Health Service Focus

06.03.20

Tackling toxic tribalism in the healthcare service

Richard Peachey, HPMA Regional Committee Member and Employee Relations Consultant, CMP

It’s not surprising that relationships within groups of senior hospital doctors and consultants can become fractious. The levels of pressure and stress combined with a sense of seniority - they’ve earned the right to be listened to - make for frank, sometimes undiplomatic conversations.

Relationship breakdowns between clinical teams can have serious implications for patient care, management and the running of entire organisational operations. Last year, complex heart operations were moved out of London’s St George’s Hospital due to an above average death rate. Care Quality Commission inspectors found a “toxic” culture where surgeons with strong personalities had become unable to work together effectively. There was tribalism among groups of consultants, cardiologists, anaesthetists and senior leaders, who’d begun to mistrust each other.

The quality of conversations is the problem. It’s an essential issue highlighted by the Civility Saves Lives charity, set up by healthcare professionals to emphasise how rudeness in clinical situations leads to errors, stress and lower levels of care.

There’s nothing wrong with ‘difficult’ conversations, with an honesty that clears the air and provides a basis for moving forward. But those kinds of conversations

require a particular set of skills. Often there’s an assumption that the most senior staff, so obviously possessing the highest levels of technical expertise and intelligence, will have people skills and a limitless stock of maturity by default.

Our experience of workplace relationships, across NHS bodies, emergency services, local authorities and Government departments, has shown the importance of developing ‘Conversational Intelligence’ for all levels of staff. In terms of dealing with divisions between specialist areas, among the kind of people that will identify more with their peers than their employer, there is evidence of the value of group mediation.

Government policy for change and the restructuring at one primary care trust, for example, was creating a climate of uncertainty and stress across the organisation. A review was conducted of the relationship between management and trade union representatives, which appeared to have suffered a breakdown in partnership working. Formal meetings had been fraught and tense, leaving participants feeling angry and under attack and relationships between both sides were starting to collapse.

Group mediation was introduced: a process that typically begins with private talks with each member of staff to build rapport and

identify the issues from their individual perspectives. Small group mediations are carried out over a number of weeks before the mediator brings the team together to rebuild trust and working relationships. People feel able to be frank about their views and feel listened to, and for effective ways forward to be mapped out in terms of specific and measurable agreements. The process serves to dispel some of the myths and misunderstandings that have grown into a tangle, defusing people’s negative emotions and finding ways for people to relate more effectively.

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