Undermining patient safety

MEDICAL training is not known for its softly-softly approach when it comes to teaching the vital skills needed to make life-or-death decisions. And while a no-nonsense style may be useful in imparting the vast amount of knowledge doctors need, there is a point at which this can develop into something more sinister and altogether less constructive.

Recent research by the General Medical Council revealed thousands of doctors across the UK have been the victim of bullying or undermining behaviour or have witnessed it in their workplace.

The regulator’s 2013 National training survey of over 54,000 doctors in training found more than 13 per cent had been bullied or harassed, almost a fifth (19.5 per cent) had seen someone else being bullied and more than a quarter (26.5 per cent) experienced undermining behaviour from a senior colleague.

These findings support research published in the BMJ in July 2013 which suggests bullying remains a “significant but under-reported problem” in the NHS.

The GMC survey found doctors near the start of their training are much more likely to raise concerns than those in the later stages of training – 8.7 per cent in the first year of foundation training (F1) versus 2.8 per cent in year eight of specialty training (ST8). This was also true of GPs at the start of training compared to those near the end of their programmes.

An obvious consequence of bullying is that it creates an unpleasant work environment but, more importantly, MDDUS is aware of instances where it has had a negative impact on patient care and safety.

A key risk area relates to communication between colleagues.

MDDUS medical adviser Dr Barry Parker says: “If there is a breakdown in communication or bad atmosphere between colleagues then it is likely that open communication about patient care will be adversely affected, damaging continuity and the team approach to care that is so important.”

In addition, research has shown that being the victim of bullying or undermining behaviour can distract medical team members and draw their attention away from crucial tasks, leading to potentially serious errors. This can pose a particular risk in enclosed areas such as operating theatres.

Doctors who do not feel supported at work might also feel less inclined to report and learn from “near misses” or adverse events. Trainee doctors can be particularly vulnerable in such an environment.

Dr Parker adds: “Aggression or rudeness and bullying behaviour can severely impact on their learning and development. Trainee doctors rely on senior colleagues for support and should feel comfortable seeking their advice. They should also be able to look on their senior colleagues as positive role models.

“If they face criticism and are undermined, then this may have an adverse effect on their confidence and performance. It may also make it more difficult for them to seek advice from a senior colleague when this is needed in order to treat patients safely.”

The BMJ research article from July 2013 also found that male staff and staff with disabilities reported higher levels of bullying. Bullying and witnessing bullying were found to be “associated with lower levels of psychological health and job satisfaction, and higher levels of intention to leave work.”

Bullying behaviour also breaches professional standards guidance set out by the GMC and could lead to complaints about a doctor’s fitness to practise.

The BMJ research noted that: “Managers were the most common source of bullying.” But the GMC’s Good Medical Practice guidance makes it clear that all doctors “must work collaboratively with colleagues, respecting their skills and contributions. You must treat colleagues fairly and with respect and must be aware of how your behaviour may influence others within and outside the team.”

The regulator also warns that: “Undermining or bullying behaviour is in total contradiction with these values – it is more than a simple failure to comply. Serious or persistent failure to follow our guidance puts a doctor’s registration at risk.”

It is important that doctors with concerns regarding bullying or harassment seek advice before the problem escalates and has a negative impact on their work. In such cases it can be helpful to discuss the matter with a trusted colleague or an MDDUS adviser.

Equally, individuals who are responsible for bullying or harassment are in need of advice and support as this type of behaviour may be symptomatic of issues such as stress or burnout. Those who exhibit such behaviours should be encouraged to seek help or risk a GMC complaint that could have serious consequences for their professional practice.

MDDUS is very experienced in helping healthcare professionals with health problems that impact upon their fitness to practise. Members with concerns about their behaviour are encouraged to discuss the matter with an MDDUS adviser.

Joanne Curran is an associate editor of GPST