Perioperative practice
The panel consisted of Oliver Tierney (AfPP President), Lisa Tierney (AfPP Trustee), Maxine Page (Matron for Theatres at Princess Alexandra Hospital), Professor Scarlett McNally (Consultant Orthopaedic Surgeon, East Sussex, and Deputy Director at the Centre for Perioperative Care) and Will Windsor (Deputy Head of Nursing – Theatres, Pre-assessment and Pain Services, at Morriston Hospital). Together, they gave a call to action, inviting delegates to sign up to the AfPP’s Behaviours Charter, in a bid to drive improvement. They explored how toxic behaviours, ranging from low-level gossip to overt bullying, negatively impact patient safety and staff retention. The conversation covered the distinction between necessary directness in high-stress situations and unacceptable rudeness. The panellists emphasised the critical need for support from senior leadership, the power of data collection through incident reporting, and the personal responsibility of every team member to challenge poor behaviour. Professor Scarlett McNally described how
incivility impacts patient care: “People are 20% less likely to volunteer something that might help the patient; some become ‘frozen’; even just witnessing it reduces a person’s ability to do what they need to be doing,” she explained. She went on to highlight some statistics from the Civility Saves Lives website, based on a study by Christine Porath,1
which found that incivility
led to a 61% reduction in cognitive ability; 78% reduced their commitment to work; 48% reduced their time at work; 25% took it out on others; and 12% leave. “Sometimes you think ‘I can take it – I’m a big girl’; then you think about how this incivility might impact a new member of staff or a student. You don’t want them quietly quitting or not coming back – and it’s not just the high-level stuff; it’s the low-level incivility that can get to people. These behaviours create the culture,” she continued.
Will Windsor commented: “I think each of us should feel empowered to say, ‘enough is enough’ and ‘it’s not acceptable’. Even that coffee room talk – the backbiting about other members of staff – it’s not fair and it’s not kind. In a world where we can be anything, we can be kind. We have an immense amount of empathy built within us as human beings. I think we should start using that empathy and talk more.” Oliver Tierney shared a powerful anecdote about a talented, new perioperative practitioner named “Jenny” who left the profession after being reduced to tears and being “verbally eviscerated” by a surgeon, during a complex case, demonstrating the real-world impact on staff retention.
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www.clinicalservicesjournal.com I October 2025
A panel of experts discussed the impact of incivility in operating theatres “It happens all the time,” added Lisa Tierney.
“We lose so many staff because of this kind of behaviour – that toxic atmosphere becomes accepted; people become complacent. They don’t report incidents that they should,” she commented. “All of you must have the moral courage to stand up and challenge, but you also need to have the support from the top.” She urged delegates to callout the ‘Three
B’s’ (Bitching, Backbiting and Bullying), which is outlined in the AfPP’s Behaviours Charter. This includes stopping gossip, sabotage, and bullying, which can corrode team trust. Creating a civil workplace involves zero tolerance for these behaviours and a shared agreement to report and address them when they arise. The panel highlighted the fact that theatre staff continue to accept the behaviour of repeated offenders, who show uncivil behaviour in theatres. The delegates heard how a surgeon’s aggressive and rude behaviour was tolerated because ‘he always said sorry at the end of the list and said thank you’. The behaviour continued and there were even incidents of throwing instruments onto the patient, in this theatre. However, none of the staff reported it or saw it as a patient safeguarding issue. “Sometimes it’s difficult to challenge,”
Professor Scarlett McNally acknowledged. “You need to be quite senior to do that and sometimes you need someone else to deliver the message. You need them to take them aside behind closed doors – a cup of coffee conversation away from what’s happened. We need to educate people to know this is not acceptable.” She highlighted the importance of using the team brief to promote team working. She explained how she uses this opportunity to get the team on side, inviting members of the team to challenge her if they see anything unsafe. During the team brief, she
identifies any concerns she might have about any difficult cases on the list, and in doing so fosters a culture of openness and encourages a sense of being part of a team that tackles and overcomes the challenges together. “There is no excuse to be rude. You can be very focused but not rude. There is a difference… we need to retrain people,” she commented. Oliver Tierney pointed out that the WHO
Checklist can also help ensure the team are fully prepared – using it properly can help to remove unnecessary frustrations in the operating theatre.
Maxine Page observed that civility in the
coffee room is as important as civility in the operating theatre: “The coffee room can be such a toxic environment, with people having bitchy sessions over a sandwich; it filters through… You say one thing, and within an hour everybody knows what was said and it gets back. “Those on the receiving end can be affected
for the rest of the day and potentially even longer. It puts them on edge, they’re not able to concentrate, they’re not able to focus – because their mind is preoccupied about the nasty things that have been said about them. Ultimately, this can affect patient safety,” she commented. She pointed out that this behaviour is much
easier to stamp out as staff have the power to play their part by saying they ‘don’t want to hear it’, when a colleague is sharing gossip or backbiting about a colleague. Maxine Page said that senior theatre staff need to explain why this behaviour can impact patient safety – people don’t always realise how a hurtful remark can impact a colleague and affect their performance.
Will Windsor added: “It’s really important that we bear in mind that none of us know what is going on in someone else’s life. Someone could be going through a really tough time and are
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