Workshop:Why its better to prepare and prevent, than repair and repent

Tackling Bullying  The GMC Survey 2012 revealed that undermining behaviour is very rife amongst Foundation Year trainees in London(1)  This leads to low morale impacting productivity and leading to sick leave absences. The Northwick Park Report (2) and Bristol Heart Inquiry (3) have also implicated undermining as a factor in patient safety.

Trainee satisfaction by stage of training

Effects of B&H  Low morale  Increased abscences  Poor job satisfaction  Effect on team  Patient safety

‘Staff will not feel confident to raise concerns until there really is protection against the bullying and harassment that all too often follows the raising of concerns within the NHS.’ Kim Holt, consultant paediatrician

Northwick Park Inquiry  Poor staff relationships  Little guidance or support for juniors  Junior staff not encouraged to seek input  Poor clinical leadership  Prevailing culture did not facilitate learning from adverse incidents  Blame culture

Bristol Royal Infirmary (BRI) Inquiry  A public inquiry into children receiving complex cardiac surgery at BRI between 1984 – 1995  Behavioural issues emerged as a major factor, which affected the quality of care  As a result 1/3 of children received sub- optimal care; More deaths than expected

The Workshop (1)  Two 90 minute workshops open to all foundation year doctors at NMUH  Aims Defining bullying behavior and harassment Case studies from junior and senior doctors How bullying behavior typically manifests amongst FY doctors Exploring the effects on patient safety Practical tips Trust policies, guidelines and recommendations

The Workshop (2)  Personal experiences from FY2, and registrars  Facilitated group sharing of personal experiences  Reflection on the effects of such behavior on the team and patient safety

Results  The two workshops were attended by FY1 and FY2 foundation doctors  All the attendees found the workshops useful and enjoyable  All of the junior doctors had either experienced bullying behavior or witnessed it  None had ever reported personal or witnessed bullying  There was a general acceptance of bullying behavior in medical practice

 Most juniors experienced mainly bullying attitudes or undermining rather than bullying  FY trainees often feel isolated, and frustrated following such experiences  Most experiences were either not discussed or shared with a fellow FY trainee

Recurrent themes  Poor recognition and action by seniors for significant overtime  Stressful A&E environment – juniors often blamed for “patient breaches”  Worry of impact of reporting bullying behavior on e-portfolio sign offs

Changing behaviours  FY doctors were reminded of the Trusts zero tolerance policy to bullying  Advised to discuss any encounters with senior colleagues  Increased global citizenship and supporting colleagues when bullying or harassment it witnessed

“A substantial barrier to progress in patient safety is a dysfunctional culture rooted in widespread disrespect” Professor Lucien Leape Harvard School of Public Health

Thanks Any questions

References  GMC Dignity at Work Policy  GMC National Training Survey  Commission for Healthcare Audit and Inspection, Investigation into ten maternal deaths at, or following delivery at, Northwick Park Hospital, North West London Hospitals NHS Trust, between April 2002 and April archive.cqc.org.uk/_db/_documents/Northwick-tagged.pdf  Bristol Royal Infirmary Report inquiry.org.uk/final_report/Summary.pdf