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Power imbalances are impacting teamworking, GMC warns
Doctors under pressure are being prevented from working effectively in teams by power imbalances and negative hierarchies, a new study published by the General Medical Council (GMC) has found. Continuity, good communication and effective leadership all lead to greater team efficiency and were found to make it much easier to resolve issues, ultimately having a positive impact on patient outcomes. The research, commissioned by the GMC and carried out by Hull York Medical School colleagues at the University of York, explored how doctors and other healthcare professionals work together and across teams, what factors contribute to effective team working and the elements that make it more challenging. Perceived power imbalances and hierarchies, when structures are multi layered, steep and leaders are seen as being out of reach, were identified as major barriers, often leading to ‘intimidating, or often toxic or bullying cultures. The research found this led to team members feeling unable to speak up, resulting in more errors and poor patient care. Researchers found breakdowns in communication between specialisms which, they said, ‘clearly hindered effective teamworking’. High demands on services also played a significant role, with researchers describing the pressure to move patients through systems quickly, leading to stress, burnout and emotional exhaustion. Charlie Massey, Chief Executive of the GMC,
said: “We know healthcare teams across the UK are working under extraordinary pressures
l Effective communication. l Leaders who are understanding and approachable.
l Clearly defined roles and respect for all team members.
l Continuity and experience of those in newer roles.
Barriers included:
l Power imbalances and negative hierarchy, l High service demand and work pressures. l A lack of stability through transitory and rotational roles.
and facing evermore complex challenges. That can inevitably create friction and impact on effective teamworking. That’s why it’s vital every team member, regardless of experience, feels empowered to speak up. “That doesn’t necessarily lie with individuals working within a team. It is a much bigger, cultural picture that all of us in the UK health systems must work harder to nurture and prioritise.” Researchers spoke to doctors, healthcare
professionals and teamwork experts across the UK to understand their experiences of working in healthcare systems. They looked at the type of teams doctors work in and how these can vary by career stage. They also explored factors by organisation, individual, team make-up and workplace environment. These were separated into ‘enablers’ and ‘barriers’ for teamworking. Enablers included:
l Ensuring time and structures are in place to allow teams to meet regularly.
l A positive and supportive culture.
l Poor leadership. l Poor communication. l Lack of identification of roles and needs of the whole team, including Equality, Diversity and Inclusion (ED&I) issues.
The research suggested that employers should focus on nurturing supportive work environments, prioritising the ‘enablers’, as well as strengthening staff development opportunities and following best organisational practices to encourage teamwork. It also said teamwork should be focused on more during medical undergraduate training. Mr Massey continued: “We know open communication leads to better care, that’s why teamwork is so vital. Encouraging these environments where teamwork can flourish can only lead to better outcomes for patients. This research provides invaluable insights into how we can. All of us in the UK’s healthcare systems should take note of these findings and be prepared to act on them.” Visit:
https://tinyurl.com/2h2r7dem
News
Hospital implants novel device for acid reflux using robotic surgery
University Hospital Southampton (UHS) has become the first NHS Trust in the UK to implant a novel device to treat patients with severe acid reflux disease using robotic surgery. Known as gastro-oesophageal reflux disease (GORD), the condition occurs when contents from the stomach flows back into the oesophagus. The innovative device, RefluxStop, is fixed to the upper part of the stomach wall and blocks movement of the lower oesophageal sphincter to hold it in its original, natural position and restore normal anatomy and function. Made out of medical grade rounded solid silicone, the implant measures around 25mm – smaller than a ping pong ball – and is fitted via
robotic-assisted laparoscopic (keyhole) surgery as a day case, with patients in theatre for less than two hours. It is the second site in the UK to implant RefluxStop after Imperial College London, but the first to do so using robotic surgery. The non-active implant is expected to last a lifetime and patients who receive the surgery should see an almost immediate improvement to their symptoms once they have fully recovered from the procedure. Current standard treatments for GORD include a drug therapy called proton pump inhibitors (PPI) and a surgical procedure known as the fundoplication method, but these are not suitable for all patients and some continue to experience symptoms.
Fergus Noble, consultant general and oesophagogastric surgeon at UHS, said: “We are delighted to be the first site in the south to offer this procedure to patients suffering with this chronic and debilitating condition and the first in the UK to implant it using robotic surgery. “GORD can have such a severe impact on a person’s daily life, as not only do they suffer with the physical impact whenever they swallow and eat, but also the psychological impact of living with the condition. RefluxStop is revolutionary in that it is minimally invasive, restores the lower oesophageal valve to its natural position with no side-effects and offers some patients a viable treatment option for the first time.”
l l July 2024 I
www.clinicalservicesjournal.com 9
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