Did you catch this alarming story which sneaked through the news over first weekend in August? According to The Times, “Toxic bickering” between groups of doctors has led directly to an increased rate of patient deaths at a London Hospital. The mortality rate for cardiac surgery at St George’s Hospital had been recorded as being almost twice the national average. That’s 3.7% over recent years compared to 2%. Though there may have been several reasonable reasons for this, the output of the review into the situation makes very uncomfortable reading.
The fact that dozens more people have lost their life than would be expected has been attributed to the “tribe-like activity” among surgeons who were divided between “two camps” within a unit that was “poorly led”. In addition, there was “inadequate internal scrutiny of results” with a “defensive approach” to the data on deaths. Apparently there was even “an unsuccessful attempt to solve the problem by bringing in professional mediators to patch up disputes between surgeons.”
The press appear to have been distracted by the Bawa-Garba case and the story seems to have slipped under the radar for many.
What’s gone wrong here?
- Failures in communication
- Failures in the leadership of people
- Failures in the management of reviews and processes
St George’s, which has been in special measures since November 2016, is one of the biggest teaching hospitals in the UK. What are junior doctors learning?
The shortfalls here have been identifiable as they are concentrated with the extremes of a small group in one location. Yet, what about the consequences of the lower level failures which are happening day-in, day-out across the UK. How many poor outcomes and poor patient experiences are caused each day, week, month and year? St George’s cardiac surgery mortality rate is simply the clearest and obvious example.
It’s a hard reality that shortfalls in so-called ‘soft-skills’ have tough consequences.
Here’s a question.
Is ‘Soft-Skills’ the correct term to use?
What does the word ‘soft’ suggest to you? Comfortable? Easy? Vague? Fluffy? Mushy? Weak? Simple? Maybe an opposite of being firm, clear, strict, robust or strong? It hardly suggests something scientific or evidence based. Why bother with the ‘soft’ stuff when you can concentrate on the hard and the tangible? Is it just another box-ticking area for training programmes, appraisal and revalidation?
St George’s problems shine a bright light on the need for doctors to go beyond the natural sciences, physical sciences and physical dexterity in their development. The so-called ‘soft-skills’ sit within the discipline of social science.
The instincts that lead to tribal behaviour along with its consequences are well understood by those who have taken the time to learn about psychology. Doctors who have explored team development and the human reactions to being subject to review will also have a grasp on the reasons for warring factions adopting a common defensive mindset to criticism. Those who have honed their team communication and leadership skills will be much better equipped to play a constructive role in addressing the issues.
To quote Amanda Stanford, Deputy Chief Inspector of Hospitals at the Care Quality Commission, there is “the need to create a culture where all staff are enable to challenge poor practice.”
A new ‘Them’ and ‘Us’ challenge?
Doctors are increasingly being expected to work with professionals who have a career based on the social sciences: social-care professionals. If true integration between health and social care is to be achieved between health and social care then it will require all involved to manage the tribal instincts of ‘them’ and ‘us’ that run deep within all.
What steps are you taking to hone your social scientific skills as a doctor?
Stephen McGuire – Head of Development