The era of the bully is over

i’ve always hated bullies

since being the uh the fat jewish kid at

school that never quite

fit in and then becoming the trainee who

realized i could do something about

these behaviors

i’ve always hated bullies and so i was

pretty lucky

when i got to be part of an organization

that meant we could do something about

it

now actually this organization is a

trainee organization and it was the

uh team before me when i was just vice

president who thought we should do a

census

we wanted to ask trainees how they felt

about things

kind of a state of the union type thing

so we asked them all the questions where

do you live where do you work

and one of the things that i really

wanted to look at were behaviors like

bullying undermining and harassment

now we’re not daft and so the reason we

got this data was because we said look

we also will have a price draw and give

you two grand

if you win it so we actually got a

pretty good amount of data out of it

now i knew what i thought would happen

i knew what i thought it would say it

would say that some people are unhappy

and some people were pretty happy

but i was shocked by some of the the

data we got

now one of the other reasons that we got

such good data was

that we’d actually said to these

trainees we’re gonna make you a pledge

number one

we’re gonna keep it anonymous so that no

one can go it’s you you said this

and number two we promise that whatever

we find we’ll do something about

if it says that we’re wasting our time

bark up the wrong tree we’ll just go to

the pub and say look okay fine it’s not

a problem

but if we find something something

meaningful something we can do something

about we’ll do it

and this data came back and it blew my

mind

but people use words like bullying and

harassment undermining and they’re

pretty emotive words and they mean very

different things

so uh they need to be defined and

bullying is where someone uses

power to make you feel frightened or

afraid and do something you don’t want

to do

okay i’m your boss and you’re not gonna

have lunch today

okay undermining is far more subversive

undermining

is where you make someone feel small

worthless

powerless like they have no value and

harassment

well harassment are those protected

characteristics we talk about age

gender sexuality and so on and we asked

two really powerful questions we asked

whether or not people had uh experienced

those things

in the month pre pre proceeding the the

census and if they’d ever perceive them

one of the other big challenges people

say is well perception

it’s all in the eye of the beholder but

but is it really i think that’s one of

the more powerful things because

actually and this is one of the things

that always

comes up when we talk about these

behaviors is uh

if i’m chatting to you and you’re my

trainee and

and we get on really well and i just

tell you just man up just man up

and we have a laugh and it’s great and

everyone laughs except for that one

medical student at the back of the room

that one nurse

in theater who goes i can’t believe he

spoke to that person that way

i can’t i can’t believe he made him feel

that way

and so actually perception is really

powerful and we had some data that

showed that there was

a problem with these behaviors but don’t

get me wrong this is not

a trainee problem there’s loads of other

surveys out there and i could if i want

to put loads of graphs up to show that

everyone experiences because this isn’t

a trainee problem this is a cultural

problem

and so to fix it we need to change

culture

now here’s the thing i believe that

training

should be like family so your mum and

dad

loved you i hope

and what that meant was that sometimes

they rewarded you

you’ve done really well good for you

here’s here’s a present

and sometimes they told you go to your

room and you

mum but the next day you knew that

they still loved you they knew what was

best for you and that’s kind of the

relationship you had with your parents

you would hope

but here’s the thing a couple of years

ago someone turned around to parents and

said um

don’t hit your kids not only don’t hit

your kids

if you hit your children that’s abuse

you’re a child abuser what

yeah it’s bad parenting to hit your kids

and so what happened well the parents

said well

my my parents hit me and their parents

hit them

so does that make me a bad parent and my

parents were bad parents

in fact were all parents preceding this

press release bad parents

and what we say is no it’s not like that

at all because if you make it a blame

thing

if you make it a them and us thing a

trainee and a trainer thing or a doctor

and a nurse thing

then instantly it becomes a blame thing

and so of course people are going to

take it personally

you’re a bad parent you’re a bad trainer

you’re a bad nurse or a bad

person what we’re saying is actually no

we just know that things have changed

it’s been a paradigm shift and we know

that there are better

ways of doing things there are better

ways of training than making someone

feel small and building them up again

there’s better ways of of educating

someone than

bashing the knowledge into their head

because actually that does work

there are just better ways of doing it

that means that everyone feels better

about it

but if you think about other campaigns

to change culture if you think about

smoking or seat belts

this is going to take a generation

because it’s not easy because you know

what

you have to reflect i’m an orthopedic

surgeon i’ve reflected

and when when you reflect

that always gets a laugh when when you

reflect you realize

oh i’ve done this too i’ve done this

too and and i try to be better at work

but you know what i i’ll share something

with you

i still do it sometimes sometimes i put

my foot in it

more often than not i put my foot in it

but the fact is

that the hardest bit is admitting that

you have to change

and that maybe even the best of you and

the worst of you

can do a bit better can change but big

changes

is nearly impossible everyone stop

smoking

problem solved it’s never going to

happen so what you have to do

is small changes tectonic

change no one here will know that the

tectonic plates under your feet are

moving but they are

and you have this slow movement and

without realizing it the world is

changing

under your feet and so that’s what you

need to do and the best way to do it

is to start with yourself so you say i’m

looking in the mirror next time i say

something stupid at work or something

hurtful or something spiteful or

something that isn’t helpful or

it’s the middle of the night and someone

calls me up and i say you know what did

you even go to medical school

i’m really sorry um i’m really sorry i

shouldn’t have said that how

how can i help you okay you change

yourself

and eventually if you change yourself

enough people will notice

they’ll notice that you’re changing and

so people will go why is it that people

prefer to work with

that person than that person or they

really like it when that person is on

call and not that person

and so what they do is they role model

off you and that’s not a hierarchical

thing

people role model in all directions so

suddenly you change yourself

and so the people you work with change

so you start to change your team

suddenly

maybe your boss or maybe your junior or

maybe your colleague goes i saw simon

after a really stressful case go

do you know what guys i’m really sorry i

raised my voice during that case but

thank you very much

i think i think i might do that because

people seem to respond really well to

that so so you start to change your team

and then you realize of course

why isn’t patience like going to that

operating theater or that clinic

why is it that the nursing staff always

try and swap and do this instead of that

and so you start to have a better team

and of course we’re all competitive so

when people go well that team

that team’s better than this team i want

to be that team

how do i make my team like their team

and so suddenly you start to change

your unit and if you change your unit

eventually people go why is that you’re

doing better than that unit

and so eventually you change your

hospital and as we’ve seen from other

speakers today

certain units certain hospitals get held

up look at what they’ve done look at

what they’ve achieved and if you can

change a hospital then you can start to

change

the health service the whole health

service

not just hospital not just gp practice

not just

primary care or secondary care or

paramedics or everyone and then

because we’re doctors and nurses and

health care givers we start to also

change the way we interact with our

patients so actually we literally

start to change the world

and it all started because i asked you

to

change yourself and i actually believe

that by doing that we can completely

change the culture we work in

and the place where we make people

better

will get better you