In 54 out of 100 reviews, there were concerns reported about inappropriate individual behaviour or a lack of respect between individuals and within teams. Our experience is that this detrimental behaviour can have an impact on the standard of surgical care being provided.
Surgeons in difficulty can be dismissive of the concerns that are raised about them – their immediate response will often be to confront the individual or organisation making such assertions, rather than providing reassurance about the quality of their care. They do not readily accept feedback and can become increasingly entrenched in their position. They become ‘difficult to manage’, ‘controlling’, or ‘arrogant’ in their approach.
An individual under pressure can also become isolated within their surgical team. They respond defensively to concerns. It may become hard to source data that is needed to make judgements about the quality of the individual’s surgical outcomes.
Strengths turn to weaknesses
Without appropriate reflective practice, some of the qualities an individual will have relied on to become a highly-trained autonomous surgical professional – for example strong, independent decision-making – can be magnified and manifest themselves in personality traits that create a negative atmosphere.
Individuals may become dismissive of other healthcare professionals. Behaviour can become highly variable, and range from being compliant and non-confrontational to being aggressive and demanding.
Reluctance to accept responsibility for complications
Individuals may be reluctant to accept and deal with complications in their surgical practice, and may attempt to explain these complications away without acknowledging their significance. A tendency to blame others emerges and relationships with other colleagues are affected.
Problems with wider working relationships
In scenarios where an individual's work is under scrutiny, maintaining appropriately professional relationships is far more testing and frustrations develop. Colleagues believe that they are ‘carrying’ their team member and that this is affecting the outcomes and overall reputation of the surgical team. Confidence is lost in the individual, leading to a deterioration in other important aspects of teamwork.
Individuals under pressure can often behave in ways that are inappropriate for a ‘normal’ working environment. The manifestation of this behaviour can take an enormous amount of time to manage and address. Moreover, it has the potential to compromise the quality of patient care.
Insight, self-awareness and willingness to change
The insight an individual surgeon has into the strengths and weaknesses of their surgical practice, and the impact of their behaviour on people around them, is central to whether concerns about performance can be resolved.
Individuals who have concerns raised about them can demonstrate little self-awareness or appreciation of the significance of the situation or the seriousness of the concerns. They can be unwilling or unable to accept challenge and criticism of their performance. They find it extremely difficult to be dispassionate about their circumstances and see them from the perspective of those affected, or to be able to adapt their position and see the situation from the point of view of an objective, neutral observer.
Developing insight, self-awareness and a willingness to change are crucial to an individual’s ability to maintain good surgical practice and display appropriate standards of individual behaviour.
Concerns about poor individual behaviour need to be addressed in a timely way and resolved before they affect the safety of surgical care.