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Summary

Join our on-demand teaching session as we tackle the pressing issue of conflict resolution in surgery. To be guided by distinguished vascular consultant, Mr. Dave Riding from Manchester Royal Infirmary, who also leads the way in anti-bullying initiatives, this seminal webinar will engage and enlighten healthcare professionals on the importance of interpersonal relations in the medical field. Featuring case studies, engaging discussions, and expert advice; expect insights on managing conflict, understanding the impacts it has on patient care, and ways to foster improved professional behaviour to advance your professional practice. Don't miss out on this opportunity to learn more about interactivity, collaboration, and conflict resolution in surgical environments.

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Description

🔪 **"Cutting Through the Tension: Mastering Conflict Resolution in Surgery"** 🔪

In the fast-paced world of surgery, conflicts can emerge when you least expect them—whether it’s communication breakdowns, high-stakes decisions, or team dynamics under pressure. How do you resolve these conflicts without losing focus on patient care?

Join us for an engaging online webinar to learn essential conflict resolution strategies tailored for the surgical field. Led by an experienced surgeon and conflict resolution expert, this interactive session will cover the following:

🔹 Common causes of conflict in surgery

🔹 Techniques to manage and de-escalate high-tension situations

🔹 Real-life surgical case studies and role-play exercises

Gain insights on how to transform conflict into effective collaboration, ensuring your team thrives even under pressure.

#ConflictResolutionInSurgery #Webinar #SurgicalSkills

Learning objectives

  1. Understand the concept of conflict and its impact on the medical profession, particularly in relation to its effects on the functioning of healthcare teams and patient care.
  2. Analyze the influence of personality styles and working systems on the occurrence of conflict within the healthcare environment.
  3. Examine the intricate link between conflict and instances of bullying and harassment, as well as their effects on the wellbeing and performance of healthcare professionals.
  4. Gain insights into effective strategies to manage and resolve conflict in a healthcare setting, with a focus on preserving team dynamics and ensuring optimal patient care.
  5. Apply learned strategies in real-life scenarios through participating in interactive case-based discussions, aimed at fostering better understanding and resolution of conflicts.
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The following transcript was generated automatically from the content and has not been checked or corrected manually.

So, hi, everyone. I hope everyone can listen to me and if there's any audio issues or any camera issues, please let us know via the chat, uh, via the chat applications, um, that we will be able to chat. Unfortunately. Um I don't think everyone can turn on their cameras or talk, but we'll be communicating through that. Very pleased to see more people logging in. So we will just gonna wait a few, couple of more minutes and then we will be good to start. Um, I hope everyone is enjoying their day today. There is no rain. So that's a bit positive in comparison to yesterday. I'm also very pleased to see some familiar names from when I'm working. Thank you guys for joining. That's very good. Um, and the people I don't know. Thank you for taking the time today to join us in this very interesting webinar and actually quite a novelty, um, that we are doing today. I'm just gonna wait a few more sec seconds and then I'm gonna start with our introduction. Ok. It's five minutes past, uh, hopefully people will continue logging in and joining us. As I said, my name is Ruth. I'm an ST four in general surgery at Northwest uh currently working in Bolton Hospital. I am the wellbeing lead for the Mole Academy and October is our wellbeing month and today I bring you to do to you uh cutting to the mastering conflict resolution in surgery webinar with uh our consultant, Mr Dave Riding. He's a vascular consultant at uh Manchester Royal Infirmary. He's also uh as a slide shows the O TPD for supporting wellbeing. He's a pioneer in the anti-bullying. Um decisions have been made and part of previous um S UB as well and part of the Royal College of Surgeons, he's going to introduce himself um more extensively in a second. Um So in terms of uh if people are new to the me all, uh we have the chat options which people can uh just drop their messages in the in the group comments, questions I will um be then bringing those questions back for KN A at the end of the session. So please, this is meant to be in an interactive discussion. Um It's meant for us to actually all collaborate with each other to understand how we can become better, how we can resolve conflicts in the in the end of the day, how our wellbeing can become um also improved and more years at work and with less impactful in our um life outside work. So when we're driving back, we're not annoyed at that person that said something that we didn't like or um that conflict that we endured throughout the day. So with further ado, I'm gonna pass the words to Mr uh writing and he's gonna take us from there. Enjoy the webinar. Thanks very much Ruth and thanks for the invitation to present this evening. Um So a lot of people are probably thinking, why the hell is a vascular surgeon talking about conflict resolution? When I would say traditionally, we're probably the the people who might thrive in that situation or at least that's a stereotype. Um But as ruth alluded to, um we did quite a lot of work with the trainees committee at the Edinburgh College, er which continues uh in particular, looking at working culture um and how we interact with each other as surgeons and I think in the UK and probably further afield as well. We we get very good training in how to do the operations, assess patients, pick the right operation and the right treatment. Um But what we probably get less high quality training in is how to interact with individuals, how to work as a team, um how to conduct ourselves on a on a day to day basis and also understanding the impact that has on patient care um and the the well being of our colleagues and their performance. Um So I think the purpose of this webinar is not that everyone can finish it and be a master in conflict resolution because that is essentially an impossible task. But what I can hopefully do is put conflict resolution in its context and the idea of conflict in departments and what effect that has. Um And hopefully give some pointers as to, to how you might navigate situations differently in future um compared to how you did in the past. So these are the learning objectives that I thought we should cover. So what is conflict? And again, I think that's key um in particular the effects of, of conflict. Um If you understand the effects of conflict, you're in a much better position to be able to navigate situations of conflict, the influence of personality style and working systems. Um So personalities are a big contributing factor to why we have conflict with our colleagues but also working systems. So the, the, the kind of structures of how NHS care is delivered um also has a big influence on that, how hospitals are structured, things like that. Um And I'm also gonna talk um a little bit about how to manage situations of conflict um towards the end of, of the presentation. Um Having spoken to Ruth A, we're gonna do some questions at the end if there are any rather than stop things in between. If that's OK, we will discuss some uh some specific cases. Um Some of most of them are out in the media. Um But I'd just be grateful for confidentiality if that's OK. So I guess from my thinking about conflicts, one of the first questions we have to ask is it always a bad thing? Um, and the answer may not be as, as clear cut as you might expect. So this is the worst case scenario. Um So this is a, a news article from our local newspaper in Manchester, er, where it made its way into the media that a surgeon and an anesthetist had had a punch up in the corridor. Um, and it named them uh and it went into great detail about what was presumed to have happened. And if you just do a little thought exercise about how you would feel as a surgeon or an anesthetic, if you were named in this kind of article and what kind of impact that would have on yourself, on your family, on your colleagues. Um You wouldn't be in a good place and it, it's not something that you want as a surgeon, particularly because a lot of patients these days will immediately Google the name of their surgeon when they're listed for an operation. And if this is the first thing that comes up, then it's not going to inspire much confidence. Um So I think this is obviously reasonably exceptional but y you know, this stuff does end up in the media and it, it will cause problems for you if, if you get to this stage, but there is another side to conflict as well. And it, it can drive progress. Um, so Dubay and Cooley were two, American surgeons working in Texas, er, in the cardiovascular center there. Um, and they'd initially worked together, er, when Dubay was training poly, uh, but it got to the stage where their rivalry for doing cardiac transplantation was so intense that it ended up in the national media in the States. So this is a cartoon from the LA Times but there's also articles you can find from uh Time magazine, I think um talking about their rivalry and their interpersonal conflict. And Cooley himself submitted journal articles talking about their feud. Um and it, it got to the stage where it was beginning to impact patients because Cooly set up or tried to set up at least a cardiac transplantation unit in a hospital in Texas and basically sidelined him by um deploying tactics, the mean he couldn't get access to organs or to perfusionist that would allow him to do those operations. And so the, you know, the the kind of flow of patients through Texas cardiovascular surgery systems that needed um heart transplants was essentially compromised by their rivalry as is indicated in this cartoon where the patients kind of lying helpless underneath the two war insurgents. But the other side of that is that they undoubtedly progressed their specialty um and having read the articles that they've written and their thoughts on it, it was definitely conflict that drove that. So you do have to be a bit careful. It's not always a bad thing, but there are good, good examples of conflict, but there's also a very toxic conflict and unfortunately, that tends to predominate. So, II guess why do surgeons often find themselves in conflicting situations? And II guess historically, that's because of the personality type of people that chose surgery as a career. Um But it's also a self fulfilling prophecy because if you are someone who thrives on conflict, you're more likely uh through selection bias to choose people to be surgical trainees, um who also have a same personality and you end up with something called people like us where you just end up employing people like us to be on your team and, and, and the the kind of cycle perpetuates itself. And obviously, we all work in a kind of high stakes and high risk environment where, you know, there are often situations where things can be incredibly tense, emotional, dangerous, all of the above and more and that will drive conflict. Um But that doesn't mean to say that we should just blindly ignore that because there are things that we can do that can help to minimize it. So as I said, at the beginning, this, this work on conflicts um arose from some of the bullying work that we've done at the Edinburgh College. And the reason there's a link is because the way we behave as consultant surgeons or as trainees. Um has an effect on people around us. Um And as you become more senior that influence and that impact on the department that you work in becomes greater. And one of the things that's really important to understand is that when you're talking about bullying or undermining or harassment, that the intention of the person who is accused of bullying or undermining is not the important thing. It's how the, how the person on the receiving end perceives that and that's all stated in black and white in GMC guidance. Um that it's the perceptions and feelings of the recipients that are the important thing here and that, that's not something that necessarily sits easy with um people with a traditional surgical personality. Um And there's, you know, often talk of Snowflake generation, et cetera, but nonetheless, this is all there and it's across the literature regarding harassment and bullying and undermining in whichever specialty or whichever um you know, workplace that you, you care to look at another way of thinking about it is that if you have someone who is feeling harassed or bullied, then there are, there are two possibilities. Really. One is that that is a complete misinterpretation of the intentions of the person they perceive has been bullied them or the person has intended to bully them or undermine them. Either way you get an underperforming person who is feeling bullied, harassed and therefore, is not able to operate at the level that they or anyone else would, would like and expect an interpersonal conflict, risks, er perceptions of bullying undermining where there's a power differential. And obviously in, in surgery, um there is a hierarchy and there has to be a hierarchy. Um but it's built into the system and it's built into the system all the way through from the Department of Health, all the way down to uh people who are starting out their careers. Um to the point where decisions made in the Department of Health will just apply pressure in a kind of domino rally style and it'll end up impacting clinicians on the front line. Um Recent example being that the government decided that we had to see everyone within a certain time frame to get the waiting list down and that put huge pressure on the NHS managers er to achieve that and they themselves then transferred that er, that pressure onto the clinicians and on it goes and because of that hierarchy and putting people under pressure, then that kind of conflict can lead to accusations of bullying and people feeling bullied and undermined, which itself leads to underperformance. So just thinking about the effect of conflict in department, um I'm gonna talk a bit about empath fine. There's poor quality educational experiences, it, it suppresses diversity, which we'll talk about as well. But the most important thing is that you get poor patient outcomes um and possibly even prison and we'll, we'll talk about that in more detail too. So this is quite an interesting paper um from the States where some psychologists looked at the ability of medical students to empathize with their patients. And there is a, a psychometric test, uh sorry psychological test to look at empathic ability called the Jefferson scale. And you'll notice that before er, medical students start to meet patients, their empathy scores are relatively high. So when they're doing their blood work and in lectures, um without any kind of clinical pressures, without meeting patients, their, their ability to empathize is pretty good. But when they start to meet patients, uh their ability to empathize declines significantly and that, that's a recognized phenomenon. Um and it, it happens when people move from one stage of their career to the next. So we did a qualitative study with some foundation doctors in the region and we talk to them about how they perceive their ability to empathize with their patients. And without exception, um they all talked about the fact that it was a conscious decline in empathy. So it's not a subconscious thing. Um but it's just that they felt that their priority was to make sure that the physical aspects of the patient care were taken care of. So they felt under pressure to make sure the blood results were all updated, to make sure the patient had, had the right investigations um to make sure that on the ward rounds, all that information was readily available to the consultant and that felt they felt that they didn't have any time left or any space to offer their patients empathy, which they also felt was what their patients needed the most. And II apologize if there are any neurosurgeons on, on the call. But this is my analogy for, for why that happens because when you're working as a doctor, um particularly in surgery, it can be take some time to find your homeostasis, but you usually find your homeostasis just before you progress to the next level. So by the time you get to the end of the foundation program, you can pretty much be a foundation doctor without thinking about it. Um If you compare yourself to how you were on the first Wednesday in August, and it's the same when you get to the end of your registrar years. So you've got your Fr CS exam in the bag which makes you feel pretty good. Um You might even have a job lined up. Um, you feel like your ability to operate is, is pretty good. Um, you've ticked all the boxes on your ACP and you've reached a level where you're completely comfortable in that role that you've been doing for at least six years. And then all of a sudden someone thrusts you into being a consultant or whatever the next level is and immediately does increase clinical responsibilities, take up space and the stuff that drops off is your ability to empathize and also your sanity. And when you throw in interpersonal conflict, oppressive behaviors, like bullying and undermining your ability to empathize declines even more. And that makes you more likely to display those oppressive behaviors or to engage in conflict, to feel stressed out and it, it becomes a vicious circle and there's also systemic factors as well. So whenever you see surgery portrayed in the media, you often get these kind of images of a dimly lit er operating theater. Surgeons generally portrayed as quite calm people who were just focused entirely on the operation at hand. Um, and it all seemed quite calm and controlled and all the rest of it. But actually, we know that people are under huge amounts of pressure and it's essentially a plate spinning exercise where you have to constantly balance multiple influencing factors and considerations just to even get a patient to the theater. So last week, I was um I was one of the consultants of the week in our department, which is incredibly busy department. And in theory, my job is to do the emergency operating for the patients that come into the vascular department for that seven day period. Um So in, in, in, if you know, in, in practice or in theory, at least I should be like the surgeon here pretty chilled out in an operating theater ready to operate. Whereas in essence, this is the reality of what you have to deal with and you can pick any one of these figures that was me last week, probably the guy in the middle with a hat on trying to run around with his arms in the air and this is what it's like. There's chaos, there's people throwing arrows at you from all directions. Um There's just clinical carnage and logistical carnage at every step. You don't know whether there's gonna be a, a test in theater takes ages to get a patient with an acute limb from A&E and so on. It goes and all this stuff is a huge distraction. Um And you end up focusing more on that than on the patient's care. Um And that in itself reduces your ability to empathize and you feel that your tension levels are rising, you can't control it. You're more likely to be short with people and to enter into conflict in situations with people. And it, it's a world away from the calm surgeon in theater ready to operate. But this is, this is the reality of, of what life is like in the NHS. Now, for many of us, one of the other um things that I think is worth thinking about is what happens when um to our minds, when when this kind of stuff happens. So this is uh an excerpt from the K AC review into the conduct of the Metropolitan Police. Um So you may recall this, this kind of a rose after the Sarah Everard case. Um and other cases that were similar in which um the conduct of police officers who were obviously meant to be highly trained professionals like us who were public facing, um how they conducted themselves during, during that particular time period. And one of the findings was that most of the time police officers are in threat perception and threat management mode. And that's a bit, that's a bit, um that's very, very similar in fact to what conditions are like in the NHS at the moment where because of the working pressures, um, the threat perception of threat management, you're, you're on fight or flight mode all the time. And as the case report concluded here, um, it, it, it stopped the part of the brain that manages threats, the, the part of the brain that managed threats was in such overdrive that the part that deals with creativity, empathy and compassion was switched off. So it's not just in surgery that this happens, it's, it's a phenomenon that you see across different disciplines. It, it, it stopped the officers from moving from job to job on duty and seeing each incident with a clear mindset. And that's one of the key findings of, of the report and to the police and it's not too much of a mind shift to think that might happen in a hospital too. So some of you may be familiar with, er, stability saves lives um, program which, which looks at this in a kind of a from an academic view. So this was a, a study that was done in a simulated theater environment where um anesthetists were uh introduced into a simulation and the surgeon that they worked with, um they were blinded to what kind of behavior they were going to exhibit. So some of the surgeons were deliberately rude and some were deliberately polite and it affected their cognitive function and their ability to perform uh as reviewed by um a hidden group of anesthetic experts. And that is quite a significant drop in in performance. Um from 91% to 63%. The reference to the paper is there. Um There's lots of other papers and Ingrams available on the Stability saves lives website that I'd urge you to have a look at because this stuff does have an impact and you are able to prove it quantitatively as well as qualitatively and it also has an impact on educational experience as well. So this is uh some data from the GMC survey looking at trainees who made a free text, bullying comment and their survey. So this essentially is trainees who perceive that who are being bullied or undermined. And you'll see that for every aspect of their training, they scored lower than the mean. So even things like the quality of their local teaching and the quality of their educational supervision, um their overall satisfaction, the quality of their induction, every aspect scored lower than the mean um for people who felt that they've been bullied. So it just has a catastrophic effect on the educational experience for that particular trainee in that particular placement. The other thing that bullying and undermining and conflict does is it affects uh minority groups, er, more than others. Um And this is a, a review paper that one of our foundation doctors did um, six years ago now and all this evidence is out there. So women, people from ethnic minorities, non heterosexual individuals are particularly deterred from pursuing surgical careers if they experience negative workplace behavior. Um And that decreases the diversity in the surgical w workforce. And again, going back to the Casey review, um there is a kind of political movement I would say towards um you know, the ideas of diversity and you hear a lot about how people are talking about the work agenda and political correctness and all, all this stuff. Um And in the, in the nineties and the NS it was, it was termed politically correct and now it, it's termed work, but it's essentially the same thing. So this was a paragraph from the final report into the Metropolitan Police. And excuse me, you can read that for yourself. But essentially what it says is that if you have a, a lack of diversity in your workforce and it doesn't reflect the people that it's there to serve and that makes it more likely that the people it's intended to serve will be damaged by the conduct of the police officers. And again, it doesn't take much of a leap to think that with a few words, change, this could be a future report from government. Looking at a particularly egregious example of uh patient care. We're just changing a few words. You can easily imagine that this can happen in a surgical department. Um If we don't have a diverse workforce, then we can't treat our diverse group of patients, uh which damages patient confidence and it, it doesn't enable the creation of a service that, that can offer people the appropriate care. There's all sorts of health inequalities that are, you know, they are all out there. They're all proven that people from ethnic minorities, whether it's maternity care or surgical care, they get worse care um just by virtue of being from an ethnic minority. And so when people criticize having a diverse workforce, that's one of the effects of not having a diverse workforce. And it's something we all need to think about. And if, if we, if our behaviors are stifling diversity, then again, that that's a problem for us as a profession. It's also a patient safety issue in the, in the most stark terms as well. So on the left is Ian Patterson who is the breast surgeon who um was performing unnecessary surgery or kind of off MDT surgery, um and subsequently ended up with a 20 year jail sentence. Um and when you read the report into that case, there was a huge amount of interpersonal conflict between that surgeon and the rest of the team. Um There was also bullying undermining and all the rest of it. There are inappropriate relationships with staff members. It it takes every box really and it that interpersonal conflict, intimidation and bullying, it allows poor patient care to flourish. Um And and you can see it also in the Francis report into mid staffs, which is many years ago. Now, some, some of you may not necessarily be aware of it, but it was looking at in particular geriatric care in midst staffs. Um and again, poor patient care underpinned by culture of bullying and intimidation and huge amounts of interpersonal conflict. And it was the same in Morecambe Bay in, in the obstetric care offered to women there um where there was all sorts of conflict between midwives, obstetricians, trainees, et cetera, et cetera. So when whenever you look at these really serious examples of of malpractice and and poor patient care, there's always an undercurrent of conflict bullying undermining that allows it to flourish and stops people from blowing the whistle. Cos understandably people want to keep their head below the parapet, particularly if they're trainees when they're gonna move on in the next six months. I also wanted to talk about Brighton and I II don't know whether any of you work there, but you'll notice that there are an increasing number of uh, news articles about what's been going on at Brighton. Um, it's all out there in the media and some of the BBC and there's other stories about assault during surgery. Um, there was a surgeon who used a pen knife uh to do an operation and now the police are involved and I think this particular case has, it has all the hallmarks of a case that will end up with one of those public inquiries with the same kind of outcomes that er Baroness Casey found in her investigation to the metropolitan police. And you can see how this kind of thing can just snowball. Um and it starts off with interpersonal conflict between consultants and ends up with entrenched camps, different positions, people having to worry about their interpersonal relationships more than their patients. And it facilitates um things like assaults in theater, sexual assault, people using penknives to do operations all the rest of it. And you never think it's gonna happen to you and your department uh until it's too late. And I suspect that none of the people involved in this case ever thought it would get to the stage where the police were investigating them. But nonetheless, you know, this is a teaching hospital in a big city. Lots of us working in teaching hospitals in big cities, we all have the same sort of work to do. And I don't think it's impossible that this can happen within departments I think it's something that can spiral out of control. Um, and if perhaps we had some skills in teamwork and conflict resolution, then it might reduce the risk of this happening. So, one of the things that um, is important to understand, er, is the effect of personality style. And I think to some degree, the people who became surgeons 50 years ago were all the same sort of people really. Um, they were largely white, middle class, men, often privately educated um with a certain style, certain characteristics. Um There were obviously some women surgeons, um but not many uh and obviously still underrepresented in the profession at large. Um And what that means is that people didn't have to really make any effort to understand personality because pretty much everyone did have the same personality. And I would argue that the outliers in terms of personality were probably Jeffersons before they ever got to the consultant stage. Again, it comes back to the concept of people like us, people who ended up being appointed, who were, you know, like the consultants that were employing them. Um And that happened at, at trainee selection level as well. What we've got to do is actively understand our colleagues. Um And that sounds easy to do, but you do have to make a real effort to do that and you have to understand what makes people take, how people like to be communicated with. Um And, and if you're inflexible in your approach to your colleagues, then you're probably gonna come unto. Um this is one of those horrible kind of questionnaires that everyone dreads doing. Um But it can actually tell you quite a lot about your own personality style and that informs how you interact with other people. So I'll just give you a couple of minutes just to have a look at that and try and put yourself in one of those groups. Um There is a Marilyn Reed questionnaire that underpins that, but you can still get a feel for what your personality type is just by looking at, at that table. So I'll just give you a couple of minutes to look at that ruth. I'm going to put you on the spot and ask, uh ask where you see yourself on that, that diagram. Oh, but looking at it, um I think it's more like I'm more like a type of a driver type of attitude and um expressive as well. So I'm more to the details. Um really is that how you say like right left or top and down? Yeah, obviously they're, they're not, they're, they're presented as discrete categories, but people will between the two or three or whatever it might be. But in general, um the arrows point towards your overall personality style and how you like to work. Um And II guess a lot of surgeons will probably see themselves more towards the driver um expressive side of things. But not all. Um And there is definitely diversity in surgical personalities that we found through, through giving this questionnaire to consultant surgeons and trainees. Um which was interesting really because you would think it would be more towards the, the tail side rather than the as side. But there is, there is variety there. And the reason that's important is because the way you interact with people is based on your personality style. Um So I if you know, again, you can, you can read this for yourself. But when, if you make an effort to understand the personality style of your colleagues, then you will be able to communicate with them on a level that is more likely to be receptive by them. Um And, and if you don't do that, then you may not be as successful when you're trying to negotiate with them. So again, I'll just give you a couple of minutes to have a look at that um route. You can maybe think about yourself as a driver and whether that yeah is how you like to receive information. It is. Yeah, it is actually um that, that question, do they get to the point? Even when I'm getting referrals and there is a lot of fucking so to speak. Um Yeah, I I'm a bit of the driver, but it is quite interesting to recognize how to approach other types of, of personalities and how to adapt language and tone of voice and Um, and, and all of that, that's actually really interesting. I was not familiar with this before. Yeah, I know this is one tool. There are different tools as well. Um, I know our, our clinical director, um, has pigeonholed everyone into a color coding system that he read in a, uh, a psychology book. Um, to maybe, you know, if this one doesn't suit you, then there are other ways of working out people's personalities. Um, and that, that allows you to communicate with that individual in a, in a way that is more likely to be successful and, and receptive by them. Mhm. The other thing that we need to make a conscious effort to do is, um, to understand, er, the fundamental sense of self that that person has. Um, and this doesn't necessarily come naturally to us as surgeons and ii understand that. But I do nonetheless think it's important and I think, speaking from our, my, my viewpoint in a department where people largely get on with each other, um, which isn't always the case in vascular surgery, um, you do get a feel for what is important to your colleagues. Um, and the way that's termed in psychology is their values, beliefs, needs and wants and everybody has these, everybody has values, everyone has their beliefs, uh, whether they're religious or, or secular doesn't matter, everybody has needs. Er, and everybody has wants now they may all be different for different people. But if you can appreciate those and your colleagues and understand the different aspects of their personality and engage with them rather than ignore them. Um Then your communication skills are more likely to be effective. Um Because you've made an effort to empathize essentially and to see things from their point of view, from their viewpoint of their values, their beliefs, their needs and their wants. And in our department, there is a whole range of personalities, a whole range of working styles. Um But nonetheless, in general, we get on with each other. And I think that's generally because we appreciate each aspect of the others personality when it comes to needs. Um There's something called core emotional concerns. So when uh when myself and the rest of the team were, were producing this work for the college, we, we did um uh a kind of course with the hostage negotiator for the Scottish police who basically spent a lot of time taking us through how she deals with um with people who were either stood on a ledge, holding someone hostage um in a position of vulnerability. And the problem that she has as a hostage negotiator is that she has to create an instant understanding of that person. And she also has to find some sort of connection with them as well. Most importantly, she has to establish what their emotional concerns are in order to start a conversation that will lead to the person stepping down off the ledge or releasing the hostage or whatever it might be. Um And it was actually quite frightening how a lot of the analogies that she used when talking about hostage situations in Scotland were not necessarily that dissimilar from situations we find ourselves in, in, in the NHS. Um And these are the core emotional concerns that everybody needs in order to function well. And if you can appreciate these in your colleagues, then the chances of conflict is automatically reduced. So if you value your colleagues thoughts, feelings and actions, um you'll make them feel appreciated. You also want your colleagues to be affiliated and feel part of the team. And I think this is a real issue for er trainee surgeons who are essentially itinerant workers who just go from one placement to the next, sometimes as short as four months. Um even a year is not really long enough to feel kind of true affiliation uh in a lot of cases. And so this is a big deficit in the training experience. And I think as educationalists and people interested in training, you, you've got to make an effort to feel people affiliated with your department from the first week. And that will make a massive difference to how they respond and how they're able to communicate. The chances of interpersonal conflict will go down. But nonetheless, it is a challenge when you've got such a high staff turnover as we have in, in surgical departments. You've got to give people autonomy as well. And that, that is also something that can be challenging um in a surgical training environment because obviously we, we want our trainees to, to flourish. Um But we also don't want our patients to come to harm and it can be difficult to find that balance. And sometimes trainees find that they don't have the autonomy that they would wish um from a, from a, someone who's moved fairly recently from being a, a trainee to a, a trainer. Um You do have to quickly find out what people are capable of and what you need to push them towards. Um So that they feel that they have that intellectual and operative freedom to put it another way. Um And you have to kind of give them that, that security, that they can have some autonomy in, in patient care and in theater. Um And sometimes you do have to have to kind of push them beyond their comfort zone slightly to do that. And then in doing that, you're pushing yourself beyond your comfort zone as a consultant. Um You know, and it can be difficult, particularly as a junior consultant. But nonetheless, if you stifle people's autonomy, that's when you will suffer a breakdown in your relationship with, with whoever you're working with. Um, you know, in surgery, that's obviously the, the trainee trainer relationship is important aspect of that. Um And again, it will drive conflict if people don't feel that they have autonomy and treating people equably as well. Um There was a report out from the GMC today about people from ethnic minorities working in, in medicine across the board not being treated equitably. This is still going on. Um There's no immediate solution to that other than reflect on your own behavior and treat people equably that will hopefully filter down through the system. But it, it's not easy to change that culture. It takes time and it takes a real concerted effort. But again, if people don't feel that they've got status within the department, then the chances of conflict and poor communication between individuals is is greatly increased and having a clearly defined role as well. Um So I think the group that struggle with this the most is probably the core trainees because I think foundation doctors have quite a clear role in most cases. And I think when you become a registrar or a higher trainee, again, your, your role is quite clear then because you're on the final kind of push towards becoming a consultant and you've got a series of tasks in front of you um that you know that if you accomplish and complete those tasks, then you will become a consultant. Uh whether it's the exam or operative numbers or number of papers or whatever it might be. But when you're a core trainer, you're kind of in limbo a little bit um because it's not guaranteed that you're gonna progress to become a consultant. So you automatically feel um a drift. And when you start being a core trainee, all you want to do is get your hands on cases in theater. Um But increasingly it's more difficult to do that because of service demands and, and the needs of higher trainees as well. And there are some specialties where there aren't really the kind of um more basic operations that perhaps might be present in other specialties. Um So in, in vascular there, there aren't many uh procedures where um, core trainees can develop kind of quick competence. Um And certainly when I was doing general surgery, I felt there were more procedures that I could do, uh skin biopsies, uh lumps and bumps lists hernias, uh open appendixes and you could get your, your hands in and, and do stuff in vascular, it, more parts of operations that, um, that people need. Um, because it, it can be pretty rare to have, you know, that kind of level of operation. And what that means is that people don't necessarily have a role in the department. Um, and lots of our core trainees find it frustrating experience and they feel, um, you know, that they, they haven't got a clearly defined role within the team and that again can lead to problems with communication, conflict and, and disappointment amongst people in the group. So as, as trainers, we've got to find a way of making sure that you really clearly identify what your expectations are of those, those trainees. Um So you can get the best out of them and make sure that they get a rewarding educational experience. So I think in summary, to, to, to minimize conflict, you've got to understand your colleagues personality type. Um You've also got to identify their values, their beliefs, their needs and their wants, and you've got to support their core emotional concerns. And again, I, II know that some surgeons will find all this language and this, um this kind of stuff difficult because it doesn't necessarily seamlessly fit into how people perceive surgery, um, particularly in the context of kind of macho culture that has pervaded, uh particularly previously. But nonetheless, it, I hope I've demonstrated that it is important and if we ignore all this stuff, then we are actually putting individuals, whether they're colleagues or patients at risk of harm. Um And so I think it, it, it's, it's something that we have to think consciously about rather than just assuming that we're gonna get on with everybody and that our communication style will suit everybody. Now, the other thing I wanted to talk about was something called the drama triangle, which is what we enter into if we ignore all that and if we just plow on regardless. So I've got two little girls. Uh, one is nine and one is six and the eldest is the goody two shoes he wants to do everything. Right. Er, and my six year old just wants to see the world burn, essentially. Uh, she wants to tear down the system and rage against the machine. Um, and so there's immediately potential for conflict there and the way it presents itself on a regular basis is when I'm trying to get them ready for school in the morning and I'm trying to get my youngest daughter to tie her shoelaces, which she can do very competently, but nonetheless refuses to. And every single morning, um, I ignore all the things that I've learned about conflict resolution over the last few years. And we just enter into something called the Cartman Drama Triangle, uh, which you may have experienced in your surgical department. Um, it's unlikely that you haven't. And what happens is that my six year old immediately plays the victim. So she says that she can't tie shoelaces. She says that, uh, you know, she feels sad about it, but nonetheless, she can't do it or I just wanna wear some Velcro shoes and then I just start getting pissed off and say, you know, I know you can tie your shoelaces, we just need to do it and get out of the house. And then my eldest daughter who's the goody two shoes says, well, you know, you did take her and you did buy her some shoes with shoelaces in rather than Velcro. Um, and it, and it just goes on like this and we, we enter into this drama triangle. And the other thing is that the roles can switch very quickly. Um So then I become the victim because I'm the idiot who's bought a lace up shoes rather than Velcro. Um, my eldest daughter becomes the persecutor and tells me that I've, I've done it wrong and it, and so it goes on and you can probably think of situations in your workplace where this has happened. Um But you've got to find a way of escaping this drama triangle because this is, this is the key thing that drives conflict. We've all felt like victims. We've all felt like rescuers and we've all felt like persecutors and it can flick on his head in a, in a matter of minutes, but there needs to be a way out of that. Um And this is the kind of uh the solution that is offered. So instead of being a rescuer, um you know, you've got to be a coach. So, you know, how can I help you rather than just doing it for her? Um If you're going to be a persecutor, you've got to become a challenger. So you've still got to remain assertive. We still need to get to school on time, but you've gotta find a way of, of making sure that she doesn't see it as a conflict situation. Um There's got to be a way of getting her to tie her shoelaces. Um That means we don't all fall out with each other. You have to remain assertive and conflict resolution isn't about um losing your ability to be assertive. It's about deploying it in a way that is appropriate and doesn't put people, doesn't make people feel threatened. Um And the victims who, um they need to become a creator so they need to accept their own vulnerability. Um But they need to think about how they're gonna solve that particular problem. Um And it, it, it's not easy to do this. Um, but this nonetheless is the way to escape that, that drama triangle. And that is the way to avoid in conflict within your department to, to step away from those roles as persecutor victim, er, and rescuer in an effort to stop the conflict and just take a step back and get through it. So, the, the, the last bit I wanted to talk about really was the effect of our working systems. Um And I, I've talked about a little bit with the Hieronymous Bosch picture of um, the gates of hell. And that's what it can feel like in the NHS. But there are things that you need to understand about your context, um, that will feed into your ability to minimize conflict and get what you want out of communication. So, if you think about our surgical teams, how they are in 2024 they're constantly changing. They're increasingly diverse, although there's still some way to go, but that is the direction of travel. Um The people we work with are are reassuringly vocal. And by that, I mean that they increasingly feel able to speak up. Um if things don't look right in theater or they're worried about a patient on the ward or whatever it might be. I think there has been a flattening of the hierarchy over recent years that hopefully in in progressive departments will make it more likely that people feel able to speak up. And in particular trainees feel Encouragingly empowered to, to be autonomous and to speak up and to realize that they do have influence within departments and within the workforce in general. But nonetheless, the nature of the our surgical teams does present difficulties. One of the, the things that I really recommend um whether you're interested in space flight or not is watching this documentary about um the Columbia er shuttle crew um which unfortunately crashed on reentry um after a, a tile fell off the er the fuel tank on departure. The reason um it's a good documentary in general, but the reason I particularly liked it is because there was a huge emphasis on team building er before they strapped themselves into the the shuttle and the documentary follows them through their team building. Um And it, it kind of, it shows how they went from being strangers to being an effective team. Um Obviously the ma training that they do for one flight is astronomical if you pardon the point. Um But that's what we do as well. So we also operate in high stakes high cost environments where teamwork or, or lack health can make a big difference. And if you think of some of the times you've had conflicts with your teams in surgery, if you have that in a space shuttle, it's not gonna be a case of just leaving the hospital and going home. You know, you're stuck there for a long time. The problem we have in surgery is that we don't have that option and we often meet people, uh, for the first time when we're strapped in and ready to go. And I've been a consultant two years now and I don't think I've had the same team in theater twice. Um, whether that's the trainees or the scrub team or whoever it might be, uh, who contributes to the patient's care. And that puts us in a very vulnerable position because we're expected to kind of, uh, demonstrate all the, the attributes of being a good team leader and a good team worker. But without any real knowledge of the people that you're working with. And if you, if, if NASA did that, then, you know, I imagine their missions would be far less successful. But nonetheless, like I said, we still work in that high stakes environment. So we've got to find a way of quickly understanding people's motivations and how they like to work. It makes it very difficult because of the high turnover of people in theaters in the workforce in general and talking about diversity as well. So when I started out, um, as a doctor, there wasn't much in the way of drivers towards developing a diverse workforce. Um, but thankfully that has changed over, over recent years. Um, the women in surgery group at the, at the English College is one example, but there are other examples as well. Um But what this diversity does is it, it makes it more difficult. Sorry, I'm just getting the wrong slide there to immediately feel, um that you understand people's personalities and, and drivers. Um This is not me saying that we don't need diversity. I hope I, I've explained that we do, but it does mean that it's more difficult to immediately empathize with people if they have a completely different world view or prior experience that that's just a fact of life. Um So again, going back to how things were in the fifties and sixties where you just have white middle class men, you know, you didn't really have to make a massive, massive effort to understand people because they were exactly like you. Um But the increase in diversity in the workforce means that we, we've got to make an effort to understand where other people are coming from. Um because they're no longer people like us. Um, there's a huge variety of personality types. Um ethnic backgrounds, genders, sexualities that, you know, we've encouraged quite rightly. Um, but that doesn't mean that it's instinctively harder to, to find a connection with people on a, on a very rapid basis when you're strapped into the space shuttle. And there's also a generational difference as well. So, um, the silent generation where the, the sur who grew up during the war were because of the militaristic, er, context in which they found themselves, they would just take orders and they would just do exactly what they were told to do um, without questioning it, which kind of understand if they'd gone through one or two major wars, it was really the baby boomers that started to change that. So, if you think about, um, if you think about the kind of uh groups like asset or the specialty groups or things like the trainees committee at the Edinburgh College, they're all set up by Boomers because they realized that there was a need for people to have a voice. Um, and that, that, you know, that is reflected in wider uh societal impulses for that generation. Oh, I'm gonna find myself in a millennial group. Um, just about, um, and it's getting to the stage now where you can notice generational differences between the group of people, er, in my, my cohort and, and generation Z. Um and they are much more empowered to speak out about things, er, to voice protests, to give, er, feedback on things because they've been encouraged to do so. But because also there are tools that are social media websites where that allow you to rate your educational experience at a particular hospital. And there are pros and cons of that. But in general, it's a good thing um because it gives people uh that autonomy um that is part of their core, emotional concerns that we talked about earlier. I think it gives them a um a voice that they, they need to have because they have just as much contribution to make as, as anyone else does. But nonetheless, uh their worldview is very different than uh some of my more senior colleagues who are coming to the end of their careers. And there can often be a dissonance in how those groups understand each other. And that can also lead to interpersonal conflict. The way to mitigate that is to understand that these generational characteristics are absolutely immovable and they are reflective of forces of human nature that no one can control. If you try and resist them, you'll just be crushed and the conflict will continue. Um You've got to make an effort to understand the people coming behind you. And the younger generation also have a responsibility to understand the viewpoint of people towards the end of their career. Both are equally important and come into these two characters. So, um Jeremy Hunt and Steve Barclay. Um So I think these two politicians have probably had the most influence on the generation coming through of anyone in surgery because they've essentially militarized them into feeling that they have a voice and that it'll be listened to and that if they do go on strike then it will achieve the results that they want. And I don't think there's ever been any other time in history where the action of, um, of surgical trainees and obviously, you know, um, trainee doctors in general has been more influential um because really there's not been a history of strikes up until the strike in 2016, the strike in 2016 was not successful. I would argue, but nonetheless, it empowered people to feel that they could have an influence over things. And if you look at the outcome of the most recent industrial action, now trainees have, what most people would agree is a satisfactory outcome. It may not be perfect, but at least it's a step in the right direction. And that just creates the neurons in younger doctors brains that their action can have a direct impact on their working conditions. And some people feel immediately empowered uh and they feel empowered to, to speak up and to understand that their actions can have consequences in their favor. But what that does is it, it means that we need to make more effort to understand our colleagues values and their beliefs and their needs and their wants because they're more likely to be different from ours. For all the reasons that I've, I've hopefully explained and it, it's not something that you can just afford to be passive about if you want to minimize conflict whilst essentially getting a good outcome for whatever it is that you, you want to communicate. So if we can just finish by giving a gratuitous plug for our, our course that's, er, running at the Edinburgh College. Um, it's a one day course. Um, it's much cheaper than most courses. Um, and I hope it, it gives a good grounding and a good basis for people wanting to develop their teamwork skills, their ability to minimize conflict while still getting what they want. Um, and it's just a different aspect of surgical training that I don't think we get trained in effectively. Um, like I say, I think we get great training in how to stitch the tubes together. Um, but this side of things I think is, is probably there's a deficit there in our, in our curriculum. Um, and hopefully this course goes some way to, to meeting that, that deficit finishing on a positive. This is, er, Cooley and the, er, finally making friends when I think Daki was like 96 or something. Um, so they did eventually, er, make friends and, and settle their feet eventually, albeit when the stakes were low because I don't think either of them were operating at this point. Um, and II won't talk about, er, Deby entering into conflict with his junior trainees. He tried to, a junior colleague, sorry, he tried to repair his aneurysm against his wishes. We'll leave that for another day. So I'm happy to take any questions if anyone has any. Oh, this is great. It, reading fantastic webinar and so much, so much food for taught and so many questions that probably are going through our minds at the moment. There is no questions in the chat. I um I'll ask if anyone has any questions. If not, I have some of my own, um I'll probably start firing some of questions towards you. That's ok. Whilst we wait for them to come. Um In the, in the webinar, there was discussed multiple times about the Iraqi and that, you know, whilst we are aware that surgical, surgical um teams do rely on the and they also been flattened. How do you think um how can we manage conflicts that may arise from differences in surgeries? For example, because, you know, it is difficult. He said for us as other trainees that going to, to a consultant say, you know what ii disagree with you in this or I disagree with you in that. And we go into a second um consultant, you know, to ask for um no, not, not necessarily second opinion but um relay for some information sometimes as can be a bit difficult to, to manage that. How do you have any, any suggestions, how we can try to achieve that, manage it. So, II guess I kind of reflect on um my experiences as a trainee in particular where the hierarchy seems particularly acute sometimes. Um So when I think of um the successful training placements I've had, whether it's been in theater or in clinic or on the wards. Um yy, you're, you're, you're acutely aware that there is a hierarchy, but I think it's how that hierarchy is um is appreciated by everyone within it. So, for example, I've had experiences with consultants um where there's just been an expectation that you will do whatever you're told and not ask any questions and not raise any issues and not complain about anything. But I've also worked with consultants who, whilst they were obviously the team leader in theater. Um they created an environment where people were able to speak up where people could uh talk about how they felt they could get something from the operation. So one of the things that I've taken from, one of my trainers is making sure that at the start of the operation, when you're doing the new checklist, you identify which bits of the operation, everyone there is going to do that doesn't flatten the hierarchy, there's still a hierarchy there. You know, I'm, I'm still in charge of the team as, as the consultant, but I've given room for people to get something from each operation um and to speak up if they think I've done something stupid and it fundamentally, it just comes down to how you communicate with people. If you're aggressive and kind of curt and, you know, unfriendly towards people, then you very unlikely in my experience to get the best out of them. Whereas, you know, a lot of this isn't, isn't rocket science, but nonetheless, it has been lacking in surgical working cultures. Um If you show an interest in people's personal development and in them as people, then I don't think the hierarchy matters that the, the core trainees I work with and the registrars I work with no, that I take responsibility for the operation and then it gives them the freedom to make mistakes um to identify other people's mistakes. And that's the same with the scrub, the scrub team. You know, it, it everyone knows that there is a hierarchy but it's about how you, how you deploy that, that is an important thing really. And when it's just an autocratic um do, as I say, hierarchy than it, it, that's when things fall apart. Um Yeah. Yeah. Yeah. A absolutely right. Like um as I said, we all underperform if we are doing it on call and the fear of calling the consultant with a question. And then as I said, we are jeopardizing patient safety in the end of the day just because we are afraid of being shot. That for example, um we do have a question from um Tamir. The question is um uh do we have a pathway in the Deanery to follow if there is a building incident in the region? Yeah. So thanks for the question. Uh um This is a really tricky one and this, this is reflected in some of the data that we've got at the college. So there's very little um confidence and reporting systems for er oppressive behavior um across the board in the NHS, not just in surgery. Um And trainees in particular are in a vulnerable position uh because their employer is the lead employer. I never set foot in the hospital where my lead employer is. So, but nonetheless, they are responsible for your, um you know, if it ever got to the point where there was an employment tribunal, that's who you would, you would be litigating against. So I put the Chinese in a vulnerable position. There's also the issue of people just keeping their head down and, and moving on and after six months. So every trust has an anti-bullying policy and it has guidelines about how those cases should be managed. The deaneries have them too. The problem we've got is that there's very little confidence in them. Uh and people automatically feel vulnerable. So in the Northwest, that's something we're working on at the moment, on a deanery level to try and take it out of the hospitals um where we know that things are not managed particularly well there because um there isn't the expertise to be able to manage it well amongst most departments. Um And b because the deanery really is the, should be the first port of call as, as the kind of responsible officer for want of a better term for your, uh, your kind of occupational training and, and wellbeing. Um, unfortunately, the hospitals kind of wash their hands of it a little bit. Um, so it's something we're trying to optimize in the northwest and I know all the deaneries are trying to do the same. But it, it's, it's one of those wicked problems that isn't easily solved, unfortunately, but hopefully we can, we can optimize things in, in the northwest at least. Yeah, absolutely. I think, um, the culture of, at least as you said, being able to talk about it and, and raise it, it's, um, it, it has changed, it has shifted a bit, unfortunately, the, the, the privacy or being able to keep it anonymous can be quite challenging and it does attract some people to voice it. Um, as often as it should be done, um, as fear of repercussions. But, um, hopefully time we tend to improve and we do better. Um, I wanna ask maybe one more questions. Um, so we talked about, um, trying to understand sources of conflicts in terms of the personality, the constant mutations, the empathy as well. Um How can we, what's your opinion now, how can we or can conflict resolution training be implemented in our surgical department. So we actually have some training about it. And of course you are doing the, the course you, you're about to deliver it, but uh on a day to day or how can we improve? So it, it, it's a another difficult one, I'm afraid because in order to, in order to uh to engage with conflict resolution training, you have to potentially accept that there might be a gap in your development, either as an individual or as a department and that's not something that surgeons necessarily like to do. Um And there is always a risk of it falling into the kind of mandatory training, um style of, of intervention where people think it's another kind of tick box exercise. Um You know, that the departments are making them do quote unquote. So the, the, the conundrum we always have with anti-bullying work and with the conflict resolution stuff is the people who need it the most, probably the people who are least likely to engage with it. Um And that's a really difficult nut to crack. Um But I think you've got to take a longer term view that if you get people early um when they're coming through the training program. Um and you explain to them that toxic cultures have a direct effect on patient safety, that's a kind of unavoidable truth really that is well demonstrated. Um And if there was a medication or an operation that was having such a negative impact on patient outcomes, then, you know, you would, you, you would struggle to market it. Um I guess one of the inspirations for the course was the knots course. So I doubt many consultants coming towards the end of their career had any kind of human factors training. Um But nonetheless, it's kind of widely accepted now that human factors have a huge role to play in the outcome for patients. Um And conflict resolution is a, is a subset of human factors, obviously. So, II think culture change takes a long time. Um, but it doesn't happen by accident either. So you, you've got to have a consistent message. Um, you've got to offer people who are interested education about it so that they can then pass it on in the same way that you pass on learning to do a vascular anastomosis or a hernia or whatever it might be. Um, because we know that's how doctors learn, they learn from their role models, they learn by watching other people do things and then being guided through things. It's no different with conflict resolution than it is in the, the kind of nuts and bolts of surgery really. But it, it does require people like the Edinburgh College to put it front and center to make people realize that it, it's important. Yeah, absolutely. Maybe a tiny bit of, um, a controversial question. But, but do you think that could be considered not exactly a gap but something maybe that it, it could be done more about it, even, even in our surgical training or course surgical training or even medical training, maybe. Do you think it should be something that um maybe um the leaders should, should start looking into that? So, so we are more emotionally intelligent a as we continue developing so we can manage better conflict and therefore achieve better outcomes for everyone involved. Yeah, I mean, I guess you would expect me to say yes, but like I say, I think we're as a surgical trainee in the UK, I personally feel you get brilliant training in managing patients doing the operations, understanding the pathology, etcetera, etcetera, etcetera. You, you get really world class training in that. Um But II do think we don't, we do not get good training in how to work in um unpredictable teams, uh how to manage those interpersonal relationships. Um It, it, it's definitely a deficit in the curriculum. There's obviously a time pressure because the focus is relentlessly on your clinical abilities and your operative abilities, which is right. I'm not disagreeing with that. Um But I think we do need to start weaving this other stuff into the, into the curriculum and making it mandatory. Um because it, it, it does have a massive impact on patient care whether we like it or not. Um And you know, the analogy of, of NASA sending up astronauts who met each other on the same day as they flew off into space. It just wouldn't happen and it wouldn't happen in lots of other high stakes, um, high cost industries, whether it's sport or theater or, you know, global entertainment. It, it just doesn't happen. People don't just get flung together and expect to crack on with it. But yeah, we do that too in surgery and expect it all to work perfectly. And we need to find a way of, of addressing that and giving people the tools to, to overcome that systemic um imposed problem. Absolutely. We do that every four months for, for the foundation doctors in which they keep being rotated around teams and at the score surgical and as a surgical trainee, it's every six months. So as you said, um we just thrown into a new place with the new persons and new team that we know they don't know us, we don't know them. And then we have to adapt building new relationships and by the time that we invested to six months and then it's time to rotate again, which brings us to um your, one of your first slides about empathy, declining with the time. I think this could be a factor also takes less empathy because at some point you're gonna think is it really worth it? Me putting all of my time, all of my effort to connect with, with my team if I'm living in six months and vice versa, like if from the trainer's point of view. Um Whether um is it worth so to speak, investing in someone that's gonna leave in a, in a few months. And so, so that's something that probably, um it's, I think it's been looked at uh by the de but something to, to keep in the back of our heads. There is uh one more question in our chat. Um The question is, are there more resources to learn more about conflict resolution in the surgical team and theaters? Yeah. So there, there is literature out there um As Ruth will know because she's reviewing it at the moment and hopefully for a paper that we're going to produce um next year. Um So there is stuff out there. Um Again, it, it, it is a difficult thing to study and qualitative work doesn't necessarily come naturally to surgeons who like dealing with numbers and um you know, meta analysis and things like that. But nonetheless, there is, there is a literature there. Um There is some stuff on the Edinburgh College website which is open access. You don't need to be a member of the college to, to access it. Um in theory, all deaneries should have this stuff out there as well. But in my experience, that's highly variable. Um and, and not always effective uh which is something else we're working on in the northwest. Um So, yeah, I don't think there were huge amounts of resources. Um Obviously, we identified a gap um that encouraged us to design the course. Um But again, it's just about putting it out there as a, as an idea and hopefully you can get some momentum behind it in the same way that the human factors causes it. Mm um Tama comment on, on the chat that um he said or they said um in our hospital we have a department developed for freedom to speak up. I think it should be encouraged across the NHS cultural changes uh need time and efforts from everyone similar to this webinar. Yeah, II agree to, I mean, I mean, every um every hospital in England and Wales should have a freedom and speak up guardian. Um I have to say, I'm not sure they're necessarily always that visible. Um which is something that, you know, it, it may be variable amongst different hospitals, but nonetheless, there will be someone in each hospital who have, who has that role. Um Again, I think it's, it's a good initiative because it, it raises the idea of it. Um you can draw your own conclusions as to whether people have confidence in, in that system that will allow them to speak up. Um It's variable, unfortunately, yeah, I welcome any last questions. Um If people would like to, to put them in the, in the chat, um I will ask you something. I asked her yesterday on Twitter, er, what would be your top tips in terms of conflict resolution? If you have to give lists maybe like three or four. What would you say for us to go home and, and think, yes, this is something that I can implement. This is something that when I'm really stressed in A&E being constantly bleed, I have to think of these three things and then, and then continue with my own call without start shouting at everyone, which unfortunately, sometimes we all do. Yeah. So, uh I guess I can only, I can only kind of describe what I try and do um, amidst the chaos of being the on call consultant. Um, just think about one person at a time, just treat the patient in front of you and do your best for that patient in front of you. And remember that behind each patient there is family members, um, you know, er, friends who were actively engaged in their experience as a patient as well and worried about them just as a side point. Um, a lot of the complaints that I deal with, uh, for our, our department come down to lack of communication with friends and family. Um, and it, it's exhausting and it's the last thing you want to do when you spend six hours in theater is to have a 20 minute chat with the family. Cos it, you're exhausted but that kind of stuff that empathic approach goes a long way. So that, that's, I guess that's a way of minimizing conflict with patients. I think um in terms of minimizing conflict with your colleagues, again, just understanding where they're coming from is an active process. Um And if you, if you're not flexible in the way that you communicate, then you'll just have conflict left, right and center. Um And I think the, the, the examples of conflict that a lot of people give is um with managers in particular. And I think we don't do enough as consultants to think about the experience of managers. Um They are under huge pressure from the Department of health, particularly the more senior managers in the hospital and they're essentially running a multibillion pound organization in some situations. Most of them are multimillion pound organizations um with increasingly fewer resources with increasing patient demands and expectations. And if they don't perform, they get sacked, which is something that's actually very hard to do to a surgeon. Um It's very rare that any surgeon would go around feeling they're gonna be, they're gonna lose their job for underperformance, but that is a daily experience for particularly the senior managers in a in NHS trust. And a lot of the time, like I say, the, the managers are transferring the pressure that they are under from the department of health onto the clinicians. The best managers find a way of triaging that and only applying pressure to the clinicians that is absolutely necessary. And again, excuse me, again, I think we don't really see that as, as surgeons um we tend to think that the managers just transfer it all, but actually the best managers filter a lot of the stuff out to keep it away from the clinicians. II, don't think we necessarily appreciate that as a group of clinicians. Um And there are also factors way beyond the control of most individuals that um that can, that can cause conflict but perhaps perceived differently by a surgeon who just wants to get a patient on the table. Um And I guess if you identify those kind of systems failures in your, your trust, then you're an important part of the team and it, and it, you, you at least share some of the responsibility to try and optimize our systems to minimize conflict and patient harm in future. Um So, yeah, I think fundamentally, it just comes down to empathy, whether it's with your patients or your colleagues doesn't really matter. You just have to see things from their point of view. You still may not agree with them, but at least you might understand where they're coming from and that might minimize conflict. And if you can do that with a flexible communication style, then you're more likely to get what you want and less likely to run into the kind of situations where you end up having a punch up in the corridor. No, that's really, that, that's very useful um advise and um something for us to really try to, to take back and um and, and apply those two types of advice on our day to day job. And uh I think as I said, empathy is really key and um with the pressures of that we are facing, whether it's our life work, um staffing levels, um et cetera, we can see the empathy um bar slightly going down, especially at the end of four or five days of being on call on the stretch, we are just um almost burned out. So, um well, thank you so much for giving us your time in this evening. I hope everyone enjoyed this webinar. I for sure did. I think I've learned quite a lot and I have a lot of food for thought and reflections to do on my own time and certainly changed c certain behaviors to improve. Um Please um if there's any of the last questions, let's do it now. And if not, um thank you everyone for joining us and do, don't forget to fill in your feedback so you can receive your certificate for attendance today. And this is part of the uh academy as part of the wellbeing month. So make sure you're looking at yourself, remember, empathy, but first of all, remember empathy for yourself as well. Some days are tough. So it gives you time to recover and be aware of burnout. So you never reach that point. And um there are multiple helplines that you can uh seek for support and uh we are here to keep guiding you as well and we on Twitter with our well being Wednesday, so keep following us. Uh have a nice evening. Everyone will not take more time and I'll see you later in a little later in in a different webinar. Bye everyone. Thank you. Thanks for coming. I appreciate it. Thank you. Yeah. Mhm.