Royal college tells trust to tackle ‘dysfunction’

A report from the Royal College of Surgeons said, while the urological surgery team at Great Ormond Street Hospital for Children were “excellent dedicated surgeons”, there were “significant difficulties in interpersonal relationships”.

The RCS team, invited into the trust by GOSH’s medical director Sanjiv Sharma in March, said the issues between two of the six consultant paediatric urologists “may have the potential to affect patient care and safety”.

It said the “apparent lack of trust and respect” between the pair and the unwillingness to collaborate could affect the unit, already under pressure from high workloads and the transition to a new IT system.

The service, based in central London, has around 3,300 elective admissions a year.

The RCS investigation said: “The difficulties in interpersonal relationships have impacted the effectiveness of the consultant team and its ability to share ideas and constructive criticism. Areas specifically identified as affected include: patient management, the development of the service, the ability of the service to adapt to changing demands, involvement in national audit and clinical outcomes.

“In addition, the significance of the dysfunction between the two consultants, seems to have resulted in trust management focussing on this, at times to the detriment of the rest of the consultant team.”

In response to the report, the trust said a coach and a mentor had been hired to work with the medics, while work on agreeing subspecialisation would follow.

The RCS report said: “There also appeared to be significant competition between some consultants for work, without clear subspecialisation being taken into account. This seemed to be adding to the conflict within the team as well as creating the potential for waiting time breaches.”

The review team said the outcomes data it was provided with was “inadequate in several respects”, and there was concern about the accuracy of data for one procedure and individual surgeon complication rates.

In its list of responses to the RCS recommendations, GOSH said it would change the way new consultants were recruited.

The report, published with the trust’s most recent board papers last year, said: “Previous recruitment has followed trust guidelines. Future shortlisting will be done with all urology consultants as per request.”

A separate, national, RCS report published in March said poor teamwork was a factor in more than three-quarters of the cases it had investigated on behalf of trusts over the previous decade.

A spokeswoman for the trust said: ”It is important to us that we are open and transparent about our services. This is why we included the review into our Paediatric Urology Surgical Service in our public board papers in November. We have also discussed this review with NHS England and Improvement and the Care Quality Commission.

”As the papers explain, in March 2019, we decided to commission a review from the RCS. This was prompted following feedback from staff and families and to ensure that the service was set up to provide the highest standards of care to the children, young people and families it looks after.

“We recognise that team dynamics and leadership within the service were not working well and that if they were not addressed there potentially could be an impact on patient care. We have therefore taken the issues raised in the report and the recommendations extremely seriously and are now implementing a robust action plan which has included mediation, leadership development and mentoring.”