Advertisement

Managers' and Leaders’ Perceptions of Sexual and Gender-Based Public Harassment in the Veterans Health Administration

  • Shay Cannedy
    Correspondence
    Correspondence to: Shay Cannedy, PhD, VHA: Veterans Health Administration, 16111 Plummer St., Bldg. 25, North Hills, CA 91343-2036.
    Affiliations
    Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Health Services Research and Development (HSR&D), Los Angeles, California
    Search for articles by this author
  • Karen E. Dyer
    Affiliations
    Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Health Services Research and Development (HSR&D), Los Angeles, California
    Search for articles by this author
  • Anneka Oishi
    Affiliations
    Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Health Services Research and Development (HSR&D), Los Angeles, California
    Search for articles by this author
  • Karissa M. Fenwick
    Affiliations
    Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Health Services Research and Development (HSR&D), Los Angeles, California
    Search for articles by this author
  • Tanya T. Olmos-Ochoa
    Affiliations
    Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Health Services Research and Development (HSR&D), Los Angeles, California
    Search for articles by this author
  • Tana M. Luger
    Affiliations
    Covenant Health Network, Phoenix, Arizona
    Search for articles by this author
  • Theodore K. Gideonse
    Affiliations
    Department of Health, Society, and Behavior, UCI Program in Public Health, Irvine, California
    Search for articles by this author
  • Ann M. Cheney
    Affiliations
    Department of Social Medicine, Population, and Public Health, UC Riverside School of Medicine, Riverside, California
    Search for articles by this author
  • Ismelda Canelo
    Affiliations
    Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Health Services Research and Development (HSR&D), Los Angeles, California
    Search for articles by this author
  • Elizabeth M. Yano
    Affiliations
    Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Health Services Research and Development (HSR&D), Los Angeles, California

    Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, California

    Department of Medicine, UCLA David Geffen School of Medicine, Los Angeles, California
    Search for articles by this author
  • Alison B. Hamilton
    Affiliations
    Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Health Services Research and Development (HSR&D), Los Angeles, California

    Department of Psychiatry and Biobehavioral Sciences, UCLA David Geffen School of Medicine, Jane & Terry Semel Institute for Neuroscience & Human Behavior, Los Angeles, California
    Search for articles by this author
Published:March 09, 2022DOI:https://doi.org/10.1016/j.whi.2022.01.009

      Abstract

      Purpose

      Managers and leaders have a critical role to play in sexual and gender-based harassment prevention within organizations. Although the Veterans Health Administration has committed to eliminating harassment through national directives and training programs, it is unclear how aware local-level managers and leaders are about public harassment at their facilities and how they perceive sexual and gender-based harassment. We examined middle managers' and leaders’ views about whether harassment is perceived as a problem locally, and what policies and procedures (if any) are in place to address public harassment.

      Methods

      We conducted 69 semistructured telephone interviews with middle managers and facility leaders before implementation of an evidence-based quality improvement project designed to improve delivery of comprehensive women's health care. Transcripts were coded using the constant comparative method and analyzed for overarching themes.

      Results

      Perceptions of the prevalence of sexual and gender-based public harassment varied among middle managers and leaders. A little more than one-half of respondents were unaware of facility-level policies and procedures to address public harassment between patients. To decrease patient-to-patient harassment, both groups generally supported the creation of separate clinical spaces for women. However, middle managers also stated that education was needed to change patient harassing behavior, which they tied to male military culture.

      Conclusions

      Aligning divergent perspectives of what constitutes sexual and gender-based harassment and how to address it is a necessary step towards tackling harassment at the local level. Managers and leaders should continue to assess environments of care and share findings widely among employees and leadership to improve awareness and inform a unified response.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Women's Health Issues
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Barth S.K.
        • Kimerling R.E.
        • Pavao J.
        • McCutcheon S.J.
        • Batten S.V.
        • Dursa E.
        • Schneiderman A.I.
        Military sexual trauma among recent veterans: Correlates of sexual assault and sexual harassment.
        American Journal of Preventive Medicine. 2016; 50: 77-86
        • Best A.
        • Greenhalgh T.
        • Lewis S.
        • Saul J.E.
        • Carroll S.
        • Bitz J.
        Large-system transformation in health care: a realist review.
        Milbank Quarterly. 2012; 90: 421-456
        • Birken S.A.
        • Shoou-Yih D.L.
        • Weiner B.J.
        Uncovering middle managers’ role in healthcare innovation implementation.
        Implementation Science. 2012; 7: 28
        • Brunner J.
        • Cain C.L.
        • Yano E.M.
        • Hamilton A.B.
        Local leaders’ perspectives on women Veterans’ health care: What would ideal look like?.
        Women’s Health Issues. 2019; 29: 64-71
        • Buchanan N.
        • Settles I.
        • Hall A.
        • O'Connor R.
        A review of organizational strategies for reducing sexual harassment: Insights from the U.S. military.
        Journal of Social Issues. 2014; 70: 687-702
        • Cheney A.M.
        • Dunn A.
        • Booth B.M.
        • Frith L.
        • Curran G.M.
        The intersections of gender and power in women veterans’ experiences of substance use and VA care.
        Annals of Anthropological Practice. 2014; 37: 149-171
        • Dyer K.E.
        • Potter S.J.
        • Hamilton A.B.
        • Luger T.M.
        • Bergman A.A.
        • Yano E.M.
        • Klap R.
        Gender differences in veterans' perceptions of harassment on Veterans Health Administration grounds.
        Women’s Health Issues. 2019; 29: S83-S93
        • Dyer K.E.
        • Hamilton A.B.
        • Yano E.M.
        • Moreau J.L.
        • Frayne S.M.
        • Carney D.V.
        • Klap R.S.
        Mobilizing embedded research and operations partnerships to address harassment of women veterans at VA Medical facilities.
        Healthcare. 2021; 8: 100513
        • Engle R.L.
        • Lopez E.R.
        • Gormley K.E.
        • Chan J.A.
        • Charns M.P.
        • Lukas C.V.
        What roles do middle managers play in implementation of innovative practices?.
        Health Care Management Review. 2017; 42: 14-27
        • Fairchild K.
        • Rudman L.A.
        Everyday stranger harassment and women’s objectification.
        Social Justice Research. 2008; 21: 338-357
        • Fenwick K.M.
        • Golden R.E.
        • Frayne S.M.
        • Hamilton A.B.
        • Yano E.M.
        • Klap R.
        Women veterans’ experiences of harassment and perceptions of Veterans Affairs healthcare settings during a national anti-harassment campaign.
        Womens Health Issues. 2021; 31: 567-575
        • Fitzgerald L.F.
        • Cortina L.M.
        Sexual harassment in work organizations: A view from the 21st century.
        in: Travis C.B. White J.W. APA handbook of the psychology of women: Vol. 2. Perspectives on women’s private and public lives. American Psychological Association, Washington, DC2018: 215-234
        • Fitzgerald L.F.
        • Magley V.J.
        • Drasgow F.
        • Waldo C.R.
        Measuring sexual harassment in the military: The sexual experiences questionnaire (SEQ-DoD).
        Military Psychology. 1999; 11: 243-263
        • Frayne S.M.
        • Phibbs C.S.
        • Saechao F.
        • Friedman S.A.
        • Shaw J.G.
        • Romodan Y.
        • Haskell S.
        Sourcebook: Women veterans in the Veterans Health Administration. Longitudinal trends in sociodemographics, utilization, health profile, and geographic distribution (volume 4). Women’s Health Evaluation Initiative, Women’s Health Services, Veterans Health Administration.
        Department of Veterans Affairs, Washington DC2018
        • Hamilton A.B.
        • Olmos-Ochoa T.T.
        • Canelo I.
        • Rose D.
        • Hoggatt K.J.
        • Than C.
        • Yano E.M.
        Dynamic waitlisted design for evaluating a randomized trial of evidence-based quality improvement of comprehensive women's health care implementation in low-performing VA facilities.
        Implement Science Communication. 2020; 1: 59
        • Hamilton A.B.
        • Frayne S.
        • Cordasco K.
        • Washington D.
        Factors related to attrition from VA healthcare use: Findings from the National Survey of Women Veterans.
        Journal of General Internal Medicine. 2013; 28: 510-516
        • Harry B.
        • Sturges K.M.
        • Klingner J.K.
        Mapping the process: An exemplar of process and challenge in grounded theory analysis.
        Educational Researcher. 2005; 34: 3-13
        • Hayes P.M.
        Improving health of veterans through research collaborations.
        Journal of General Internal Medicine. 2013; 28: S495-S497
        • Hayes P.M.
        “VA: It’s our responsibility to end harassment.” Vantage Point, Official Blog of the U.S. Department of Veterans Affairs.
        (Available:)
        • Isakson J.
        • Roe D.P.
        M.D. Veterans Health Care and Benefits Improvement Act.
        Public Law. 2020; : 116-315
        • Klap R.
        • Darling J.E.
        • Hamilton A.B.
        • Rose D.E.
        • Dyer K.E.
        • Canelo I.
        • Yano E.M.
        Prevalence of stranger harassment of women veterans at Veterans Affairs Medical Centers and impacts on delayed and missed care.
        Women’s Health Issues. 2019; 29: 107-115
        • Klingensmith K.
        • Tsa J.
        • Mota N.
        • Southwick S.M.
        • Pietrzak R.H.
        Military sexual trauma in US veterans: Results from the National Health and Resilience in Veterans Study.
        Journal of Clinical Psychiatry. 2014; 75: e1133-e1139
        • Logan L.S.
        Street harassment: Current and promising avenues for researchers and activists.
        Sociology Compass. 2015; 9: 196-211
        • Miles-McLean H.
        • Liss M.
        • Erchull M.J.
        • Robertson C.M.
        • Hagerman C.
        • Gnoleba M.A.
        • Papp L.J.
        “Stop looking at me!”: Interpersonal sexual objectification as a source of insidious trauma.
        Psychology of Women Quarterly. 2015; 39: 363-374https://doi.org/10.1177/0361684314561018
        • National Academies of Sciences, Engineering, and Medicine
        Sexual harassment of women: Climate, culture, and consequences in academic sciences, engineering, and medicine.
        The National Academies Press, Washington, DC2018
        • Purcell N.
        • Shovein E.
        • Hebenstreit C.
        • Drexler M.
        Violence in the a U.S. Veteran Affairs healthcare system: Worker perspectives on prevalence, causes, and contributors.
        Policy and Practice in Health and Safety. 2017; 15: 38-56
        • Relyea M.R.
        • Portnoy G.A.
        • Klap R.
        • Yano E.M.
        • Fodor A.
        • Keith J.A.
        • Adams L.
        Evaluating bystander intervention training to address patient harassment at the Veterans Health Administration.
        Women’s Health Issues. 2020; 30: 320-329
        • Sadler A.G.
        • Booth B.M.
        • Nielson D.
        • Doebbeling B.N.
        Health-related consequences of physical and sexual violence.
        Obstetrics & Gynecology. 2000; 96: 473-480
        • Stop Street Harassment (SSH)
        Unsafe and harassed in public spaces: A national street harassment report.
        (Available:)
        www.stopstreetharassment.org/our-work/nationalstudy/
        Date: 2014
        Date accessed: February 23, 2022
        • Stop Street Harassment (SSH)
        The facts behind the #MeToo movement: A national study on sexual harassment and assault.
        (Available:)
        • Street A.E.
        • Gradus J.L.
        • Stafford J.
        • Kelly K.
        Gender differences in experiences of sexual harassment: Data from a male-dominated environment.
        Journal of Consulting and Clinical Psychology. 2007; 75: 464-474
        • VA National Center for Veterans Analysis and Statistics
        Women veterans report: The past, present, and future of women veterans.
        Department of Veterans Affairs, Washington, DC2017
        • VA National Center for Veterans Analysis and Statistics
        Profile of veterans: 2017.
        (Available:)
        www.va.gov/vetdata/report.asp
        Date: 2017
        Date accessed: March 9, 2021
        • Veterans Health Administration (VA)
        VHA directive 1330.01—Health care services for women veterans.
        Author, Washington, DC2017
        • Viglianti E.M.
        • Oliverio A.L.
        • Cascino T.M.
        • Meeks L.M.
        The policy gap: A survey of patient-perpetrated sexual harassment policies for residents and fellows in prominent US hospitals.
        Journal of Internal Medicine. 2019; 34: 2326-2328
        • Washington D.L.
        • Bean-Mayberry B.
        • Riopelle D.
        • Yano E.M.
        Access to care for women veterans: Delayed healthcare and unmet need.
        Journal of General Internal Medicine. 2011; 26: 655-661
        • Wesselman E.
        • Kelly J.
        Cat-calls and culpability: Investigating the frequency and functions of stranger harassment.
        Sex Roles. 2010; 63: 451-462
        • Yano E.M.
        • Haskell S.
        • Hayes P.
        Delivery of gender-sensitive comprehensive primary care to women veterans: Implications for VA Patient Aligned Care Teams.
        Journal of General Internal Medicine. 2014; 29: S703-S707
        • Yano E.M.
        • Bastian L.A.
        • Bean-Mayberry B.
        • Eisen S.
        • Frayne S.
        • Hayes P.
        • Washington D.L.
        Using research to transform care for women veterans: Advancing the research agenda and enhancing research-clinical partnerships.
        Women’s Health Issues. 2011; 21: S73-S83
        • Zinzow H.M.
        • Grubaugh A.L.
        • Monnier J.
        • Suffoletta-Maierie S.
        Trauma among female veterans: A critical review.
        Trauma Violence & Abuse. 2007; 8: 384-400

      Biography

      Shay Cannedy, PhD, is a Cultural Anthropologist and Research Health Scientist at the VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy.

      Biography

      Karen E. Dyer, PhD, MPH, is a Medical Anthropologist and Research Health Scientist at the VA HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy (CSHIIP).

      Biography

      Anneka Oishi, BA, is a Research Assistant at VA HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy (CSHIIP).

      Biography

      Karissa M. Fenwick, PhD, MSW, LCSW, is a Research Health Scientist at the Center for the Study of Healthcare Innovation, Implementation & Policy (CSHIIP) in the VA Greater Los Angeles Healthcare System.

      Biography

      Tanya T. Olmos-Ochoa, PhD, MPH, is an Investigator at the Center for the Study of Healthcare Innovation, Implementation, and Policy at VA Greater Los Angeles. Her work focuses on improving the organization and delivery of care to address health care disparities and better support the health care workforce.

      Biography

      Tana M. Luger, PhD, MPH, is the Director of Research and Analytics for Covenant Health Network, a non-profit group of post-acute health care providers. Her work focuses on the application of patient-facing and clinical informatics to optimize health care quality and population health.

      Biography

      Theodore K. Gideonse, PhD, MFA, is an Assistant Professor in the Department of Health, Society, and Behavior and Director of the Undergraduate Program for University of California, Irvine's Program in Public Health.

      Biography

      Ann M. Cheney, PhD, is an Associate Professor in the Department of Social Science Population and Public Health. Her work focuses on structural inequality in vulnerable populations, including immigrant, veteran, and rural populations.

      Biography

      Ismelda Canelo, MPA, is a Health Science Specialist, VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy. She has 20 years of experience managing VA primary care and women's health organizational and implementation research.

      Biography

      Elizabeth M. Yano, PhD, MSPH, is Director of the VA HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy (CSHIIP) and Director of the Women's Health Research Network Consortium, and Adjunct Professor in Public Health and Medicine at UCLA.

      Biography

      Alison B. Hamilton, PhD, MPH, is a VA Research Career Scientist and Chief Officer of Implementation & Policy, VA HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy (CSHIIP), and Professor-in-Residence in the Department of Psychiatry and Biobehavioral Sciences, UCLA David Geffen School of Medicine.