Within the SEIPS model, environment refers to the physical setting in which healthcare is provided. This can be considered at different levels. At a macro level, we may consider the physical terrain of a country and population concentration in the layout of national resources. At an intermediate meso level, we may consider hospital design and layout. Finally, at a micro level, we consider the immediate workspace; which may need to include characteristics such as layout, noise, temperature, or airflow.





At a Macro Level, the 2018 opening of an international office in Kuala Lumpur, Malaysia reflects the College’s global outlook and reflects the aims of its International Strategy.

The Global Surgery Foundation works to tackle inequalities in surgical care on a global scale by working in partnership with local agencies to build sustainable surgical capacity in communities suffering from a chronic shortage. The Foundation has ongoing projects in Ethiopia, Rwanda, Malawi, and Haiti.

Similarly, the Faculty of Pre-Hospital Care has helped establish pre-hospital care systems in several countries including Nepal, Sri Lanka, and China. The Faculty of Remote, Rural, and Humanitarian Healthcare, putting understanding of local context at its core, facilitates shared learning between groups in different isolated, resource-limited locations be it an Island community in South East Asia or an oil rig in the North Sea.



At a Meso level, the RCSEd report on ‘Improving the Working Environment for Safe Surgical Care’ made recommendations regarding local team structures, rota design, and rest facilities.

The Trainees’ Committee has carried out a recent survey on out-of-hours working including determining access to rest facilities, food, Wi-fi, and other IT facilities; this has formed the basis of a suite of online resources to improve trainee wellbeing. RCSEd has been an active member of the GMC Scottish Advisory Group on the Wellbeing of the Medical Profession.



Techniques to control the micro-environment feature in ergonomics workshops and are highlighted in non-technical skills training with techniques to minimise distractions and optimise conditions during critical phases of work.


Patient Safety Resources - Environment



RCSEd International Office


RCSEd International Strategy


Global Surgery Foundation


The Faculty of Remote, Rural, and Humanitarian Healthcare


Improving the Working Environment for Safe Surgical Care


RCSEd wellbeing resources


GMC Advisory Group on the Wellbeing of the Medical Profession


Non-Technical Skills for Surgeons (NOTSS) resources


Learn more about the other areas of the SEIPS model here.

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