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Bullying, Bias and Behaviours

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Bullying, Bias and Behaviours Strategies to tackle unconscious bias in surgery Mrs Scarlett McNally BSc MB BChir FRCS(Tr&Orth) MA MBA FAcadMEd Consultant Orthopaedic Surgeon, Eastbourne D.G.H. Council member, Royal College of Surgeons of England I have no conflict of interest £0 Unconscious bias • Is normal • We all instantly form judgements • We must force ourselves to look beyond them • Don’t say the first thing that comes into your head Who has unconscious bias? • You • Surgeons in training • Nurses • Other staff • Patients • Students Other effects of unconscious bias Success their work and failure luck (if similar) Attribution bias Success is luck and failure their fault (if different) Confirmation bias We expect. We seek info to confirm. Comparison bias When comparing, we exaggerate the differences. Source bias We challenge less if one source. Benevolent bias We try to protect, by not exposing to challenge. Halo – horns bias One characteristic colours our judgement. Primacy, Recency and Impact bias First time / major embarrassment easier to recall. Status Quo bias Desire to not ‘rock the boat’ Bias Blind spot Can’t see defects in our own decision-making Stereotyping Apply group stereotypes to an INVIDIVUAL Why? • How we behave as a result of Bias can be interpreted as Bullying • How we select… Unfairness? • How we de-motivate… Lack of diversity? FACTS: • Bullying is how the victim feels • Equality is pretending there is no difference and judging against criteria • Diversity is listening to how an individual needs to be better • Behaviour can be changed How to avoid it? • Think of every action (thought / word / deed / body language): • Listen / Employ / Work with / Give feedback / mentor • Have positive contact with people from other groups • Put yourself in their shoes • Avoid pejorative jokes. Challenge others • Avoid triggers / slow down • Fake it • Smile • Focus on the task • Be clear “The Iceberg of Practice” (Fish & Coles, 2008) • People can’t see: • why you do something • what other alternatives you considered • what you meant • Behaviour change is possible • Re-setting the culture of what is normal is also possible Find out more: www.surgeons.org/respect • Australian surgery has/had bullying problem • 48% surgeons in training had witnessed it • They recommend: “Call it out” • Most alleged perpetrators (Australian surgeons) didn’t realise how they were perceived. Being accused of bullying… • Can be devastating • “The second victim” • Medical Women’s Federation: “the perpetrators of domestic violence need help too” • Often a sub-optimal trainee • Often a stressful environment • Often a trigger Who is most at risk of being accused of bullying? • Is a doctor who qualified when teaching by humiliation was normal • Is very dedicated to patient care • Is very irritated by cases of failure in patient care • Is personally very detailed • Is highly intelligent • Has had plaudits from many trainees • Is poor at coping with below-average trainees or staff • Expects too much of trainees at a junior level • May not have insight into the effects of their actions and behaviours There is a fantastic e-learning package on bullying, 50 minutes on BMJ learning LINK http://learning.bmj.com/learning/module-intro/tackling-bullying-in-medicine.html?moduleId=44 The operating theatre – reduce difficult behaviour Use the team briefing well o Introductions o Explain which ops tricky o Plan who should assist, scrub, etc. for the whole list Get new staff/students to understand the possibilities & expectations: o Be clear – eg where to meet? o Send them the RCS guidance: “learning in operating theatres” Try very hard not to make assumptions. Treat everyone as their role requires. Be polite. Just try. TRAINERS SHOULD: • Be equal in training opportunities • Avoid favouritism • Feedback: • About the TASK/action not the PERSON • Offer strategies to change • Prompt & constructive • Highlight positive • Avoid behaviour that belittles, humiliate, threaten or undermines • Avoid inappropriate behaviours: shouting/swearing/public outbursts about trainees • Make time UNACCEPTABLE BEHAVIOURS • Persistent attempts to belittle and undermine work / undervaluing efforts • Persistent and unjustified criticism and monitoring of work • Intimidating use of discipline or competence procedures • Destructive innuendo and sarcasm / persistent teasing / threats / inappropriate jokes • Withholding necessary information from individual • Freezing out, ignoring or excluding Work • Unreasonable refusal for applications for leave/training style • Setting impossible deadlines/ Undue pressure to produce work • Shifting goalposts / removal responsibilities without telling the individual • Persistent attempts to demoralise individual • Persistent attempts to humiliate individual in front of colleagues • Physical violence / Violence to property • Discrimination based on racial, gender, sexual orientation and disability • Unwelcome sexual advances SAS It is like a party invitation… • Unless you say what the rules are, you can’t penalise them for not adhering • Start time • Expectations • Dress code • Leave policy “It’s another one of your tick-box forms, Scarlett” • Set clear rules • Induction • Write it down Performance management is bureaucratic • Clear person specification • Regular review / appraisal • Clear goals / targets • Multi-source feedback • Team / group to talk things through including management • Everyone should have a friend / mentor • Set up a system • Make time • Collect evidence In 1990s we lived for work = some excuse Now, be the work persona for the 48 hours of work-time In 1996: Emergency procedures: 41% at evenings, nights Many at weekends Now, we have CEPOD lists Why? • FAIR Supporting individuals – to be the best they can be • BUSINESS Less grumpiness / productivity • FUTURE Better workforce – more adaptable Royal College of Obs & Gynae – advice to trainees see Appendix in RCSEng bias Be assertive: Learn from mistakes. Explain what you want the perpetrator to do and why. Talk it over: with someone you can trust. Take no further action: If isolated event, perhaps. Underminer must realise their actions Speak to the perpetrator: If the behaviour happens again: Some undermining isn't deliberate. Arrange a meeting in private and take along a trusted companion. Plan what you're going to say beforehand to explain how their actions made you feel. Stay calm and polite. Afterwards, make a written record. Write it down: Make a note of each episode. Collect any documents that may back this up, especially emails. Evidence and reflection. Speak to a senior colleague: Before pursuing a formal complaint, try talking to a senior colleague. Eg: Educational Supervisor, Clinical Supervisor, College Tutor, Clinical Director, Medical HR, Training Programme Director, Postgraduate Dean. +/- occhealth, the BMA or a Trainees' representative. Extra support can be found through counselling. What if the undermining persists? NUCLEAR OPTION = make a formal complaint in writing with evidence Very destructive and, like resigning, can be done only once. It effectively ends the relationship. The underminer will know this too and will be just as anxious to avoid it. So when am I bullied every day? People not realising they are behaving badly… So where are the rules? Rule 163 Give cyclists as much room as you would when overtaking a car Rule 182 Do not overtake just before you turn left 23 24 Unconscious bias leads to: A lack of diversity Perth, Australia Fellowship Jan 2000 – Jan 2001 [email protected] 27 EXERCISE on www.aomrc.org.uk 1. The Glass Ceiling Morrison, A. M., White, R. P., & Van Velsor, E. (1987) 2. The Glass Cliff Ryan, M. K. & Haslam, S. A. (2005) 3. The opt-out revolution Belkin, L. (2003) Identity Fit Model - traits 30 Trainees who perceived their own and Consultants’ personality traits as similar reported: • higher fit perceptions (r=.54, p<.001). • This in turn predicted higher career ambition (r=.35, p<.001) • and lower burnout at work (r=-.37, p<.001). www.rcseng.ac.uk look in “careers” section JUST KNOW – there is a way We need men and women to support the future… Mentoring: New RCS guide www.rcseng.ac.uk Search “mentoring” This is a simple guide about being a mentor or mentee, basic ground rules https://www.rcseng.ac.uk/library-and- publications/college-publications/docs/gsp-mentoring/ Equality vs. Diversity Equality Diversity Embracing difference; Being equal at the point of asking what else is needed; selection/ exam / how to get the individual to be the best that they can be. Eg if you are their supervisor Behaviour change Is possible 39 Behaviour change strategies • I was lead author for this www.aomrc.org.uk • Exercise at 30 minutes 5x per week reduces risk • breast cancer 25% • Dementia 30% • Hip fracture 50% • Get started, then do more • Know what is stopping you • Make it a habit It is worth making time to talk and to plan The Red Queen in Alice in Wonderland – always running to stay in the same place • We all have unconscious bias • Start by NOT saying the first thing that comes into your head • Start by saying hello and looking welcoming • Try to find common ground • Focus on the task not the individual • Have systems to reduce your stress Start… Thiedeman’s (2008) Seven Steps for defeating bias in the workplace 1. Become mindful of your biases 2. Put your biases through triage 3. Identify the secondary gains of your biases 4. Dissect your biases 5. Identify common kinship groups 6. Shove your biases aside 7. Fake it till you make it (what we say can become what
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