The hospital programme that allows staff to safely report poor behaviour

“There is a high prevalence of bullying, harassment and discrimination particularly among medical trainees. This can impact on individual performance and safe care of patients, leading to poor diagnosis, less vigilance and poor communications,” says Prof Johnanna Westbrook from Macquarie University in Australia.

Prof Westbrook was in Dublin recently to speak at a medical professionalism conference about a programme in several Australian hospitals to deal with bullying, harassment and discrimination. She argues that when such bad behaviour exists, it can stop medical teams sharing information. “You end up using your mental energy, asking yourself why that person is being rude or thinking about how you’ll get back at the person later in the day. Such ruminating is okay if clinical practice is going well, but when it’s more complicated, you have less working memory to co-ordinate tasks and perform well.”

Prof Westbrook cited an American study that found surgical teams with a higher number of co-worker complaints had higher rates of surgical complications. “We wanted to create a psychologically safe environment so people could speak up in the moment, which is the most effective way to deal with these behaviours.”

The so-called Ethos programme also has a reporting system where staff can safely report poor behaviour (the system also allows staff to report good behaviour) and an accountability pathway where everyone is aware what happened and knows what to expect. All hospital staff, from caterers and cleaners to medical staff, are included in the programme.

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An evaluation of the programme a few years after its introduction found there was a 24 per cent reduction in bullying and 32 per cent reduction in physical and sexual assaults. “We found that there was an increased awareness of unprofessional behaviour via formal and informal communication, and staff training meant that people were more able to speak up.” Prof Westbrook added that when peer messengers were trained to speak informally with colleagues about poor professional behaviour, further reporting wasn’t necessary for 70 per cent of these clinicians.

Prof Colin West, the director of a programme on physician wellbeing at the Mayo Clinic in the United States, spoke about the consequences of burnout at the conference organised by the Royal College of Surgeons of Ireland (RCSI).

“Burnout is not accounted for in any institutional costs, yet, in the US, we are spending the equivalent of €40,000 a year per physician. Burnout results in medical errors, reduced patient satisfaction, reduced working hours/staff turnover, depression and suicidal ideation, motorcar accidents and near misses,” he explained.

Prof West was emphatic that burnout was a systems problem, not an individual problem. “Burnout is draining our healthcare systems right across the world. It’s a public health crisis in the US. It’s not rooted in individual deficiencies. We are putting doctors in environments that are causing damage.

“When overwork is embedded in the system, it’s a recipe for distress and becomes abusive. We need to fix the workplace, not the workers.”

Prof West argued that the solution was not to have mandatory stress management seminars on a Saturday morning (which leads to cynicism) but to engage workers in finding the solutions that work best for them. “When you reduce the working hours of doctors, they are not just less exhausted, they engage better with patients on their next shift.”

Prof Pat Dolan from the University of Galway, who also spoke at the conference entitled Professionalism: the Cost of Caring, argued that empathy education should be a compulsory part of healthcare training. “It’s as important as ethics and good practice. Ethics is about what you have to do but empathy is about what you should do,” he argued.

The RCSI conference was chaired by Prof Denis Harkin, consultant vascular surgeon at the Bon Secours Hospital, Dublin who heads up the centre for professionalism in medicine and health science at RCSI. “Everything from passive-aggressive behaviour right up to verbal/physical abuse and sexual misconduct are rife in the healthcare settings and we must find ways to address them,” he said.