No time to waste

Chelcie Jewitt: Emergency Medicine Registrar and Co-founder of Surviving in Scrubs

On 12 September the sordid culture of interprofessional sexual harassment, assault and rape within the UK surgical workforce was exposed internationally thanks to a hard-hitting report published by the Working Party of Sexual Misconduct in Surgery (WPSMS) entitled Breaking the Silence: Addressing Sexual Misconduct in Healthcare.

The report brings together data on the prevalence of sexual misconduct within surgery, the impact of such behaviours on victims and recommendations on what needs to be done to start making a positive change to the surgical working environment.

A large focus of the report centres on the roundtable event hosted by the WPSMS at the GMC on 2 May. This event offered an opportunity for the WPSMS observational study data to be presented to key stakeholder organisations. Attendees formed breakout rooms to identify challenges in addressing sexual misconduct and explore potential solutions – many of which are detailed in the report.

Speaking out

We at Surviving in Scrubs were fortunate to be invited to talk at this event. As an organisation we represent the voices of victims of sexual misconduct throughout the whole of the healthcare workforce. At our core we are an online platform where anyone who works within healthcare can anonymously submit their experiences of sexual misconduct at work, from inappropriate comments up to sexual harassment and assault. This perfectly positioned us to read and comment on the hard-hitting impact statement, reminding attendees that although the figures discussed were shocking in their own right, each number represented a colleague, a peer, a human being.

We applaud this piece of work by the WPSMS, as it has been truly monumental in getting large, key organisations talking about an issue that has been brushed under the carpet for far too long. The study has provided some key findings that cannot be ignored.

We are seeing that men and women are experiencing different realities, with women much more likely to experience assault, but also more likely to witness incidences of harassment and assault compared with their male counterparts. This calls for greater education and training at both an undergraduate and postgraduate level.

It appears that men need to be made aware of what constitutes sexual misconduct so that greater awareness about this will improve acknowledgement of what comprises an incident (this should also reduce incidences occurring), how to support victims when they do witness events and how to call out behaviours if/when appropriate. This will all hopefully help to improve reporting.

There needs to be more support for victims. We frequently hear from victims that they were too afraid to report as they were scared of the impact it might have on their professional or personal reputation, that they didn’t report as they didn’t think that anything would come of it, and that many did not report because they simply did not know how.

Reporting reform

These issues highlight the need for structural reforms regarding reporting processes. We at Surviving in Scrubs are calling for an anonymous and psychologically safe reporting system that is standardised nationally. The aim is to streamline the reporting process so it follows the same structure throughout the country, minimising confusion for victims, as well as limiting repeated trauma through repeating their experiences to human resources.

We recommend that specialised training be provided to those who will work within this system, as currently there is no such training available. Finally, making the reporting process national would enable investigations to occur outside of the affected workplaces, limiting biases to the investigation process.

Those victims who do report are often left unsatisfied by the outcome of the investigations. Time and time again we are hearing about perpetrators who ‘got away with it’. On the other hand we frequently hear from victims who did not formally report their experiences as although the perpetrator’s behaviour was completely unacceptable, it was ‘not severe enough’ to report.

This highlights the need for more proportionate and appropriate sanctioning of perpetrators. This needs to occur collaboratively among hospital Trusts, Royal Colleges and governing bodies. Not all behaviours warrant reporting to the GMC, but there needs to be a mechanism of highlighting issues in someone’s appraisal or perhaps at a Trust level. Perhaps a behaviour warrants an educational supervisor having their trainees removed.

Time for action

It is not just individuals who need to be held to account, but the overall organisations as well. NHS England has recently published a Sexual Safety Charter, and the GMC has recently updated its code of conduct Good Medical Practice to include a clause prohibiting sexual misconduct behaviours and the need to act if such behaviours are witnessed.

We need to see evidence from other organisations that they have bought into these guidelines and the need for cultural change. We need published and accessible data demonstrating what is going on at Trust and national levels. We need to see the number of reports, investigations, outcomes and referrals to governing bodies or the police. We need to see what educational events Trusts are providing to train their staff and change the culture on the shop floor.

“Victims who do report are often left unsatisfied by the outcome of the investigations”

These recommendations are not exhaustive. We need a top-down and bottom-up approach. We need to continue talking about sexual misconduct so it is within the collective consciousness of everyone who works within healthcare, so we can continue to strive for change. But now we have the numbers, we have the data, we need to bring about action. We need organisations involved in the roundtable to use their influence and their resources to provide the solutions necessary – and in a timely fashion.

Sexual misconduct within surgery is not a new phenomenon. What is new is that women are not standing for this any more. We want to go to work and provide the best level of care that we can for our patients without the fear of being assaulted by our colleagues – I really do not think that is too much to ask.

The WPSMS report has broken the silence, it’s now time for those in high places to not only talk about solutions, but put their words into action.

Women healthcare workers should be able to deliver patient care without the threat of being sexually harassed or assaulted by their colleagues

Conflicts of interest

Surviving in Scrubs provides training and educational services regarding sexual misconduct within healthcare, and consultancy services relating to workplace sexual misconduct policies.

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