Care Pathways

06.12.18

Inspectors find feuding surgeons’ ‘tribalism’ and culture of hostility at cardiac unit contributed to higher death rate

Inspectors have reported weak leadership, a culture of bullying, and “tribalism” between feuding heart surgeons after a review of a troubled cardiac unit in London.

Hostilities between surgeons at St George’s Hospital became so intense they required mediation when complex heart operations were moved out of the hospital in September after a leaked document revealed a “toxic” row had contributed to a higher than average death rate.

The CQC said that mediation only worked briefly before “poor behaviour” returned, and reported that “strong” personalities were unable to work together effectively.

In their report, the health inspectorate stated that “consultant surgeons mistrusted each other, as well as cardiologists, anaesthetists and senior leaders.”

Staff told inspectors that the cardiac surgical team “had not worked effectively for several years” and described poor working relationships and a “culture of bullying and harassment” as harming the effective running of the unit.

A number of high-risk patients were being diverted to other hospitals, and the CQC also pointed at a culture of not learning from incidents, problematic patient records, and a lack of oversight.

The CQC said the cardiac surgery unit in Tooting must improve, but the trust said the services provided were safe.

An external oversight panel was brought in in September to “deal with the long-standing issues” facing the cardiac surgical services, and the week before a barred heart surgeon at the trust won a High Court battle after being accused of bullying.

England’s chief inspector of hospitals, Professor Ted Baker, said: “Issues such as weak leadership, internal unrest and multiple electronic patient record systems are just some of the problems affecting St George’s Hospital cardiac surgery unit.

“We have told the trust it must now take steps to improve the morale, culture and systems within the unit. Colleagues at NHS Improvement have set up an independent scrutiny panel for cardiac surgery to advise, challenge and support the trust through this difficult time.

“I expect to see improvements at the cardiac surgery unit and CQC will be monitoring the situation closely. We did note that there were no immediate concerns regarding patient safety, which is our paramount concern at all times.”

The report in the summer leaked by former NHS England deputy medical director Mike Bewick showed that the unit had a cardiac surgery death rate of 3.7%, which is above the national average of 2%.

Image credit - John Stillwell/PA Wire/PA Images

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