Between the end of 2025 and the beginning of 2026, four focus groups—one in each pilot country—were held as part of the BRAVE-WOW project. These sessions involved 20 participants in Italy, 12 in Portugal, 4 in Slovenia, and 20 in Spain. The participants included policymakers, healthcare professionals, institutional representatives, trade unions, NGOs, and experts from diverse professional and academic backgrounds.
The focus groups investigated three main areas:
- How gender-based violence and harassment (GBVH) is normalised and manifested within everyday healthcare environments, including its structural nature and hierarchical impact.
- The gap between existing protocols and the workplace reality, focusing on the lack of internal awareness, reporting barriers, and the penalisation of victims.
- How digital tools and technology exacerbate pre-existing problematic dynamics, blurring the boundaries between work and private life.
The testimonies collected revealed a series of issues that proved to be common across all participating countries.
The Invisible Norm in Healthcare Workplaces
When examining how gender-based violence and harassment (GBVH) manifests in everyday healthcare environments, focus group participants highlighted a pervasive presence of microaggressions, “micro-machismo”, and a deep-rooted patriarchal legacy within healthcare organisations. Rather than being treated as exceptional incidents, GBVH is frequently normalised, downplayed, and profoundly embedded into daily practices as a structural feature of the workplace.
This systemic violence and harassment disproportionately impacts staff in lower hierarchical positions—roles which are most frequently held by women. These incidents are predominantly perpetrated by patients, their family members, or senior staff, and they occur most commonly in high-pressure frontline environments such as emergency departments and home-care settings.
The Gap Between Policy and Reality
In exploring the tools and protocols designed to combat this behaviour, discussions revealed a significant gap between official policy and the workplace reality. Although formal protocols and awareness tools usually exist, they are often neither applied nor known by middle management and frontline employees.
This lack of application leads to several critical issues. First, there is rarely a shared definition of what actually constitutes GBVH, meaning it is often not clearly recognised as such by either perpetrators or victims. Instead, severe cases are frequently minimised and reinterpreted as mere interpersonal conflict, despite having a profound impact on victims’ mental health and general well-being. Furthermore, when staff do attempt to report harassment, they are often actively discouraged from using formal channels. When action is taken, institutional responses tend to penalise the victim through forced department relocations or reassignments while allowing the perpetrator to remain unaccountable. Because of these dynamics, victims frequently avoid reporting altogether out of a well-founded fear of blame, retaliation, or mobbing.
How Digital Tools Amplify the Threat
The relationship between GBVH and technology has further complicated these dynamics, with digital tools often exacerbating pre-existing offline issues and spilling over into work chats and email exchanges. Employees are frequently added to group chats without their consent, and their personal contact information is often shared, leading to a complete loss of control over their personal data.
Inclusion in these work-related chats blurs the boundary between private and professional life, driving up stress levels and exposing employees to constant peer surveillance. Despite the rise of digital harassment, organizational leadership rarely recognises or addresses these online behaviours, making mandatory training in digital safety absolutely essential. This digital hostility is not just internal; it also manifests externally through harassment on the organisation’s public social media channels and via negative online reviews.
The Path Forward: Systemic and Cultural Reform
Addressing these deeply entrenched issues requires a comprehensive approach that goes far beyond paper regulations. Focus group participants concluded that a profound cultural transformation is necessary to root out systemic biases. To achieve this, several key structural gaps must be bridged, starting with the introduction of university-level training on GBVH for future healthcare professionals. Additionally, there must be a concerted effort to increase the involvement of trade unions and employee representatives, alongside securing much stronger, active commitment from middle and senior management.