Team relationships
You have a responsibility to respect the skills and contributions brought by colleagues. You will need to work collaboratively with them to care for patients.
Incivility is not just unprofessional and unpleasant, it is a patient safety issue and can have a negative impact on patient outcomes. As set out by Civility Saves Lives, incivility can be anything ranging from rude or unsociable speech or behaviour. Importantly, it is as interpreted by the recipient.
The 2019 Caring for doctors, Caring for patients report highlighted the beneficial effects of compassionate working environments on patient outcomes and on the well-being of those who provide care. Patient safety and satisfaction is better when those providing their care focus on collaboration and teamwork.
Neglect, incivility, blaming and harassment have the opposite effects on patient outcomes.
National inquiries and reviews have repeatedly highlighted issues with team relationships and the impact this can have on patient care and outcomes. Dr Bill Kirkup’s investigation into maternity and neonatal services in East Kent found that a lack of trust and respect between midwives and obstetric staff, and between paediatric and obstetric staff, posed a significant threat to the safety of mothers and their babies.
Ockenden review: summary of findings, conclusions and essential actions
‘All trusts must mandate annual human factor training for all staff working in a maternity setting. This should include the principles of psychological safety and upholding civility in the workplace, ensuring staff are enabled to escalate clinical concerns.’
Issues and tensions within teams can arise for different reasons
- A lack of respect for the contributions made by other members of the multidisciplinary team in maternity settings.
- Entrenched hierarchies within multidisciplinary teams can lead to unprofessional behaviours among colleagues. They can also mean that members of staff feel unable to speak up through fear that voicing their opinions could be taken in the wrong way.
- A perception that members of a multidisciplinary team have ‘different agendas’ (e.g. opinions around clinical interventions for patients) can be damaging and lead to tensions. Disagreements amongst different professionals about how to approach clinical care can lead to decisions and care being delayed, which can result in risks to patient safety.
- Bullying of junior members of staff by senior colleagues.
The impact of a negative team culture can be wide reaching. Patient experience and their trust in those providing their care can be impacted by witnessing colleagues criticising each other. Incivility among colleagues can also have a detrimental impact on anyone witnessing it.
Witnessing incivility may lead other members of staff to think that type of behaviour is normalised in maternity settings. It could also mean they’re afraid about raising concerns or speaking up about patient safety.
You can find case studies from a doctor, a patient advocate about treating people with dignity and respect on the NMC website.
Reading the signals Maternity and neonatal services in East Kent – the Report of the Independent Investigation
‘What we saw and heard was that it was when clinicians were exposed to the behaviour of senior colleagues that their standards began to slip. The influence of role models, those whose positions more junior staff would aspire to fill one day, can be significantly greater than classroom teaching. If those role models themselves display poor behaviours, the potential is there for a negative cycle of declining standards.’
Key Action Area 2 - paragraph 6.14: Standards of clinical behaviour – technical care is not enough
How to improve teamworking
It is essential for good and safe patient care that you work effectively with colleagues from other health and social care disciplines. This includes working within and between teams, as well as working with other healthcare providers.
Whatever the composition of the teams you work in, you need to respect and value each person's skills and contribution. As set out in Good medical practice, in order to develop and maintain effective teamworking and interpersonal relationships:
- you must listen to colleagues
- you must communicate clearly, politely and considerately
- you must treat colleagues with kindness, courtesy and respect
- you must work collaboratively with colleagues and be willing to lead or follow as the circumstances require
- you should be aware of how your behaviour may influence others.
By embodying these values, you’ll be a role model to others and help to create a culture that’s respectful, fair, supportive and compassionate.
If you have a leadership role, consider the potential benefit that doctors and midwives undertaking joint training can have on team collaboration.
Our Professional behaviours and patient safety programme (PBPS) aims to support positive culture change and can be delivered in partnership with the NMC to maternity departments. To find out more about this programme, contact our outreach team.
Tackling discrimination and poor workplace behaviours
Everyone has a responsibility to act if they witness a colleague being bullied or discriminated against. Our racism in the workplace page, while focused on tackling racism, can be applied when tackling any form of discrimination. We provide advice on what to do if you witness it and the importance of active bystander training in healthcare environments.
The Royal College of Obstetricians and Gynaecologists, Royal College of Midwives, Civility Saves Lives and Royal College of Surgeons of Edinburgh have produced a Workplace behaviour toolkit, which includes modules on what to do if you’re responsible for a department that has a problem with bullying or undermining as well as addressing poor workplace behaviours.
