It’s always best to address issues early rather than waiting for an event to trigger change.

The research found seven key concerns around discrimination, bullying and sexual harassment.

1. Culture of Fear and Reprisals

The most prevalent view in the research was that making a complaint would be ‘career suicide.’ People were afraid to raise issues due to the risk to their career, traineeship or livelihood. This fostered the continuing poor behaviour of the perpetrators.

Surgery requires more extensive training than almost any other area.  However many industries require training followed by on-the-job experience, and the same issues can occur. 

Consider an apprentice plumber who is bullied at work. The apprentice may not speak up about their employer’s bad behaviour for fear that they may be fired.  They may be worried they will not be able to complete their apprenticeship if they have a bad reference from their former employer. 

If the employee doesn’t complain, they may leave before completing their training or suffer through the completion of their apprenticeship. The perpetrator will continue the cycle of abuse if nothing is done to stop them. 

The key to resolving the situation is in giving a voice to those who are not in positions of power, and to establish processes which investigate and lead to change. 

2. Complaint handling

There was lack of trust and confidence in the people handling the complaints, and the processes in place at the College of Surgeons and across the health sector. The processes were found to be legalistic and narrowly defined, and there was a lack of consequences for the perpetrator.

Where the complaints are handled by close peers of the alleged perpetrator or where there is a lack of trust in the process, then there may be a perception of bias and protection of the status quo. A genuine arm’s length process needs to be put in place to ensure fairness, encouraging people to come forward and communicate the issue so it can be handled appropriately. 

There needs to be consequences for the perpetrator where the allegations are upheld. If nothing is seen to occur as a result, the behaviour is likely to continue and trust in the system is lost.

Complaint handling processes should be publicised, with information made available about avenues for making complaints and resolution options. 

The focus should be on early intervention.  The process needs to include protection for those making complaints to prevent victimisation.

3. Education

While supervisors possessed technical skills, they didn’t necessarily have the teaching skills, interpersonal or leadership capacity to appropriately educate trainees. Many were also not equipped to provide constructive feedback and there were concerns about conflicts of interest.

Where on the job training is a requirement, how are the trainers trained? Do they fully understand the requirements and obligations of their supervisory role? What training has been put in place to support them? Do they know what is expected of them?

Training supervisors appropriately can help your organisation to avoid problems down the track and ensure that the organisation’s legal and moral obligations are being fulfilled.

The training may include information on the prevention of discrimination, bullying and sexual harassment, as well as adult education principles, constructive feedback, resilience, stress management, teamwork and leadership. An accreditation process may assist.

4. Lack of transparency and independent external scrutiny

This was found to occur in examinations, feedback and other forms of assessment, in complaint handling, and with data.

Where much depends on assessments and examinations, victims of workplace bullying are placed at a distinct disadvantage which could have significant career impacts. If they complain about the bullying behaviour, they may receive poorer marks if the perpetrator is also the assessor.

To counteract this, transparency and independent scrutiny can help to ensure fairness. This extends to complaint handling procedures. The organisation must be seen to take fairness seriously. This can go a long way towards preventing an ongoing culture of bullying. Likewise, the data involving bullying cases must be held securely and handled appropriately.

5. Leadership

Although there is a commitment to high standards, there are concerns about inherited bad behaviour and poor role modelling from senior to junior members, as well as a lack of leadership, abuse of power and bystander silence.

Leadership behaviour is influenced by the organisation’s culture. The modelling provided by previous generations continues as junior members of staff become senior ones. Where this leadership modelling has been negative, the traits can be difficult to confront. As a result, other staff may have learnt to maintain their silence and the abuse of power continues. 

Positive leadership enables open communication, fairness and trust. This can be reinforced through appropriate leadership training, and through oversight.

6. Conflicts of interest

Hospital reliance on surgeons stops employers acting on bad behaviour, despite their legal obligations to provide a safe workplace. Conflicts of interest are believed to compromise the assessment of international medical graduates and prevent fair complaints management.

Hospitals are frequently reliant on the skills and reputation of their surgeons to maintain their status. This also applies to other industries, whether architects, lawyers, builders or in other areas of the healthcare industry such as nursing. 

It is mandatory however for employers to provide safe workplaces for their employees, ensuring that complaint management processes are fair and not undermined in order to retain high level staff who perform well but behave badly.

If it becomes known in the industry that bullying is unacceptable, rather than just in one organisation, the behaviour of staff who abuse their positions of power is likely to improve.

7. Unhealthy work practices and training arrangements

These were often cited as barriers to gender equity, facilitating bad behaviour and precluding a work life balance for both genders. These were found to be culturally embedded in surgery, including in hospitals. Excessive unpaid working hours were used as a form of bullying. The report found that “lack of diversity, gender inequity and strong hierarchies in the surgical profession are linked to increased prevalence of discrimination, bullying and sexual harassment.

All staff must be treated with respect and consideration, regardless of their place in the organisational hierarchy. Diversity should be encouraged, including both gender and cultural inequalities. 

It is important to enable all staff to have an appropriate work life balance, avoiding excessive and unpaid overtime. This is a particular challenge for staff who are pregnant or who have young children. 

Where there is lack of diversity employers are encouraged to set targets, particularly to foster gender balance. Targets should regularly be monitored and reported. A strategy should be developed to encourage women into leadership roles. 

The full College of Surgeons report can be found here.