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Departmental and team interventions

This area of the website provides resources to help deal with bullying and undermining at a departmental level, as part of the RCOG/RCM undermining toolkit. The authors of this section are Felicity Ashworth and Sally Burton.


Maternity is well recognised as being a high-pressure specialty, where intense workloads, suboptimal staffing and high levels of litigation exist. Sadly, within this environment, poor communication and dysfunctional team working appear to thrive. Also, inter- and intra-professional rivalries in maternity care between obstetric consultants individually, and between obstetric consultants and midwives generally, are common. Furthermore, sector-wide surveys of trainees consistently report experiences of bullying and undermining within the workplace, supported by anecdotal reports which suggest an endemic culture of bullying among teams in maternity units.

Tackling bullying is a multidisciplinary problem. The ideas in this section of the toolkit are for actions that can be taken within the maternity department, particularly focusing on team working between obstetricians and midwives. The suggestions can then be used in all areas of obstetric and gynaecological practice, particularly in clinics, on ward rounds and in theatre. Interaction with department managers is also important. 

The suggestions include multiple examples of projects developed in a variety of units around the UK to reduce undermining and bullying within teams, with a simple aim of zero tolerance. Although many of the suggestions haven’t yet developed a large evidence base, there is an urgency to our actions: the Illing review highlighted clearly that dysfunctional behaviour is a problem for patient safety and needs action.

All staff must be encouraged to engage in work to reduce undermining and bullying, reduce the hierarchical work environment, learn how to form teams quickly with inclusive leadership and be respectful to each other.



We are keen to continue to develop the undermining toolkit. If you have any additional good practice examples and resources that you think would be useful, please email Sakinah Takeram at


Elsewhere on the site

Resources and support for trainees
Further resources to support specialty trainees in O&G
Resources and support for trainers
Resources to help trainers deliver the specialty training programme in O&G