The research team, led by radiographers and academics based at NHS trusts and universities across the United Kingdom, surveyed 385 radiographers registered with the Health and Care Professions Council. Participants were recruited through professional networks, societies and digital platforms between December 2025 and February 2026. The questionnaire centred on the validated Negative Acts Questionnaire-Revised, a 22-item instrument that measures exposure to behaviours such as humiliation, intimidation and social exclusion over the preceding six months. Alongside it, the team built two study-specific composite measures: a Speak-Up Climate score capturing psychological safety and confidence in organisational responses, and a Safety Impact score capturing perceived risks to patient care, disrupted teamwork and weakened protocol adherence.

The statistical picture that emerged was striking. Radiographers reporting greater exposure to bullying behaviours reported a markedly poorer speak-up climate, with a Spearman correlation of 0.51, a strong association by the standards of organisational research. The link between bullying and perceived patient safety compromise was more modest at 0.17, but it remained statistically significant after the researchers applied false discovery rate corrections to guard against spurious findings. Internal consistency was excellent for the bullying scale and the safety measure, with Cronbach’s alpha values of 0.94 and 0.90 respectively.

The most revealing result came from the regression models. In models adjusted for age, gender, ethnicity, training location, employment setting, experience and job band, bullying exposure independently predicted both a poorer speak-up climate and greater perceived safety compromise. But when the speak-up climate score was added to the safety model, the direct association between bullying and perceived safety impact collapsed from a coefficient of 0.316 to 0.052 and lost statistical significance entirely. Meanwhile, the speak-up climate itself remained strongly associated with perceived safety compromise, with a coefficient of 0.378. In other words, the statistical fingerprint of bullying on patient safety ran almost entirely through the climate of silence it created.

An exploratory mediation analysis using 5,000 bootstrap resamples reinforced this interpretation, estimating an indirect association of 0.264 with a confidence interval well clear of zero. The authors are careful to stress that this is a cross-sectional study, so temporal ordering and causation cannot be established. It is possible that poor speak-up climates make departments more vulnerable to bullying, or that the relationship runs in both directions. Still, the pattern is consistent with psychological safety theory, which holds that people withhold concerns when speaking up feels personally dangerous, and with organisational silence frameworks that describe why employees conclude that voice is futile.

The free-text responses, analysed from 188 participants, put human texture on the numbers. Respondents described departments where fear of retaliation, victimisation and reputational harm kept staff quiet. One participant wrote that people were scared to report because everyone knows who raised the concern. Another said there was fear that speaking up would make you a target. Others described bullying being ignored when the perpetrator was senior or well-connected, and reporting systems perceived as lacking confidentiality, independence or meaningful follow-up. Participants repeatedly characterised the problem as systemic rather than interpersonal, pointing to managerial inaction, inconsistent complaint handling and a sense that institutions prioritised protecting their reputation over supporting staff.

The reporting data quantified that reluctance. Of the 385 participants, only about a third said they had formally reported the bullying they experienced, most commonly to a line manager. Just 8.3 percent went to human resources, 7 percent used local incident-reporting or speaking-up channels, and a single participant escalated to the professional regulator. Among those who did not report or delayed, the most common reasons were lack of trust in the reporting system, the belief that nothing would change, and fear of retaliation. Of those who did report and knew the outcome, only 23 participants said the matter had been addressed satisfactorily.

Why does this matter for patients? Radiographers sit at critical diagnostic junctures. Errors in image acquisition, protocol adherence or communication can cascade into misdiagnosis and inappropriate treatment. Prior research in nursing and medicine has linked bullying to reduced incident reporting, communication failures and disengagement from safety behaviours, and public inquiries into NHS failures have repeatedly identified cultures of fear and silence as contributors to patient harm. The present study extends that evidence into a profession that has been largely under-researched on workplace culture, and it does so with a sample skewed toward internationally educated radiographers and Black, Black British, Caribbean and African respondents, groups that may face distinct vulnerabilities.

The authors are candid about the limitations. The speak-up climate composite showed only borderline internal consistency, with a Cronbach’s alpha of 0.67 and one weakly loading item, so it should be treated as an exploratory measure pending validation. The safety outcome was subjective perception rather than clinical incident data, meaning the study captures perceived compromise rather than demonstrated harm. Non-probability sampling may overrepresent people with direct experience of bullying. And because all measures came from the same self-report questionnaire at one point in time, common-method bias cannot be excluded, though the team took procedural steps such as anonymity, separated questionnaire sections and mixed item framing to reduce it.

Even with those caveats, the implications are pointed. If bullying erodes the willingness to raise concerns, then tackling it becomes a patient safety intervention, not merely a staff welfare one. The researchers argue that psychologically safe reporting environments, confidential and independent reporting mechanisms, anti-retaliation protections and visible leadership accountability are plausible organisational priorities that now warrant prospective evaluation. They call for longitudinal studies that pair staff reports with independently collected incident and near-miss data to establish whether fixing the speak-up climate genuinely changes safety outcomes. In a health system where imaging demand is rising and workforce morale is fragile, the message from this study is uncomfortable but clear: silence in the imaging department is not neutral, and the cost of it may ultimately be counted in patient harm.

Subject of Research: Associations between workplace bullying, speak-up climate and perceived patient safety compromise among UK radiographers

Article Title: Workplace bullying, speak-up climate and perceived patient safety compromise among radiographers practising in the United Kingdom

Article References: Ollawa, C., Lawal, O., Julka-Anderson, N., Eteng, R., Ezenwuba, B. N., Meertens, R., & Iweka, E. (2026). Workplace bullying, speak-up climate and perceived patient safety compromise among radiographers practising in the United Kingdom. Frontiers in Health Services, 6, Article 1924715. https://doi.org/10.3389/frhs.2026.1924715

Image Credits: AI Generated

DOI: 10.3389/frhs.2026.1924715

Keywords: workplace bullying, radiographers, patient safety, psychological safety, speak-up climate, organisational silence, NHS workforce, NAQ-R, cross-sectional survey, mediation analysis, radiography, health services