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Cultural change
Crossing continental barriers to focus on cultural change in surgery A podcast collaboration between RACS and the Royal College of Surgeons of England Culture change in surgery: it’s a tough and uncomfortable, but important, subject that we must talk about. That’s exactly what Associate Professor Rhea Liang, general and breast surgeon on the Gold Coast and Chair of the Royal Australasian College of Surgeons (RACS) Operating with Respect Education Committee, and Mr Simon Fleming, an orthopaedic Trainee based in London, crossed continental barriers to do. In the first ever podcast collaboration between RACS and the Royal College of Surgeons of England (RCS England), Associate Professor Liang and Mr Fleming combined their knowledge, experience and ongoing work on discrimination, bullying and harassment to produce a four-part podcast series on the theme of culture change in surgery. Surgical News spoke to Mr Fleming and Associate Professor Liang to find how the concept came about. “Simon heads the #HammerItOut campaign, an orthopaedic-led cultural change initiative in the UK, which has now extended to other specialties through related hashtags such as
#CutItOut,” said Associate Professor Liang. “It has obvious similarities with the #OperateWithRespect program run by RACS, and we share information and ideas regularly. “So when Rhea Folkers, Digital Learning Coordinator at RCS England, contacted us about recording a single podcast as part of The Theatre, an ongoing podcast series, which looks at innovation in surgical education, we thought it was a great idea to share experiences from our respective programs,” she said. “As we brainstormed, it became apparent that we would do the topic a disservice if we tried to shoehorn everything into one podcast,” Mr Fleming said. “And so the four-part podcast series around ‘culture change’ was born. It’s a collaboration that we are very proud of, and it feels almost serendipitous, as I will be in Australia in about two years to begin my Fellowship.” The podcast series has been a success, having been listened to almost 2000 times since its launch. The series aims to bring conversations
about bullying, harassment and discrimination in the surgical workplace to the forefront of professional discourse, in the hope of encouraging long-term changes in attitudes and behaviour at all levels.
“There’s that saying, ‘Oh, terrible bedside manner, but they’re a good surgeon.’ And I think we have to challenge that. Because the evidence shows that the competencies that don’t relate to your actual technical ability do affect the outcomes for your patients. So it’s not possible to say that you’re a good surgeon when you have bad bedside manner,” Associate Professor Liang said in the first part of the Culture Change podcast. Mr Fleming and Associate Professor Liang explore, among other issues, the common misconception that behaving respectfully is the same as being nice and non-assertive. “The measure of respect in a team is if you feel safe enough to disagree with and challenge each other,” Associate Professor Liang said in the first episode of the series. “It’s not about being nice and acceding to every request without question.” “Bullying is about power and silence,” agreed Mr Fleming. “Not feeling able to speak up and say something’s wrong is just as disempowering.” How can we attain culture change in surgery? Mr Fleming and Associate Professor Liang have an open discussion about why we need culture change in surgery and what is being done and can be done to achieve it. Their conversation suggests ways that ongoing national and international initiatives to attain culture
