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Managing & Supporting Doctors in Difficulty

Managing Doctors in Difficulty, and Doctors exhibiting challenging behaviour 

Dr Luci Etheridge, Deputy CMO and Responsible Officer, Consultant Paediatrician St George’s University Hospitals NHS Foundation Trust 
Performance Assessor GMC Fitness to Practise

• creating the right team and working environment: our experience
• how do you ensure early identification of concerns
• doctors in difficulty and difficult doctors: what’s the difference?
• how to diagnose the nature of the issue
• ensuring open and honest communication
• behavior and conduct: setting the ground rules
• confronting inappropriate or disruptive behavior
• understanding the root cause of the problem and tackling concerns
• supporting Doctors through complaints, investigations and inquests
• developing an approach based on values based leadership
• enhanced support through COVID-19

Luci shared experiences from St George's of changing the organisational culture to better identify and support doctors in difficulty or exhibiting challenging behaviour.  She said the organisation culture and culture of wider society does impact on doctors performance and them getting in difficulty. She said; "there is evidence of association between positive staff perception or organisation culture and patient outcomes".  It's difficult to manage in an effective and fair way, supporting doctors but keeping patients and safety paramount. 

Luci named 5 main cultures within an organisatin based on work by Suzanne Shale 2019:

-Diva Subcultures -Factional Subcultures -Patronage Subcultures -Embattled Subcultures -Insular Subcultures 

St George's worked on changing the organisational culture after a number of cardiac deaths in which the reviewer found; 'a persistent toxic atmosphere' with surgeons 'working in camps' and displaying 'tribal like activity'. They found a conflict between how to balance being seen to tackle persistently poor behaviour with being seen to be fair and just. Cultural solutions included:

-clear shared values -robust governance at all levels -promote and role model wellbeing -invest in relationships with staff -develop local leaders -shared responsibility for performance. 


The importance of looking after ones own wellbeing – a real life example of what happens if you don’t

Dr Laurel Spooner
Laurel is a Doctors in Distress representative and retired General Practitioner. Laurel will reflect on the challenges of the working culture within the NHS, and how we must move to a kinder system that treats its staff with much needed compassion.


Bringing joy back into work: supporting health professionals with mental health concerns

Dr Caroline WalkerFounder of The Joyful Doctor
Psychiatrist and Specialist in Doctors’ Wellbeing 

• finding joy at work in challenging times
• supporting health professionals with mental health concerns
• simple things we can all do to keep well and support each other


Managing and supporting clinicians in difficulty

Anne RotheryAdviser Practitioner Performance Advice Service (formerly NCAS) NHS Resolution

• introduction to the work of Practitioner Performance Advice
• support available to those supporting poorly performing clinicians
• top tips and case studies based on real experience