Harder realities of ‘soft-skills’ failures

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How important are ‘soft-skills’ for doctors?

Well, there’s general consensus across meetings, conferences and the medical press that the answer is obvious. So let’s ask a different question.

What priority is being given to genuinely improving ‘soft-skills’?

It’s a question worth considering as numerous media reports have a ‘Groundhog-Day-oh-no-not-again!’ feeling about them. We’ve had bullying in the Highlands, a persistent culture of abuse at Whorlton Hall and a study where 74% of medical student reported experiencing ‘teaching by intimidation‘.

Clearly, major transgressions by the key perpetrators are central to these cases. But such events are often compounded by ‘soft-skills’ failures from their leaders and colleagues. For a variety of reasons, when witnessing problematic behaviour, doctors are failing to take effective action. Many don’t even attempt to intervene. Perhaps they feel intimidated by a difficult personality. Perhaps they don’t know how to have the difficult conversations. In some cases, the perpetrators are simply repeating behaviours which are entrenched in the culture. So, it just seems ‘normal’.

Impacts of the failures

The direct impacts of bullying and intimidation of NHS staff members are well documented. Stress, absence and burnout are all too common. Occasionally, such negative experiences can have tragic consequences. The alarm bells ring loudly each time to flag that something must change. Again. And again.

But look further and there is a growing body of evidence of further impact.

If you are a regular reader of Oxford Medical’s Insights then even the title of this blog you are reading might give the Groundhog-Day feeling. In August last year, we shared Hard realities of ‘soft-skills’ failures by doctors. In that piece, we were commenting on the conclusion that ‘toxic bickering’ between groups of doctors led directly to an increased rate of patient deaths from cardiac surgery at St George’s Hospital, London. Poor leadership had compounded the original dysfunctional behaviour.

An isolated case?

Was St George’s an isolated case? Unfortunately, no. The Groundhog-Day feeling was there again last week with news of problems at Morcambe Bay UHT’s urology services. Dysfunctional team behaviour and bullying were directly implicated in a patient’s death. BMJ reported:

The RCS found “a lack of coordinated team approach to delivery of care and unclear lines of consultant responsibility” and, as these issues had not been resolved, a similar incident could occur again. Disagreements in how to treat patients had resulted in consultants refusing to assist one another.”

Exceptional cases?

It’s easy to dismiss these events as being down to a few bad apples. A few underperforming doctors can have a major impact. Yet, on our various courses, our delegates regularly share real experiences where team communication problems have had direct impacts on patient care and staff wellbeing. In addition, our research reveals that many doctors struggle with basic team interaction skills. That’s from their own self-assessment.

That suggests the high profile incidents mentioned are simply the thick end of the wedge.

‘Soft-skills’ can be tough

In our previous blog, mentioned earlier, we questioned if the ‘soft-skills’ label was part of the problem. It sounds a bit nebulous. And how much impact can you have with something that is ‘soft’? Maybe it’s for people who don’t have ‘the right stuff’. But the hard reality is that applying ‘soft-skills’ can be really tough.

It typically takes the bravery and determination of a lone whistle-blower to bring the extreme cases to wider attention. These doctors prioritise doing the right thing over personal concerns or even risk to their career. We commend them for their actions. Once again though, this is at the extreme end of the issue.

For successful, everyday practise, doctors must have a sound knowledge regarding how and why individuals develop into teams. They should also understand how and why teams go wrong and how to effectively deal with issues. They must be capable of getting things done without reverting to bullying or intimidation. The abilities to deal with differences, conflict and to have those difficult conversations when the going gets tough is as important as any other skill. Such skills must be learned, improved and utilised to shape a constructive culture.

Our conversations with organisations indicate they are slowly waking up to the need for doctors to be equipped with these skills. (Their motivation may, in part, be self-protection as patient care as failures can lead to litigation). And doctors must recognise that attention to these abilities is essential for continued professional development and team performance. Good Medical Practice makes this very clear. It’s the only way to break free from the Groundhog-Day cycle.

What steps are you taking to develop your ‘soft-skills’?

Stephen McGuire – Director of Development