Intended for healthcare professionals


Tackling bullying and undermining in the NHS

BMJ 2019; 365 doi: (Published 09 April 2019) Cite this as: BMJ 2019;365:l1667

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I launched an anti-bullying campaign to change culture in healthcare

  1. Abi Rimmer
  1. The BMJ

Two recent conferences highlighted an issue affecting doctors at all stages of their career, reports Abi Rimmer

At its annual conference on 3 April the General Medical Council (GMC) announced that it was piloting a training scheme designed to help doctors call out unprofessional behaviour by colleagues.1

The training will initially be delivered at about 14 sites around the UK, identified by the GMC as organisations that may benefit from the training.

Speaking at the conference, Jo Wren, a principal regional liaison adviser, said that the training was developed after doctors told the regulator that they often struggled to challenge colleagues’ poor behaviour. The aim was to tackle more of these issues before they required regulatory intervention, she said.

The training is partially based on work by researchers from Vanderbilt University School of Medicine in Tennessee, USA,2 [3] which suggested that doctors can challenge unprofessional behaviour through “cup of coffee” conversations, said Wren.

She explained, “If you see a single unprofessional incident and have a cup of coffee conversation about it—so you say to someone, ‘We saw this thing happen, we just need you to be aware of it, go away and reflect on it’—that can have a huge impact and can see that behaviour either being stopped or toned down going forward.”

Opening the conference, Clare Marx, GMC chair, highlighted the importance of good clinical leadership in tackling unprofessional behaviours. She said that the regulator wanted to take a more active role in helping doctors to maintain and improve standards.

“A big part of that is the development of leadership skills and crucially tackling unprofessional behaviour towards colleagues: anything from basic rudeness to outright bullying and undermining,” she said. “It is a constant theme of successive health inquiries and a constant in the responses we hear from doctors when we ask them what prevents them from doing their jobs as well as they would wish.”

Taking part in a panel discussion at the conference, Saffron Cordery, deputy chief executive of NHS Providers, said that the behaviour of an organisation’s leaders can dictate its culture. “If we have leaders who display bullying characteristics then it is unsurprising that we will see bullying throughout an organisation,” she said. “If we have kind and compassionate leaders—this isn’t rocket science—then we will have cultures that emulate that.”

Freedom to speak up

This theme was echoed at the Royal College Surgeons of Edinburgh and the Royal College of Obstetricians and Gynaecologists’ joint meeting on tackling undermining and bullying in the NHS, held in London on 4 April.

Speaking at the event, Catherine Calderwood, chief medical officer for Scotland, placed the emphasis on the importance of good team working to improve patient safety.

“If 5% more of our staff worked in true teams we would reduce mortality by 3.3%—[for] an average district general hospital, around 40 deaths a year,” she said. “It’s a magic bullet, one that we don’t necessarily know about.”[4]

She later added that, every time she had been involved in an unresolved patient safety issue at an organisation, “there are poor relationships and poor behaviours in that department.”

She said that she had spoken to the GMC about the fact that doctors’ behaviours and attitudes were not seen as a medical negligence issue for fitness to practise panels. “I think that [doctors’] behaviours, values, attitudes, and the way that their team works should be as important as people’s technical skills,” said Calderwood.

Henrietta Hughes, national guardian for the NHS, also spoke at the event about the work of “freedom to speak up” guardians, which all NHS trusts and foundation trusts are required to have.

She said that over 7000 issues had been raised with guardians in 2017-18. Almost half of these contained an element of bullying and harassment, and a third contained a patient safety issue.[5] “What I think is clear is that you can’t always separate these things: it’s not always cut and dried,” said Hughes.

At the close of the conference David Riding, chair of the Royal College Surgeons of Edinburgh’s trainees committee, announced the publication of a document put together by the alliance against bullying, undermining, and harassment in the NHS. It gives an overview of some of the many initiatives being enacted throughout healthcare professions to tackle undermining and bullying.[6]