New initiative to tackle ‘culture of silence’ among surgeons after adverse events

The Royal College of Surgeons of England (RCS England) will today (January 29) launch a new collaborative to support surgeons’ wellbeing after adverse events.

Adverse events and complications, including those that seriously impact a patient's health, are an inevitable aspect of surgical life. As well as impacting patients and their families, the surgeon and the surgical team can be profoundly affected, but for too long, many surgeons have remained silent about the mental distress they experience.  

In 2020, RCS England, in collaboration with Bournemouth University’s Surgical Wellbeing Research Team, published a Good Practice Guide (Supporting Surgeons After Adverse Events) to help prepare surgeons for when things go wrong and to support them when they do.

Building on this guidance, the RCS England SUPPORT (SUrgeon Peer-led Post-incident Response Teams) Improvement initiative will enable Trusts participating in the Collaborative to design and deliver one-to-one peer support to surgeons in their hospitals.

The MPS Foundation, a global not-for-profit research initiative that aims to shape the future of patient safety and the wellbeing of healthcare professionals and teams, will also fund a Clinical Fellow to work with the RCS England SUPPORT Collaborative project team and deliver the collaborative. This is an exciting opportunity for someone with a passion for quality improvement, and applicants can express their interest by emailing qi@rcseng.ac.uk.

“We recognise the profound psychological impact of adverse events on surgeons personally and professionally, and by implementing our guidance, we hope to improve the support provided to surgeons after adverse events in surgery,” said Professor Vivien Lees, Vice President of the Royal College of Surgeons of England.

“Improving morale and ensuring their wellbeing remains a top priority and will help to retain surgeons at all levels, which is crucial to tackling the current challenges faced by health services. Through RCS England's support and the expertise of our surgical community, the SUPPORT collaborative will create a robust network for surgeons after adverse events.”

The MPS Foundation Chair, Dr Graham Stokes, added: “Surgeons experience strong emotional reactions when things go wrong on the operating table, yet for many, the sadness, anxiety, and guilt they feel isn’t always shared or managed through appropriate support networks. The SUPPORT Collaborativewill help tackle this at a personal and organisational level, and embedding the guidance and principles into hospitals could not come at a more important time.”

“Frustratingly, surgeons are the least likely of all doctors to engage with existing support initiatives when they are involved in an adverse event: We must support surgeons better.”

The RCS England SUPPORT Collaborative will work with 12trusts and health boards across the UK and a hospital in Ireland, which will receive support for over 18 months as they integrate the guidance into their hospitals. For example, clinical or medical directors should be able to rapidly link a surgeon to a first responder and to meet them in the first 24 hours after an incident.

Surgeons account for only 4.3% of medically qualified users of NHS Practitioner Health, a mental health service for staff, even though 11% of UK medical practitioners are surgeons, according to its medical director. Similarly, 42.5% of surgeons don’t talk to anyone at all about the impact that an adverse event has had on them.

RCS England’s team will be made up of a consultant surgeon clinical lead, clinical psychologists, and project managers, in addition to guest speakers.

Participants will attend a series of online and in-person events and peer group support calls. The first phase of the Collaborative will run until December 2024. The evaluation and reporting phase kicking off in January 2025, with the findings to be compiled into a final report.

Notes to editors:

1. More information on RCS England’s SUPPORT Improvement Collaborative: https://www.rcseng.ac.uk/standards-and-research/standards-and-guidance/service-standards/rcs-england-support-improvement-collaborative/

2. The Royal College of Surgeons of England (RCS England) provides world-class education, assessment, and development to 30,000 surgeons, dental professionals, and members of the wider surgical and dental care teams at all stages of their career. Our vision is to see excellent surgical care for everyone. We do this by setting professional standards, facilitating research, and championing the best outcomes for patients.

3. Contact details for the RCS England press office are as follows: telephone: 020 7869 6053/6054/6047; email: pressoffice@rcseng.ac.uk; out-of-hours media enquiries: 0207 869 6056.

4. The MPS Foundation is a global, not-for-profit research initiative that aims to shape the future of patient safety by investing in research, analysis, education, and training. The MPS Foundation is part of the Medical Protection Society (MPS) - the world’s leading protection organisation supporting more than 300,000 doctors, dentists, and healthcare professionals around the world.

5. Gerada C. Clinical depression: surgeons and mental illness. The Bulletin of the Royal College of Surgeons of England, Volume 99, Number 8, 2017; 260–263.