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Respect is at the heart of professionalism and central to being a good surgeon. How we behave shapes our culture and profession and impacts on the safety of our patients.
Much has changed inside and outside the College over the last six years, in relation to discrimination, bullying and sexual harassment. It will take much more time before these problems are a thing of the past. In the meantime, we are at the forefront of a wave of change that is transforming an historic, global tolerance of unacceptable behaviour and creating an appetite for a new order, based on respect.
RACS is grateful to all our partners across the health sector and within the College who are committed to positive system-wide change. Formally and informally, we are collaborating with many organisations and individuals who share our goal of improving patient safety by fostering respect in surgery.
Within the College, we work closely with our Speciality Training Boards and Specialty Training Boards to maximise the impact of our efforts to build respect in surgery. Externally, we work with employers and other agencies committed to positive cultural change. We now have 35 partnership agreements with organisations across the health sector that share our goal of building a culture of respect in surgery and in healthcare more broadly.
Our Action Plan (PDF 1.05MB) continues to guide our work and is focused on three main areas: culture and leadership, surgical education and complaints management. Successive RACS Councils continue to endorse and actively support this long term plan.
Collaborating for change
RACS is working with health services and employers of surgeons, signing agreements which commit both agencies to actions that support a culture of respect.
Information Sharing Protocol
As part of our work to build respect in surgery, we’ve adopted a new protocol (PDF 63.63KB) to guide information sharing with hospitals, to help RACS monitor and manage the training environment.
The protocol applies to information sharing in complaints management, when concerns have been raised about breaches of the RACS Code of Conduct, including discrimination, bullying and sexual harassment.
It sets out structured information sharing thresholds and details what information about surgeons’ professional conduct will be shared between a hospital and RACS, and when it will be shared.
The protocol (PDF 63.63KB) is consistent with RACS privacy policies and the principles of procedural fairness.
Answers to frequently asked questions can be found here (PDF 53.92KB).
Improving surgical education is a cornerstone of our commitment to building a culture of respect in surgery and is consistent with our vision to lead surgical performance, professionalism and improve patient care.
The first wave of ourBuilding Respect Improving Patient Safetyeducation program focused on increasing awareness and knowledge of discrimination, bullying and sexual harassment through a mandated e-learning module. This training is now a pre-requisite for application to surgical training.
More recent work has focused on surgical educators and RACS committee members, by expanding their teaching skills (including their ability to give constructive feedback) and equipping them with strategies and skills to respond to unacceptable behaviour.
As we roll out our Building Respect program, we continue to draw on the intellect and guidance of Professor Jerry Hickson, an internationally acknowledged leader in approaches to promote quality, patient safety, and risk prevention in health care.Read more about our courses and training.
Feedback and complaints
Complaints management, and working with employers, are areas of ongoing focus for the College. Effective complaints management is a shared endeavour between RACS, individual surgeons, Trainees, employers, and in the most serious cases, regulators. Each of us has a role to play.
One of the big challenges is to get the best possible interface between complaints processes employers have in place and RACS internal systems. An important goal in this work is to agree how to best work together to understand problems and deal with them effectively.
Our success in complaints management long term will be measured by the surgeons who improve their practice, increase their professional skills and help foster a culture of respect in surgery.
Policies and procedures
We have updated many of our policies and procedures to make sure they reflect RACS' commitment to building respect, and improving patient safety.
Some of the most important policies and procedures that have been developed or updated include:
- Code of Conduct
- Privacy of Personal Information (PDF 148.59KB)
- Privacy (Conduct Matters) policy (PDF 160.63KB)
- Complaints policy (PDF 163.97KB)
RACS routinely reviews and updates its policies and procedures. We will update this section progressively.
Evaluating our work
RACS Action Plan: Building Respect, Improving Patient Safety sets eight clear goals. Meeting them involves a sustained effort over many years. To make sure our work is targeted and effective, we have developed and published an evaluation framework.
This comprehensive evaluation framework (PDF 757.1KB) (PDF 757.1KB) is helping us measure our progress and continue to refine and improve all our work to build respect in surgery.
A systematic process led by external consultants, backed by a Project Reference Group, supported its development. The evaluation framework is helping RACS assess the reach and impact of our work over the short, medium and long term, and specifically after five and ten years.
The first evaluation
Our first evaluation was conducted in 2019 and examined whether we had done what we set out to do. Future evaluations will assess the impact of our work.
The first evaluation included a survey open to all Fellows, Trainees and International Medical Graduates, qualitative interviews and analysis of other data sources. Using the Action Plan’s planned outcomes as a base, key evaluation questions (PDF 231.54KB) (PDF 231.54KB) and appropriate indicators and data sources were identified.
Results of the phase one evaluation informed the next phase of our work and helped shape our priorities as we continue to build respect in surgery. The College is delighted that independent scrutiny has endorsed the work we have done and our commitment to doing it.
“The College is now seen to be in step with public opinion and broader societal shifts. More than this, the College is now seen as leading the way as an institution that has acknowledged these problems and made a serious commitment to addressing them. “
The second evaluation
We have checked that our work to build a culture of respect in surgery is on track and starting to make a difference, through a second evaluation conducted in mid-2021.
The five-year evaluation examined perceptions of RACS’ implementation of the Action Plan: Building respect, improving patient safety. It found overwhelming (more than 90%) support for RACS work, leadership and commitment to working in partnership to improve the culture of surgery. Detailed evaluation results will inform RACS’ next five year plan.
A separate follow-up prevalence study, also conducted in mid-2021, looked at reported rates of unprofessional behaviours. Results of the 2015 and 2021 prevalence studies are not directly comparable. The 2015 study detailed participants’ total experience of discrimination, bullying and sexual harassment, over their working lifetimes. The 2021 study tracked reports of these kinds of unprofessional behaviour in the last 12 months.
A second, external review of our feedback and complaints process is now complete. The review was conducted in 2020, and designed to ensure that our process was timely, transparent and procedurally fair, as recommended by the Expert Advisory Group.
The reviewer endorsed RACS feedback and complaints process as appropriate and adapted to the limits on the College’s powers and the environment in which it operates.
Read the findings (PDF 428.08KB) of the independent external reviewer.