This is one of the recommendations from the ‘strategic’ section of the RCOG/RCM undermining toolkit.
Routine data collection and data monitoring
Organisations should consider proactive monitoring of data to identify patterns and outliers to help target interventions. There is already ample data to identify organisations and individual units within those organisations where bullying and undermining is a significant issue. These include:
- NHS staff survey
- GMC survey
- Surveys by regional training committees (see below for an example from Yorkshire and the Humber)
- RCOG Trainee Evaluation Form
- Feedback from monitoring of undergraduate, medical, nursing and midwifery staff
Surveys raise awareness. They give a clear indication that the organisation carrying out the survey is interested in and concerned about the issues.
Survey responses allow organisations and leaders to better understand workplace issues and inappropriate behaviours. Some surveys show that bullying of consultants, qualified midwives, nurses and other non-trainees is often as common as among trainees. We have some notable examples of this already – see below for one account.
Strategic use of this data by the General Medical Council (GMC), medical royal colleges, deaneries/Local Education Training Boards (LETBs) and the wider NHS will influence change. Work in this area includes check visits by the GMC, follow-up of the GMC survey in schools and deaneries and monitoring placement activity by LETBs.
The RCOG is developing a new Trainee Evaluation Form, which all trainees will complete. The form will provide anonymous feedback about undermining from all departments. This will provide even better data, but more important is the subsequent action to identify and address key issues.
The RCM could consider wider use of surveys, particularly with undergraduates, to identify maternity units where a poor midwifery culture is prevalent.
Tackling bullying, harassment and undermining in Yorkshire and the Humber
Below is an account of how Yorkshire and the Humber used a survey to identify and address workplace behaviour issues.
‘In the last 18 months we have undertaken a detailed survey of trainees’ experience of bullying, harassment and undermining in O&G within the region throughout their career. This involved:
- Obtaining their views on what they perceived constituted such behaviours. For example, they were asked if they agreed or disagreed that a statement describing an action(s) or behaviour constituted bullying/undermining; this included asking about feedback during workplace-based assessments.
- They were then asked if they had ever experienced any of the behaviours and what they did about it if they had.
- We also asked questions about what action they took if they felt they had suffered from bullying/undermining and why they chose to report it or not. We also asked what happened if they took any action.
- Finally, we asked trainees for suggestions on how to improve the situation.
We performed a similar survey in one large unit in the region for consultants in O&G. This included an additional question about whether they had ever been accused of bullying/undermining and what happened.
The results of each survey acted as a stimulus for departments to discuss these issues and make suggestions on how to improve the situation in each unit. Local teaching sessions were used to disseminate the results and highlight possible suggestions for improvements. Multi-disciplinary attendance was encouraged.
The trainees’ suggestions on how to improve the situation were used as the basis for developing strategies aimed at changing the culture, especially on labour wards. These included:
- More multi-disciplinary team training incorporating human factors. The MOSES course run in South Yorkshire is a good example of multi-disciplinary team training where senior and junior obstetricians, anaesthetists and midwives come together to deal with rare obstetric emergencies. Most of the day is spent focusing on how the team interacts with each other during the emergency rather than skills or medical knowledge.
- Raising awareness that there is a problem by talking openly about it. It was hoped that the presentations and discussions in teaching sessions would act as a starting point for this.
- Focusing on everyone’s behaviour and not stereotyping ‘bullies’ and ‘victims’, encouraging the use of reflective practice and also using other methods such as the ‘Johari window’ to help focus on your own behaviour (this was included in the presentations).
We also wrote a report on the findings from the survey and the suggestions made, which was made available on the homepage of the School of O&G’s website.’