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CSJ THE CLINICAL SERVICES JOURNAL Editor


Louise Frampton louiseframpton@stepcomms.com


Technical Editor Kate Woodhead Business Manager


Dean Walford deanwalford@stepcomms.com


Sales Executive Holly Goldring hollygoldring@stepcomms.com


Journal Administration


Katy Cockle katycockle@stepcomms.com


Design Steven Dillon Publisher


Geoff King geoffking@stepcomms.com


Publishing Director Trevor Moon trevormoon@stepcomms.com


THE CLINICAL SERVICES JOURNAL is published in January, February, March, April, May, June, August, September, October and November by Step Communications Ltd, Step House, North Farm Road, Tunbridge Wells, Kent TN2 3DR, UK. Tel: +44 (0)1892 779999 Fax: +44 (0)1892 616177 Email: info@clinicalservicesjournal.com Web: www.clinicalservicesjournal.com


Civility saves lives


A second survey by the Association for Perioperative Practice (AfPP) has confirmed that bullying remains a major problem within the operating theatre and associated areas. A dedicated feature in the CSJ Operating Theatre Supplement, reveals that a staggering 96% of respondents had witnessed some form of bullying in the operating theatre or perioperative team, with 89% stating they had been a victim of bullying themselves. A shocking 50% of respondents had been shouted at in the operating theatre and 47% of participants had witnessed colleagues being sworn at. There is no place for these behaviours in any workplace but, in the operating theatre, this creates an unsafe environment. Effective teamworking and the ability to raise concerns are critical to patient outcomes. Bullying isn’t always as overt as shouting and swearing, and it isn’t always easy to call out bullies for this reason. It can also include views and opinions being ignored, being overloaded with work, being ignored or excluded, and having information withheld. A culture of fear prevents individuals from speaking up to intervene when colleagues are about to make a mistake. It also leads to increased sickness levels and absence, as well as valuable staff members leaving their roles on a more permanent basis. This impacts theatre lists, skills mix and the efficient running of surgery services. While operating theatres are among the most safety critical areas within the hospital environment, the issue of bullying crosses all sectors of the health service and affects the quality of care delivered to all patients. The Civility Saves Lives campaign


© Step Communications Ltd, 2020 Single copy: £19.00 per issue. Annual journal subscription: UK £114.00 Overseas: £150.00


ISSN No. 1478-5641


The Publisher is unable to take any responsibility for views expressed by contributors. Editorial views are not necessarily shared by the journal. Readers are expressly advised that while the contents of this publication are believed to be accurate, correct and complete, no reliance should be placed upon its contents as being applicable to any particular circumstances. This publication is copyright under the Berne Convention and the International Copyright Convention. All rights reserved, apart from any copying under the UK Copyright Act 1956, part 1, section 7. Multiple copies of the contents of the publication without permission is always illegal.


states: “Almost all excellence in healthcare is dependent on teams, and teams work best when all members feel safe and have a voice. Civility between team members creates that sense of safety and is a key ingredient of great teams. Incivility robs teams of their potential.”


Incivility has been shown to reduce team functioning, clinical decision making and patient outcomes. A number of studies have demonstrated this impact. Riskin et al, for example, conducted an experiment to investigate the impact of rudeness on clinical performance. Twenty-four NICU teams participated in a training simulation involving a preterm infant whose condition acutely deteriorated due to necrotising enterocolitis.


AUGUST 2020


The diagnostic and procedural performance scores were lower for members of teams exposed to rudeness than to members of the control teams. Ultimately, bullying and incivility affect more than just the recipient. It affects everyone – those who witness it and the service users. Surgeons who receive the most complaints against them have been found to have the highest complication rates. (Catron et al, 2016) Research also shows incivility leads to an average 61% in cognitive ability for recipients; bystanders experience a 20% reduction in cognitive ability and are 50% less likely to help others; and there is a 75% reduction in net promoters of the organisation among patients and their families. (Source: Incivility Saves Lives)


A staggering 96% of respondents witnessed some form of bullying in the operating theatre or perioperative team, with 89% stating they had been a victim themselves


Tackling the problem requires effective training, systems to enable safe reporting, support and protection for those affected, and transparency when dealing with bullying or uncivil behaviours. There needs to be training on what ‘civility’ means and why it is important, and staff need to be helped to develop coping mechanisms to deal with stress, which can lead to uncivility, and educated to recognise these behaviours in themselves and others.


Louise Frampton l Editor louiseframpton@stepcomms.com


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