows how these conditions interact to generate behavioural risk in high-stakes teams.
Funding Information
  • Australian Government

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