End bullying and sexual misconduct

In 2016, Professor Mike Lavelle-Jones, then RCSEd President, commissioned a short-life working group to look at the impact of bullying and undermining in the surgical workforce. The 2014 General Medical Council Trainee Survey and 2015 RCSEd Membership Survey had highlighted that increasing numbers of surgeons were witnessing and experiencing oppressive workforce behaviour. 

While this conduct had been experienced by surgeons throughout previous generations, there was an increasing body of evidence that it had a direct impact on patient safety and led to increased patient morbidity and mortality¹. From a professional standards perspective, Professor Lavelle-Jones felt that RCSEd had an obligation to explore the extent of the problem, offer ways to tackle the issues and highlight the implications for patient care. 

A team of 10 surgeons from across the RCSEd membership, including trainees, SAS doctors and consultants, were enrolled into the working group. Using literature searches, social media and membership engagement events, it quickly became apparent that undermining, bullying and harassment were rife across the NHS. The team launched the #LetsRemoveIt campaign and produced a website containing relevant literature, ready-made PowerPoint presentations, posters and information about the subject. Four national conferences were arranged, where organisations were invited to share how they had successfully tackled oppressive behaviour. Links were developed with other Royal Colleges and NHS organisations leading, ultimately, to the formation of a pan-NHS anti-bullying alliance. This group comprised institutions across the UK that had developed resources to challenge this behaviour. All of these resources were collated in a document that was sent to all trusts and health boards across the UK.

The timing was fortuitous – with the expansion of social media platforms such as Twitter (now X) promoting our work, connecting with others and reaching the sceptics was happening much more quickly. 

The subject was topical and following the 2017 #MeToo campaign in Hollywood, linked to the sexual abuse carried out by disgraced US film producer Harvey Weinstein, there was a move to look at sexual harassment in the NHS. In 2021, the British Medical Association published the results of a survey of almost 2,500 doctors, which demonstrated that 91% of women doctors in the UK had experienced sexism at work with more than 42% feeling that they could not report it. This was quickly followed by a survey of the surgical workforce (Breaking the Silence 2023), which recorded shocking levels of sexual offences against both men and women, including sexual assault and rape. 

In response to this publication, our College relaunched the #LetsRemoveIt campaign, with a new poster and media campaign directed at raising awareness around sexual misconduct and providing resources to help those affected by this behaviour. We also updated our Code of Conduct for our members and fellows, making it clear that the College has zero tolerance for behaviour of this type. We worked collaboratively with the Working Party on Sexual Misconduct in Surgery and other stakeholders to improve the reporting structures in the NHS and were delighted when NHS England introduced an anonymous reporting system in October last year.

Recently, the Addressing Conflict in Teams course has been developed to teach people the skills to challenge poor behaviour in the workplace. This one-day interactive session can be commissioned and delivered locally (more information can be found at rcsed.ac.uk/education-exams/courses).

It is always hard to determine the impact of such campaigns. What we do know is campaigns such as this have helped publicise the impact of poor conduct on patient care. And while surgical culture will take a long time to change, it is an important step in the right direction, and one our College is proud to be at the forefront of.

Reference

1. Rosenstein A, O’Daniel M. A survey of the impact of disruptive behaviors and communication defects on patient safety. Jt Comm J Qual Patient Saf. 2008; 34(8): 464–71.