Behaviour in the Perioperative Care Team

The culture within surgery can be poor and bad behaviours persist. This is bad for the wellbeing and retention of staff. It is also bad for patient safety. CPOC is uniquely placed to bring together excellent resources created by CPOC Board members and others. As with any change, improving behaviour needs an understanding of “WHY” and “HOW”.

Why

Good behaviours create a good culture.

The extent and impact of poor behaviours around surgery is huge. Individual staff suffer. Poor behaviours create a negative culture. Conversely, good behaviours create a lovely working atmosphere – staff feel able to contribute and confident in the care pathways. The entire team working well together and anticipating issues is good for patient empowerment.

Co-workers reduce productivity 20% on witnessing rudeness.[1]
48% of recipients of poor behaviour reduce their time at work.[1]
30% of women surgeons experience sexual harassment.[2]
91% of women doctors experience sexism regularly.[3]
17% of staff from BAME background experience discrimination from other staff.[4]
Poor behaviours mean staff leave or do not perform at their best.
Many Serious Untoward Incidents for patients have poor team-working as a contributory factor.
54% of departments with poor surgical results have individual bad behaviours.[5]
Diverse teams work better.
Harassment is illegal.
It is possible to change behaviours.[6,7]
Impact is important (even if no bad intent).[6]
No one is too important to be polite.

How

Change is possible. There are patterns of behaviour. Some interventions work well. We can learn.

There are actions for individuals. These include: showing respect, being clear, and being allies and active bystanders when they see poor behaviour.
There are actions for organisations. These include: fostering good team-working, meeting across professions, creating pathways together, having clear standards, showing visible, inclusive leadership, providing induction and education, and following up on patterns.
The NatSSIPs resources explain the expectations for interventional teams and stop moments during each invasive procedural session. The Team Brief resource shows how to create a team for the session. Team-working and interactions should be nurtured across all staff groups – clinical, administrative, managerial and support staff and across sectors and patient care pathways.

To quote Simon Fleming, who started the “#HammerItOut” campaign to reduce bullying in surgery: "I ask people to do both the hardest and easiest thing in the world; to change their culture by changing themselves. Be kinder. Say thank you. Think before you speak. Be mindful of the feelings of others. Try to be better. Apologise when you aren’t. Because if we can change ourselves, this is how we change the world."

Recommendations for change

Individual Actions

Respect each person
Be clear
Give feedback on task not person
Know others' name and role
Anticipate issues
Explain issues (eg challenging parts of surgery)
Include others
Have a minimum standard of behaviour
Know (and reduce) what stresses you
Be an ally
Welcome new staff/students
Do active bystander training
Stop instances of poor behviour: "I notice you are stressed, is there anything the team can do to help?"
Encourage focus on the patient
Be ready for a (private) cup of coffee conversation

Organisational Actions

Hold meetings across professional groups
Foster team-working
Identify patterns
Work with staff to improve team-working
Welcome each new staff/student
Be clear about processes, standards and expectations
Reduce stress
Set up standard care pathways with staff - and explain when these should be individualised
Have inclusive visible leadership
Follow up on reports suggesting where change is needed

Resources

NatSSIPs Team Brief

Attach

Behaviour in the Perioperative Care Team

Why

How

Recommendations for change

Resources

References