Could Workplace Bullying Be Silencing Radiographers’ Concerns About Patient Safety?

A survey of UK radiographers found that greater exposure to workplace bullying and harassment was linked to a poorer environment for speaking up and stronger concerns about patient safety.

A radiographer who spots a potential safety problem needs to know that raising it will not put their job, reputation or working relationships at risk. A survey of UK radiographers found that greater exposure to workplace bullying and harassment was linked to a poorer environment for speaking up and stronger concerns about patient safety.

The research, "Workplace bullying, speak-up climate and perceived patient safety compromise among radiographers practising in the United Kingdom," was published in Frontiers in Health Services. Led by Chidi Ollawa and colleagues, it examines how repeated humiliation, intimidation and exclusion relate to staff confidence in raising concerns across imaging and radiotherapy workplaces.

Radiographers contribute to diagnosis, treatment planning and communication between clinical teams, making their ability to question unsafe practice particularly important. The findings draw attention to the organisational conditions surrounding those conversations, although the survey recorded staff perceptions and did not establish that bullying caused clinical errors or patient harm.

A survey of the people behind scans and treatment

The researchers surveyed 385 practising diagnostic and therapeutic radiographers registered with the Health and Care Professions Council. The anonymous online questionnaire ran from 18 December 2025 to 3 February 2026, with volunteers recruited through professional networks, societies and digital platforms.

A validated 22-item questionnaire assessed exposure to bullying behaviours during the previous six months. Separate scores measured the environment for speaking up and perceived effects on patient safety, including teamwork, adherence to protocols and confidence in safe practice. Optional written responses from 188 participants added accounts of reporting difficulties and suggestions for improvement.

Most respondents worked in the NHS, which accounted for 83.4% of the sample, and 93% practised in England. Black, Black British, Caribbean or African radiographers represented 61.8%, and 55.1% had received their primary radiography education outside the UK, features that matter when considering how widely the results apply.

Bullying had its strongest link with reluctance to speak up

Greater bullying exposure was more closely associated with a poor speaking-up environment than with perceived patient safety problems. The correlations were 0.51 and 0.17 respectively, indicating a moderate relationship with speaking-up conditions and a smaller relationship with safety concerns.

The pattern remained after accounting for factors including age, gender, ethnicity, training location, employment setting, experience and job band. Once the researchers included the speaking-up score in the patient safety model, the separate bullying association became much smaller and could no longer be clearly distinguished from zero. Poorer speaking-up conditions remained linked to greater perceived safety compromise.

An exploratory analysis using 5,000 bootstrap samples supported an indirect association involving the speaking-up environment. Checks using complete responses and samples restricted to NHS employees, UK-trained staff or diagnostic radiographers produced similar patterns. These findings cannot establish which problem came first or prove that silence connects bullying to harm, because all measures were collected at one point in time.

Fear and distrust shaped decisions about reporting

Across the full sample, 30.6% selected reporting to a line manager, 8.3% to human resources and 7% through local incident-reporting or speaking-up routes. A further 33.8% selected that they had not formally reported the behaviour, and 27.8% chose not applicable. Respondents could select several options, so these figures are not mutually exclusive.

Lack of trust in the reporting system was selected by 27.8% of all participants, the belief that nothing would change by 26%, and fear of retaliation by 23.4%. Some had not recognised the behaviour as bullying, regarded it as part of the job or did not know how to report it. Only 23 respondents, equivalent to 6% of the full sample, said a reported matter had been addressed satisfactorily.

Written accounts described fears of identification in small departments, professional isolation, damage to career prospects and complaints being ignored. Participants questioned the fairness of investigations and perceived protection of senior or well-connected colleagues. The survey also captured concerns about malicious use of regulatory referrals, although it did not independently verify such misuse. Three recurring themes concerned organisational silence, leadership accountability and the conditions needed for a psychologically safe workplace.

Safer reporting depends on visible organisational action

Participants wanted confidential, independent reporting routes, protection against retaliation, and clear evidence that complaints are fairly investigated and followed up. Their suggestions included training on recognising bullying, respectful communication, bystander responses and raising concerns, supported by regular opportunities for staff feedback. Managers were expected to enforce behavioural standards regardless of seniority and show what had changed after concerns were raised.

The authors identify these approaches as priorities for future evaluation, including through existing NHS Freedom to Speak Up arrangements. The research did not test an intervention, so it cannot establish that improving reporting systems will reduce bullying or improve patient outcomes. Its practical contribution is to connect staff treatment, trust in leadership and perceived safety within the same investigation.

The findings require caution because participants volunteered, potentially attracting more people with experience of bullying, and the sample cannot represent the entire UK radiography workforce. Using one questionnaire for all measures may have strengthened apparent relationships through shared perceptions.

The speaking-up measure was newly developed and had only modest internal consistency, requiring further validation. Following staff over time and combining their accounts with independently collected incidents, near misses, and protocol deviations would help clarify how workplace culture relates to patient safety.