Intended for healthcare professionals

Opinion Dissecting Health

Scarlett McNally: Small changes for better use of time and teams

BMJ 2024; 385 doi: (Published 10 April 2024) Cite this as: BMJ 2024;385:q812
  1. Scarlett McNally, professor
  1. Eastbourne
  1. scarlettmcnally{at}
    Follow Scarlett on X @scarlettmcnally

At the start of the year I made a few small changes that have transformed my quality of life. Alongside doing Dry January,1 I bought myself an alarm clock. Now, instead of my phone waking me up it stays on the other side of my bedroom. I no longer waste hours every week crafting tweets, scrolling, or checking information online before starting my day. It feels as though the sensible me is looking after my impetuous self. We assume that we’re rational beings, but we’re not. We’re all both logical and emotional.

So, how does this apply to healthcare? Patients and staff are human, and change is tough—but small changes can make a big difference to our habits and behaviours. Changing behaviours can improve our own health and the care we provide in the NHS. We talk about working as a team, but we often work in silos. Poor behaviours are woefully common. In the recent NHS staff survey 28% of over 700 000 respondents said that they’d been bullied by a manager or other colleague in the past year.2 The Royal College of Surgeons of England, in a report about invited reviews of surgeons or surgical departments, found that 76% of reviews highlighted poor teamwork.3 When I was on the college’s council we launched guides about team working4 and how to deal with disruptive behaviour5—but nobody realised that they were there as a guide to changing behaviours.

NHS staff have little time for workshops or away days to learn about good teamwork, communication, and behaviours. But some more “bite sized” solutions are available. For example, the Royal College of Obstetricians and Gynaecologists has a “teach or treat” initiative to encourage discussion of each critical decision about a patient, as an educational moment across professions.6 The Academy of Medical Royal Colleges has information about sharing skills and meeting as a team.7 The Centre for Perioperative Care has guidelines on holding team briefs8 before any session of interventional procedures, including radiology, cardiology, and surgery. Making these small changes in our teams opens up communication and encourages cooperation.

The introduction of “perioperative care coordinators” in the NHS in England is a new opportunity.9 Any staff in relevant specialties should find their local coordinator and talk to them about practical changes that the patient and healthcare team can make to streamline care for people having operations. Patients must be at the centre of the team, and I’ve written before about the importance of shared decision making.1011 For any critical decision the patient should be empowered to discuss the benefits, risks, alternatives, and no treatment (BRAN) options. Patients bring their own values, ideas, challenges, and commitment to the plan, which promotes autonomy and improves their care.

Gimmicks such as Dry January and getting an alarm clock can help us break habits and make better choices for our health. Although it worked for me, making a change isn’t always easy, but it’s important that we try. The World Health Organization describes how “point of decision” prompts, tips, or opportunities12 are valuable in promoting behaviour change. But behaviours are rooted in cultures and expectations, reinforced by advertising and our financial, physical, and social environment.

Comprehensive change to behaviours and norms needs bold messaging, community involvement, policies, enforcement, and encouragement.12 Changing behaviour, for good team working and better health, should be celebrated.


  • Scarlett McNally is a consultant orthopaedic surgeon, deputy director of the Centre for Perioperative Care, president of the Medical Women’s Federation, and a previous council member of the Royal College of Surgeons of England (2011-21).

  • Provenance and peer review: Commissioned; not externally peer reviewed.