Bullying and Undermining Programme
The link between undermining and bullying behaviour and patient safety has become clearer and less contentious over the past few years.
Evidence that these behaviours have a negative impact on the workings of a team or unit are growing.(1) Whilst undermining and bullying extend beyond the specialty of surgery, it is important to recognise that being a surgeon requires far more than just technical expertise, but also the behaviours required to work with and lead a team.
How we behave shapes the culture we work in, those we train and the profession as a whole. In order to instigate change, one must define and understand the problem. Whilst numerous definitions of bullying and undermining exist, the core principles remain.
A widely accepted definition is provided by the Advisory, Conciliation and Arbitration Service (ACAS); Bullying may be characterised as offensive, intimidating, malicious or insulting behaviour, an abuse or misuse of power through means that undermine, humiliate, denigrate or injure the recipient.(2) Undermining describes behaviour that has undermined professional confidence of selfesteem.
According to the Equality Act 2010, harassment is defined as ‘unwanted conduct related to a relevant protected characteristic, which has the purpose or effect of violating an individual’s dignity or creating an intimidating, hostile, degrading, humiliating or offensive environment for that individual’.
The problem of bullying, undermining and harassment is not isolated to surgery. The 2017 NHS England Staff Survey reported that 24.3% of all NHS staff had experienced these behaviours, equating to over a quarter of a million people.(3) In 2016, the Royal College of Obstetrics and Gynaecology (RCOG) provided their members and fellows with initiatives to tackle bullying. This was in response to almost half of surveyed Consultants reporting persistent bullying and a third labelling this as severe.(4) Furthermore, these problems are worldwide.
In 2015, the President of the Royal Australasian College of Surgeons issued a public apology for the level of bullying, harassment and sexual discrimination that had been identified in surgical practice in Australia and New Zealand. This then led to the launch of their “Let’s Operate with Respect” campaign.(5,6) A survey of the Royal College of Surgeons of Edinburgh (RCSEd) own membership demonstrated the scale of the problem, with almost 40% of respondents reporting that they had experienced or witnessed such behaviour.
The monetary cost of this behaviour to the NHS is overwhelming, with reports estimating this at £13.75 billion annually.(7) More importantly, the effect on patient safety is startling with one report attributing disruptive behaviour in the perioperative area to 67% of adverse events, 71% of medical errors and 27% of perioperative deaths.(8) The RCSEd have developed a comprehensive set of resources that are freely available for all healthcare professionals (www.rcsed.ac.uk/bullying).
A CPD accredited e-learning module has also been developed, giving individuals more confidence in identifying and managing incidents of bullying, undermining or harassment. The #LetsRemoveIt Campaign has a significant web presence with almost 18,000 visits to the Bullying and Undermining section of the RCSEd website. Notably, the most visited elements on the website are “Resources to help change the culture” and “Are you a bully?”.
The commitment of the RCSEd to deliver the highest standards of education has led to the development of workshops on conflict resolution and bullying and undermining behaviours. A collaboration with the General Medical Council and the Royal College of Obstetricians and Gynaecologists has resulted in a joint learning module that will be delivered across the UK over the coming year . To disseminate a positive message to members, fellows and the wider healthcare community, the RCSEd has set professional standards with regards to conduct in the workplace. Individuals are expected to:
1. Demonstrate exemplary professional behaviour in ensuring that they do not bully or undermine colleagues, either deliberately or inadvertently;
2. Adopt a zero-tolerance approach to bullying and undermining behaviour; and demonstrate to their colleagues that undermining and bullying is unacceptable when encountered;
3. Challenge and report bullying and undermining behaviour appropriately, whenever it is experienced or observed;
4. Identify, report and in if in a leadership role, where possible investigate allegations of bullying or undermining behaviour .
5. Ensure all colleagues are informed to identify and report undermining and bullying behaviour , both as a victim and an observer .
6. Contribute to or conduct investigations into allegations of bullying and under mining behaviour without prejudice to either the alleged victim or perpetrator, and must raise concerns about the conduct of such investigations if they are perceived to be prejudiced, compromised or insufficiently robust;
7. Demonstrate leadership by contributing to the development of local reporting systems that are effective and have the confidence of colleagues. The RCSEd are committed to meeting the challenges facing our profession, to change the culture within surgery and build a safer, more respectful workplace that will be beneficial for patients, trainees and all our colleagues. The RCSEd are acutely aware that they cannot achieve these changes alone. Change will neither be immediate nor easy to achieve. A long-term coordinated set of collaborations will be required to deliver this impact.
British International Doctors’ Association
Issue No.1, Volume 25 February 20198
1. Effective team working in health care West, M.A., Markiewicz, L. 2016 In: The Oxford Handbook of Health Care Management. Oxford : Oxford University Press p. 231-252. 22 p. ISBN: 9780198705109
4. Shabazz T , Parry-Smith W, Oates S, Henderson S, Mountfield J. Consultants as victims of bullying and undermining: a survey of Royal College of Obstetricians and Gynaecologists consultant experiences. BMJ Open. 2016; 6(6):e011462
5. Cebbin W, Cambell G, Hillis D, Watters DA. Prevalence of bullying, discrimination and sexual harassment in surgery in Australasia. ANZ J Surg. 2015 Dec;85(12):905-9
7. Giga S, Hoel H & Lewis D. (2008) The Costs of Workplace Bullying. Unite/Department for Business Enterprise and Regulatory Reform, London
8. Rosenstein AH, O’Daniel M, (2008). A survey of the impact of disruptive behaviours and communication defects on patient safety. The Joint Commission Journal on Quality and Patient Safety 34(8), cited in ‘Workplace bullying and harassment of doctors; A recent review of research.’ British Medical Association, 201
RCS Edinburgh Campaign: Bullying and Undermining Campaign.
Olivia McBride, A Hartley, C Sanderson, D Riding, S Backhouse, J Evans, V Srinivasan