“It's not bullying if I do it to everyone”: What are the red flags of a toxic healthcare workplace culture? #MedTwitter responses from UK NHS healthcare professionals – A qualitative study

The study aimed to understand NHS healthcare workers’ perceptions of toxic organisational cultures and behaviours, by undertaking an analysis of tweets. The prompt tweet was posted in late 2022 by @DrLindaDykes (a prominent UK physician), inviting healthcare staff to share their experiences of “red flags that indicate you’re probably in a toxic organisation”. A qualitative analysis of response tweets was undertaken, using inductive thematic analysis. A total of 462 tweets were examined, revealing five key themes of what constitutes a red flag of a toxic workplace culture. The first theme was emotional depletion, with staff feeling drained and futile about their work. The second theme was incivility and unfair treatment, often rooted in a bullying culture. A third theme was a culture of blame shifting, whereby leaders and managers pressured frontline staff to resolve or take the blame for systemic issues, including understaffing. This also fed into the fourth theme, regarding staff feedback and/or concerns being ignored by leaders/managers. A fifth underlying theme was the fear of speaking out, with some employees facing punishment for doing so. This study highlights the pervasive and complex nature of toxic workplace cultures within the NHS, as experienced by healthcare professionals on Twitter. The findings demonstrate the importance of analysing social media posts to amplify critical voices often absent from more traditional methods of capturing healthcare workers’ opinions, such as staff surveys, offering valuable insights into the complexities of organisational dysfunction. There is an urgent need to tackle a culture of incivility to safeguard staff wellbeing. • Key themes of what constitutes a red flag of toxic NHS workplaces were identified. • X/Twitter analysis captures underreported issues and nuances of organisational culture. • Inductive thematic analysis offers flexibility and depth in exploring complex issues.