Remaining compassionate under pressure

The key duties of doctors, physician associates (PAs) and anaesthesia associates (AAs) include treating people with respect and helping to create a working environment that is compassionate, supportive and fair. Where everyone feels safe to ask questions, talk about errors and raise concerns.

We recognise that in a stressful environment, compounded by workforce and capacity pressures, professional behaviours may not be front of mind. It may not be the intention of staff to be rude to colleagues or act unprofessionally. However, the impact of this behaviour and the negative culture that can become entrenched as a result, can be significant.

How to remain compassionate in pressurised settings

To prevent the normalisation of incivility or unprofessional behaviour, look to embed systems and processes within your team that encourage openness and relationship building. 

Huddles

Huddles can be an effective way of improving teamworking:

• The Royal College of Obstetricians and Gynaecologists have designed the team of the shift intervention to standardise a huddle at the start of every shift, prior to clinical handover.
• NHS England explain in their clinical and operational improvement guide on theatres, surgery and perioperative care, that huddles can improve communication and allow for clear definition of the roles within the team. They’ve produced a blog demonstrating the positive impact of implementing huddles in maternity units

Using first names

• Sponsored by Health Education England, NHS England and NHS Improvement, Capital Midwife produced a Civility toolkit. It focuses on embedding kindness and civility in maternity units and tackling unprofessional behaviours. While targeted towards midwives, it includes ideas about multidisciplinary working for doctors. One idea suggested by the toolkit includes consultants using their first names at work to flatten hierarchies and improve communication.

Organising shared social activities

• The Caring for doctors, Caring for patients report sets out a range of suggestions and case studies focused on team working. While they’re not specific to maternity settings, there are elements of these that could be transferred into maternity wards. For example, organising social interactions like shared coffee breaks, meals and celebrations.

Hot debriefs

• The Obstetric Anaesthetists Association provide recommendations for debriefing. This includes ‘hot debriefs’, which take place immediately after an event. It includes ensuring that staff understand what occurred, that they’re able to ask any questions and to make sure they feel able to continue working.

Schwartz rounds

• Organise a Schwartz Round to provide a forum in which all staff, clinical and non-clinical, come together to discuss the emotional and social aspects of their work.