RCSEd Resources to Complement CPOC’s Initiative
Anna Paisley, General and Upper GI Surgeon, RCSEd Council Member & Patient Safety Group Chair and Member of CPOC Board shares insights on improving behaviour and culture within the perioperative team.
Bullying, incivility, sexism, harassment, and other poor behaviours in the surgical workplace damage team communication, erode trust among colleagues and undermine patient safety. Such negative behaviour creates a hostile work environment, leading to increased stress, reduced morale, and higher staff turnover. For trainees and new team members, it normalises unacceptable conduct, perpetuating a culture of fear rather than learning and collaboration. Patients may perceive the tension or rudeness, reducing their confidence in care. Crucially, the effects of poor behaviour distract from critical tasks, contribute to errors, and compromise outcomes. Respectful, professional conduct is not optional, it is essential for effective teamwork, safe surgery, and maintaining the dignity of all those involved in perioperative care.
The Centre for Perioperative Care (CPOC) works tirelessly to improve perioperative care for patients. Through guidelines, national standards, educational resources, and by bringing together multidisciplinary organisation, such as the Royal Colleges, NHS bodies, and patient groups, CPOC strives to embed best practice in perioperative care. Thus, CPOC is ideally placed to drive change and improve the perioperative culture to the benefit of patients and the healthcare team.
This important and timely CPOC initiative to improve behaviours in perioperative care, closely aligns with the core values of respect, professionalism, inclusivity, integrity and innovation at the heart of the Royal College of Surgeons of Edinburgh mission. The College has taken a leading role in offering resources designed to promote behavioural change and foster a positive culture within the perioperative environment for all members of the team. Recognising the critical impact of professionalism, teamwork, and psychological safety on surgical outcomes, the College has developed a range of practical tools, educational programmes, and leadership guidance specifically tailored to multidisciplinary teams. In this context, I would like to outline several ways in which RCSEd provides training and professional resources to support this vital CPOC campaign which highlights why poor behaviours are so detrimental and how we can all learn to change the culture.
#LetsRemoveIt
A cornerstone of the RCSEd’s efforts in embedding a safer culture is the #LetsRemoveit campaign, launched in 2017 to address bullying & undermining in the surgical workforce, and extended in 2024 to focus on stamping out sexual misconduct in surgery. The online hub offers an extensive suite of tools for the whole perioperative team, including posters designed for display in theatre, wards & teaching areas as well as prepared presentations to stimulate conversation on poor behaviours. There are CPD-accredited learning modules to help professionals recognise, address and prevent undermining behaviour. Links are provided to innovative tools such as Schwartz rounds, a group reflective forum where staff come together to discuss the emotional and social aspects of working in healthcare, aimed at fostering increased collaboration and shared motivation in patient care.
Human Factors Training
RCSEd has pioneered global training in non-technical skills through the Non-Technical Skills for Surgeons (NOTSS) framework. This system categorises key skills into four areas: situation awareness, decision-making, communication & teamwork, and leadership. NOTSS courses are used internationally to improve intra-operative behaviour and team cohesion.
To support allied professionals, the College also offers the Perioperative Care Practitioners Intraoperative Non-Technical Skills (PINTS) one-day course for Surgical Care Practitioners (SCPs) and Surgical First Assistants (SFAs).
Practical Guidance in Professional Behaviour
The RCSEd Code of Conduct outlines expectations for respectful professional behaviour and explicitly states a zero-tolerance approach to harassment and misconduct. To complement this, as part of #LetsRemoveIt, RCSEd provides behavioural guidance and promotes self-reflection to help individuals improve their interpersonal skills:
- “Is My Behaviour Affecting the Team?” is a self-assessment checklist prompting reflection on micro-behaviours and unconscious habits.
- “How Oppressive Behaviour Affects the Team and Patient Care” uses real-life case studies to highlight the link between poor behaviour and patient safety risks.
- “How to be Assertive Without Being a Bully” offers advice for maintaining clinical authority without creating a hostile environment.
In parallel, the College has a wealth of wellbeing resources including webinars, such as: “Improving the Workplace” and “Can We Change the Surgeon Personality?”, which explore mental health, civility, and the cultural norms that shape operating theatre behaviour.
Faculty of Perioperative Care
An ongoing webinar series tailored to Surgical Care Practitioners, Anaesthetic Care Practitioners, and Surgical First Assistants is offered by the College’s Faculty of Perioperative care. These sessions highlight the shared responsibility of all perioperative staff in creating a respectful, effective team culture.
Patient Safety and Team-Based Learning
Inappropriate behaviours harm patients: US studies have attributed disruptive conduct in the perioperative area alone to over two-thirds of adverse events. The RCSEd has worked hard to compile a wide-ranging team-learning resources focused on communication, decision-making and conflict management. Along with those already noted, another key initiative has been Addressing Conflict in Surgical Teams (ACT) – workshops for improving interpersonal relationships.
With its comprehensive, robust suite of tools and learning opportunities aimed at improving the culture and behaviour in the perioperative setting, the RCSEd is closely aligned to the aims of CPOC in advocating for safe, person-centred, team-based care. By incorporating the RCSEd’s behavioural and cultural-change resources, guided by the CPOC national framework, all surgical services can move towards truly integrated perioperative care, with wellbeing and civility at the core of safer, effective teamwork to the ultimate benefit of patient experience and outcomes.
Below are resources from Centre for Perioperative Care (CPOC), which were designed to help staff and organisations embed positive behaviours that improve team culture and therefore improve patient outcomes.
- Resources hub on the CPOC website
- Poster
- Infographic