Recommendations for the delivery of safer surgery

The National Health Service is currently traversing some of the most challenging times since its inception. The King’s Fund Quarterly Monitoring Report for November 2016 highlighted the persisting struggle the emergency services are facing. Patients waiting more than four hours from arrival to discharge in accident and emergency (A&E) peaked at its highest level since 2003/2004. Compared to the same quarter in 2015, A&E attendances were up 5%.1 Coupled with strained finances and £2.45 billion overspend by NHS Providers in England in 2015/20161 the trajectory the service is hurtling towards appears somewhat off course. 

Workforce dissatisfaction and burnout are terms that are now common parlance on the front line. Taking one example, only 50.4% of foundation doctors progressed to specialty training posts in 2016 – a dramatic decline over the last four years.2,3 This should be sending alarm bells ringing in the Department of Health, as not only does this have huge implications for workforce planning, but perhaps more crucially, intimates a deeper problem with postgraduate medical education. Surgery held the accolade of having the lowest satisfaction scores across all medical specialities in the General Medical Council (GMC) National Training survey for 2014.2 Since then, scores have not altered dramatically and the profession still has a long way to go to improve its image. A recent study reported that “good working conditions” came top of the list of what UK doctors’ value in a post – far surpassing financial reward – indicating the solutions to improving the working environment in which we train, work, and learn may hold the key to recruitment and retention of staff.4 Indeed, a recent focus by The Royal College of Surgeons of Edinburgh (RCSEd) has been to highlight ongoing concerns around the level of undermining and bullying within the surgical profession, which can impact negatively on a trainee’s confidence. Disruptive behaviour has been shown to have a negative impact on cognitive function, not only of the recipient, but also the witnesses to the behaviour. Impaired cognitive function within a surgical team during an operation will undoubtedly have implications on the level of care the patient receives.5,6 Some literature suggests as many as 21% of deaths and 67% of adverse events in hospital are related to disruptive behaviours.7 RCSEd has initiated the #LetsRemoveIt campaign whose aim is to change the culture as well as offering support and resources for those affected by bullying, undermining and harassment. 

The RCSEd are leading the way on tackling some of the issues faced by the profession through initiatives such as the Non-Technical Skills for Surgeons (NOTSS) programme which aims to improve surgical performance by focusing upon human factors training. In addition, the Faculty of Surgical Trainers has recently published guidance which focuses on the support and recognition of trainers.