Britain’s Oldest Surgical Royal College Demands Safer Work Environment

Britain's oldest surgical Royal College has today published a number of critical recommendations to government to greatly improve safety in the delivery of surgical treatment and patient care, with seven simple recommendations for best practice.

The Royal College of Surgeons of Edinburgh (www.rcsed.ac.uk) surveyed opinions from a cross-section of the UK surgical workforce; from trainees to consultants; which highlighted broad inefficiencies on the frontline which impact the working environment and the delivery of a safe service.

The damning report notes factors adversely affecting morale include a lack of team structure, poor communication, high stress levels and limited training opportunities. The report also records staff, at times, feel diverted away from the patient-centred care they strive to deliver because of administrative and IT issues, and believe that being more innovative and efficient with existing resources could make a positive difference.

And while there is no doubt the NHS needs more funding, the report indicates improvements can be made by changing how funding is allocated. This view is supported by the chief inspector of hospitals in England, Professor Sir Mike Richards, who recently told BBC Radio 4’s Today programme there were more cost-effective ways of running the NHS, such as ending the use of what he called ‘very expensive’ agency nurses. Another example is illustrated by a recent study, supported by the RCSEd, which found the introduction of a ‘mini operating theatre’ allowed trauma patients requiring plastic surgery to avoid being cancelled from the main trauma theatre. The minor theatre could also be run at 75% less cost than a full-service operating theatre.

The RCSEd advocates a combination of simple steps that would have a cumulative effect for the better. The recommendations include re-establishing the traditional team structure; reintroducing a communal area, such as the hospital mess; supporting the extended surgical team; maximising training during daylight hours; minimising use of shift systems; providing rotas six to eight weeks in advance; providing recognition and job-planning for trainers; providing a better title for ‘junior doctors'.

While the College cannot implement these changes itself, these recommendations are being made broadly to the wider profession and lobbied at a political level, along with other medical organisations and colleges and key stakeholders in healthcare, with the objective of protecting the health and lives of the surgical workforce and its patients.

RCSEd president and consultant general and colorectal surgeon Professor Michael Lavelle-Jones, said:

“While the issues facing the NHS are broad and complex, we should not lose sight of the fact that strain within the system ultimately has an impact upon individual lives. As a College, we have been deeply saddened and concerned in recent years by the deaths of several doctors in training, in circumstances believed to be associated with work-based stress or tiredness. This report offers a snapshot into what a cross-section of UK healthcare profession thinks is lacking from their working environment. It is the College’s responsibility to represent the views and offer potential solutions to the wider profession and to the government.”

The report’s co-authors Mr Simon Paterson-Brown and Mr Richard McGregor, said:

“With the immense financial strain and staffing problems facing the NHS it is essential we look seriously at how we can improve the whole working environment for all those delivering front line surgical care. This is a team effort and action needs to involve everyone in the team. While lack of additional resources is clearly one of the problems, it is also about much better use of current resources and changing how we do things to become more efficient and more productive.”

The report, entitled Improving the working environment for safe surgical care, is being issued to General Medical Council, Care Quality Commission and NHS organisations and makes the following seven recommendations:

1. Establish structured senior support

This can be done by re-establishing the team structure with consultants at the forefront of the delivery of care. Time should be made for safe handovers and structured ward rounds, utilising every opportunity to train. Finally, opportunities should be identified each day when Foundation Doctors and Core Trainees can contact seniors to discuss problems.

1. Reintroduce the hospital mess

It is important for doctors to have a protective environment in which they can unburden themselves and socialise with colleagues across the specialties. A hospital mess reduces staff isolation and enhances a sense of community within the working environment.

1. Intelligent design of rotas

Continuity of patient care, safety and a symbiosis between service and training must be integral to

rota design.

1. Streamline and reorganise the overall workload to prioritise core clinical duties and create an integrated multidisciplinary surgical team

Systems and staff (medical and non-medical) could be organised more efficiently to allow doctors to dedicate the maximum amount of time to the clinical responsibilities most relevant to their grade. Where appropriate, consideration should be given to developing the extended surgical team to enhance the continuity and delivery of safe surgical care.

1. Recognise that better training delivers better care

Educational supervisors must be supported to deliver training through protected time in job plans.

But training can also benefit from the merging of tiers within training and maximised training opportunities during the day. It is also important to use training to develop and invest in the multi-professional workforce.

1. Promote human factors training

The profession must embrace a safety-centred team approach from the early stages of medical training.

1. Support and Training the Trainers

Trainers should be supported to plan, manage and focus on training at a local level, while having the opportunity to develop their faculty through formal activities such as ‘Training the Trainers’ courses and informal activities such as developing enhanced mentorship programmes for trainees and consultants alike.