Invited Service Review Report Report on the adult cardiac surgical service The Newcastle-upon-Tyne Hospitals NHS Foundation Trust

The Trust must encourage learning and engagement across the Directorate to improve interpersonal relationships and to effect positive change. The Trust should consider professional mediation to facilitate this process. The RCS Eng’s “Managing disruptive behaviours in surgery”18document provides some usefulguidance.

Personnel changes and/or creation of new posts must be actioned to further assist the improvement of cultural behaviours in the unit.

The Trust should work with the regional training programme and postgraduate medical dean to improve its trainee programme, which requires removing trainees with a ‘National Training Number’ from adult cardiac surgery posts for a temporary period to protect their wellbeing.

The Trust should investigate and address any claims of bullying and sex discrimination sensitively and even-handedly.

There should be a robust mechanism for reporting on the DATIX system and a learning/ feedback exercise outlining any trends and how these will be positively addressed. Assurances should be given that any feedback will be treated in confidence.

The Trust should revise the current ‘unstable cases’ and for out of hours procedures, clarifying consultant surgeons’ responsibilities. All consultants should have an input into the development of the revised process and all views/opinions should be respected.

Given the important regional transplant and mechanical support, and aortic services provided, the Trust should ensure that the aortic and transplant services processes are improved and the appropriate support is provided to team members. The aortic service could be strengthened by the appointment of a second consultant cardiac surgeon with an aorto-vascular interest. The team, in association with vascular surgery and interventional radiology should, taking into account likely demand, decide the scope of the interventions they will undertake and where necessary arrange training and proctoring for the whole team to develop these skills. They should develop necessary, common protocols, especially for follow-up of patients after aorto-vascular surgery and aortic dissection.

Leadership and managers shouldembark on a programme to improve their communication and coaching/mentoring skills. The RCS Eng’s “Surgical Leadership: A guide to best practice”19 document provides some useful guidance.

There shouldbeformal documentation and a clear audit of any decision making and action points being noted for MDT and M&M meetings, and other interdepartmental MDTs.

The Trust shouldconsider creating the role of a dedicated MDT Coordinator to attend the meetings to ensure notes were accurately recorded and disseminated following the meetings. Each consultant’s job plan should also be updated to incorporate dedicated time for MDT attendance.

The Trust should draw up a formal code of conduct of expected behaviours at MDT and M&M meetings. This would entail the agreement of the affected personnel to actively apply the code.

The Trust should take steps to ensure that clear and comprehensive systems are put in place to monitor the quality and safety of the ongoing operative outcomes of the service, and to ensure that these continue to exist within nationally understood parameters for cardiothoracic surgical services. This should include contemporaneous monitoring of surgical outcomes and early review and discussion of any unexpected outcomes or surgical complications.