The recent press reports of a 'toxic' atmosphere at St George's hospital in South London are distressing to say the least but unfortunately by no means isolated.
Relations between colleagues in any profession can break down or face difficulties at times. However, healthcare professionals are often a keen focus for criticism in the media and so it's important not only to understand how to prevent unprofessional behaviour in the first place but also how to manage high-performing professionals into cooperative team-working when under pressure.
In over 16 years of working with health and social care professionals across a wide spectrum of disciplines we have encountered far too many instances of uncivil behaviour sometimes directed at us and certainly at fellow team members.
It is worthwhile mentioning that this applies at all levels and specialties and not as some apparently think, doctors alone. Currently we are working with organisations where problems exist within nursing bands. When trying to help teams understand the effects of uncivil behaviour we ask the following:
WHAT DOES IT MEAN TO HUMAN? VS WHAT DOES IT MEAN TO BE PROFESSIONAL?
Here are sample answers, by no means exclusive:
Maintaining high standards of professional behaviour is a major challenge in any high-pressure working environment. We will sometimes fail to get it right because we can not avoid being human.
One clinician sought to excuse his colleagues inappropriate behaviour by saying the surgery (neuro) he performed was very complex, high risk and stressful and that stress had to be vented somewhere; and so in this way he justified the bullying his colleague dished out to theatre teams!
Thankfully, this clinician always behaved impeccably with patients and relatives but there is no excuse for undue criticism or abuse of colleagues.
Why does he think it is an appropriate way to behave?
Does he realise the impact he has on staff feeling that they can speak up in the unlikely (we hope) event of some avoidable error?
How will the added stress of working with someone difficult effect the performance and focus of the rest of the team?
If you look again at the 'What makes a professional' image; what makes him believe that he is practicing in a 'professional' manner?
Everyone has what we refer to as their personal 'stress bucket'.
So in dealing with 'difficult' people, especially as a manager or team leader it can be helpful to consider why they behave this way.
Could they be ill or facing huge personal stress, having a personal crisis? Could they lack insight or skill? Could they believe it to be acceptable because that's what they experienced? Could it be my fault? Winding them up? Could they just be plain awkward?
The first step is to recognise the 'human' elements, treat everyone as an equal with dignity and compassion and by that try to encourage the 'difficult' people into the same behaviour.
This can be easier said than done, especially if you're not in a management position but one of those perhaps at the blunt end of the behaviour.
In those circumstances the simplest advice would be to reframe your response to this behaviour. For inappropriate behaviour such as bullying or intimidation, it is common for individuals to be singled out as the 'victim'.
Therefore sticking together as a team is crucial. It is certain that you are not the only one who has noticed or feel uncomfortable with the behaviour. As a collective it's important to not allow yourselves to become victims but to stand together and respond professionally, politely but firmly.
As a common example if someone refuses to follow a procedure (such a safety checklist, briefing etc) declaring it a waste of time or they know better etc. Together the team needs to take the stance "I'm afraid we will not be going forward with this until this is done."
Regardless of your faith in reporting systems there should be one that enables you to get support from your management, but any reporting with regards to inappropriate behaviour must be evidence based.
REPEATED UNCIVIL BEHAVIOUR
The NHS is notorious for having a culture where professionals are treated effectively like children. If you treat people in such a manner don't be surprised if you get a child-like response.
However if you treat people in an adult manner, as equals, with respect and understanding it is more difficult for them to maintain an unprofessional behaviour pattern.
At the same time it should be made clear that continued unprofessional behaviour and bullying cannot and will not be tolerated. This comes under the heading of duty of care to the rest of the staff. A fundamental management responsibility.
However, we know of a current situation where after evidence of repeated uncivil behaviour, a formal interview was undertaken with an official warning on file.
The staff member has returned to work, but the manager suspects no behaviour change has taken place and is not getting any further evidence from other staff because presumably they feel that nothing has been done and therefore why waste time making reports?
A conundrum indeed because managers cannot publish confidential personal reports for obvious reasons. Here we believe having a cadre of Human Factors Champions in the workplace could help.
They could be the interface in the workplace and offer advice and support to both staff and management.
So we return to a Just Culture - one where genuine human error is treated with understanding but equally failure to follow standard procedure habitually and inappropriate behaviour towards others is simply not on.