What is it, and why do you need it?
In March of this year, a man brutally attacked a 65-year-old Filipino woman in broad daylight on a Manhattan street. As he kicked her and shouted racial slurs, bystanders — including a security guard — watched from the lobby of a nearby luxury apartment building and did nothing. In the wake of COVID-19, anti-Asian attacks like this have increased all over the country. New York City alone experienced an 833 percent spike in anti-Asian hate crimes from 2019 to 2020, reported Michelle Lee, M.D., in a post on KevinMD.com.
Dr. Lee believes this increase in violence is a public health issue, and calls for bystander intervention training to help save lives. After all, doctors undergo mandatory training to prepare for unexpected medical emergencies and to identify child and elder abuse or neglect, she wrote. “Bystander intervention should also be on that continuum of responsibility and training.”
What is bystander intervention?
Bystander intervention is a specific type of training to prevent disrespect, harassment and violence targeted at people because of their race, gender, orientation, disability, age or religion, among other reasons. It’s a way to actively and visibly take a stand against harassment, according to Hollaback!, a nonprofit that provides bystander training for individuals and organizations.
Of the nearly 25,000 workplace assaults that occur annually, 75% are in health care and social service settings.
Do you think harassment and violence can’t happen in your medical practice? The Medical Group Management Association reports that:
- The health care industry has more than five times the rate of violence of all other industries.
- 75% of nearly 25,000 workplace assaults occur annually in health care and social service settings.
- During the COVID-19 pandemic “increased levels of anxiety and stress, perceived loss of control by patients and their families, and staffing shortages have contributed to increased risk of violence for health care workers.”
Even if you don’t encounter violence, harassment is all too common in health care settings. A recent study published in the journal Women’s Health Issues found that one in four women veteran patients reported experiencing sexual and gender harassment when attending the Veterans Health Administration (VA) for health care. The study evaluated the results of harassment awareness and bystander intervention training to teach health care staff how to identify and intervene in these situations.
The 5 D Methodology
Hollaback! has developed a methodology called the 5 D’s to respond to harassment. They are: Distract, Delegate, Document, Delay, and Direct. Here’s a brief explanation of each, however, this is only a piece of what goes into the organization’s corporate training programs.
Distract. This is an indirect approach to de-escalating a situation. For example, let’s say a staff member witnessed a person making unwelcome and potentially offensive comments to another person in your waiting room. (e.g. “Why are you wearing that scarf on your head? Where are you from, anyway? Do you even speak English?”)
You could distract the person being questioned by asking them to fill out some paperwork, or what doctor they are there to see. You could even accidentally-on-purpose spill a drink. The idea is to interrupt the incident, ignore the harasser, and engage directly with the person being targeted.
Delegate. Delegation is when you ask for help from another person, such as someone in authority. If another patient witnessed the above interaction, for example, they might go up to the front desk staff and ask them to intervene.
Document. In some situations, it can be helpful to record an incident as it happens to document it for the victim or authorities, if necessary. Consider the teen who recorded George Floyd’s murder on her cell phone. Always assess your own safety first, and afterwards, check with the targeted person about what they want to do with the recording. For ethical and legal reasons, never post a photo or video online without permission. Here is a resource for tips on filming hate-related incidents.
Delay. This means waiting until after the incident is over and checking in with the targeted person. Sometimes things happen quickly, or a bystander may not feel safe intervening during the incident. You can still make a difference by asking the victim afterward if they’re OK, offering to call for help or sit with them, or walking them to their destination.
Strategies for addressing harassment range from creating a distraction to interrupt the interaction to calling out the harasser directly.
Direct. Responding directly to the harasser is the riskiest tactic. This could escalate the situation or make you the target. Before taking this action, assess the situation. Hollaback! suggests asking yourself: Are you physically safe? Is the person being harassed safe? Does it seem unlikely that the situation will escalate? Can you tell if the person being harassed wants someone to speak up? If you can answer yes to all of these questions, you might choose a direct response.
Examples of this tactic include saying, “That’s inappropriate, disrespectful, not okay” or “leave them alone.” “The most important thing is to keep it short and succinct,” according to Hollaback! “If the harasser responds, try your best to assist the person who was targeted instead of engaging with the harasser.”
Why do some people take action and others don’t?
What explains a security guard standing by when an elderly woman is attacked? The reasons for the “bystander phenomenon” are many, but some factors include the number of people witnessing the incident. Studies have found that if there are other witnesses to an emergency, people feel less personal responsibility to intervene. Sometimes it’s a case of misreading the situation. No one wants to be the person who overreacts when no danger actually exists.
A bystander taking action could mean the difference between life and death in some situations.
But as Dr. Lee noted, violent situations like the NYC attack can be dangerous. The elderly woman could have been killed had a bystander across the street not yelled and screamed to distract the attacker and draw attention. Taking action could mean the difference between life and death in some scenarios.
Going through structured trainings like those offered by Hollaback! is useful because training materials address issues that not everyone may be aware of, such as that calling 911 or involving the police is not always the right action to take “since some individuals may not feel comfortable with calling law enforcement due to systemic police brutality and disproportionate mistreatment against communities of color,” as Dr. Lee noted. Of course, calling for an ambulance and medical care is necessary in situations of life-threatening danger.
Find out more about Hollaback! bystander intervention training. And for more on a related topic, read our post How to Handle Difficult Patients and De-Escalate Tense Situations.