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  • The Royal College of Surgeons of Edinburgh: Improving the working environment for safe surgical care (2017)

    Patient Safety Learning
    • UK
    • Reports and articles
    • Pre-existing
    • Original author
    • No
    • The Royal College of Surgeons of Edinburgh
    • Health and care staff, Patient safety leads


    In July 2017, the Royal College of Surgeons of Edinburgh published a number of critical recommendations to government to greatly improve safety in the delivery of surgical treatment and patient care, with seven recommendations for best practice.

    The RCSEd surveyed opinions from a cross-section of the UK surgical workforce - from trainees to consultants - which highlighted broad inefficiencies on the frontline which impact the working environment and the delivery of a safe service.

    The report notes factors adversely affecting morale, including a lack of team structure, poor communication, high stress levels, and limited training opportunities. The report also records how staff, at times, feel diverted away from the patient-centred care they strive to deliver because of administrative and IT issues, and believe that being more innovative and efficient with existing resources could make a positive difference.


    This report being issued to the General Medical Council, Care Quality Commission and NHS organisations and makes the following seven recommendations:

    1 Establish structured senior support

    This can be done by re-establishing the team structure with consultants at the forefront of the delivery of care. Time should be made for safe handovers and structured ward rounds, utilising every opportunity to train. Finally, opportunities should be identified each day when Foundation Doctors and Core Trainees can contact seniors to discuss problems.

    2 Reintroduce the hospital mess

    It is important for doctors to have a protective environment in which they can unburden themselves and socialise with colleagues across the specialties. A hospital mess reduces staff isolation and enhances a sense of community within the working environment.

    3 Intelligent design of rotas

    Continuity of patient care, safety and a symbiosis between service and training must be integral to rota design.

    4 Streamline and reorganise the overall workload to prioritise core clinical duties and create an integrated multidisciplinary surgical team

    Systems and staff (medical and non-medical) could be organised more efficiently to allow doctors to dedicate the maximum amount of time to the clinical responsibilities most relevant to their grade. Where appropriate, consideration should be given to developing the extended surgical team to enhance the continuity and delivery of safe surgical care.

    5 Recognise that better training delivers better care

    Educational supervisors must be supported to deliver training through protected time in job plans.

    But training can also benefit from the merging of tiers within training and maximised training opportunities during the day. It is also important to use training to develop and invest in the multi-professional workforce.

    6 Promote human factors training

    The profession must embrace a safety-centred team approach from the early stages of medical training.

    7 Support and Training the Trainers

    Trainers should be supported to plan, manage and focus on training at a local level, while having the opportunity to develop their faculty through formal activities such as ‘Training the Trainers’ courses and informal activities such as developing enhanced mentorship programmes for trainees and consultants alike.

    The Royal College of Surgeons of Edinburgh: Improving the working environment for safe surgical care (2017) https://www.rcsed.ac.uk/news-public-affairs/reports-and-campaigns/improving-the-working-environment-for-safe-surgical-care
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