A new code of conduct for surgeons should help address longstanding concerns about inappropriate behaviour in the cardiac surgery division, says the head of the department of surgery for Nova Scotia Health’s central zone and Dalhousie University.

“We as surgeons have been put on notice that we’re going to call each other out,” Dr. Gail Darling said this week.

“We’re going to call you out if you’re swearing or you’re denigrating or you’re bad-mouthing somebody. We’re going to say, ‘You know, that’s not OK in 2023.'”

Unprofessional behaviour by some surgeons was flagged in reviews of the division in 2010 and 2016 and, following further allegations that included bullying, harassment and racism, was part of the impetus for a third review that was ordered last year.

The 2010 and 2016 reviews both said the division needed a code of conduct with teeth to address surgeon behaviour that leadership seemed unable to get under control.

Darling said she thinks this new code, intended to work along with respectful workplace policies already in place for the health authority and Dal, should mark a turning point.

The code includes a grading system modelled after an approach used in Alberta that lays out responses to certain types of behaviour and what happens if it persists. Darling said that starts with more minor behaviour that might have been brushed off in the past or that people grew to accept as a part of working with certain people.

Darling said she thinks progress will follow as an atmosphere develops where people feel comfortable speaking out when they see problematic behaviour.

“It’s going to be little baby steps forward and that’s what we have to do,” Darling said.

While Darling and her team worked on the code of conduct and the independent review was taking place, a clinical assessment of the cardiac surgery division was also ordered.

That review centred on previous data reporting by the Canadian Institute for Health Information that showed results for 30-day, in-hospital mortality after isolated coronary artery bypass graft surgery were higher at the QEII Health Sciences Centre in Halifax by a statistically significant margin compared to other Canadian centres.

Review results ‘very similar’ to national data

The health authority has declined to release the report, which Darling classified as a quality assessment. But she said the findings are “very similar” to the CIHI results.

The information was shared with surgeons, corrective measures are happening and Darling said she anticipates improvements in the upcoming year.

“I think it’s already fixed,” she said, declining to elaborate.

“You shine a light on problems and they get better.”

The most recent division workplace review, released in March, included recommendations intended to get the workplace back on track.

Actions have already been taken on some of those recommendations while others will take more time.

Progress on recommendations

The division has a new interim chief. Veteran surgeon Dr. Jeremy Wood is filling the role until a permanent chief can be hired.

Darling said that process has not begun and officials would wait until after they finish recruiting a more junior surgeon to bolster the division’s ranks.

There are external factors influencing that decision.

“There aren’t a lot of people around right now looking for head jobs,” said Darling.

“We’re anticipating that won’t be a slam dunk, if you will.”

The review recommended hiring intensivists — medical practitioners who provide specialized care to critically ill patients — to help staff the cardiovascular ICU so surgeons would not have to split their time between that work and operating.

But Darling said officials have decided instead that new team hires should have background in working in a cardiovascular ICU so work can be distributed more evenly.

The ideal would be for the unit to be staffed with two heart surgeons, two cardiologists and two cardiac anesthetists, all with experience working in cardiovascular ICUs, along with the director of the unit who would be an intensivist.

Fellowship program to be discontinued

The review also called for an examination of the viability of the division’s fellowship program. Disagreements about roles and responsibilities among some surgical residents and fellows, and allegations by some fellows of favouritism toward residents, created acrimony in the division.

Darling said the fellowship program will be discontinued after the last remaining fellow completes their training. The cardiac surgery training program will shift its priority entirely to surgical residents.

Things reached the point where there were too many fellows in the division, said Darling.

“We just decided we couldn’t provide good training to both groups at the same time,” she said, later adding:

“The fellows, when they come, they want to be in the operating room; the residents want to be in the operating room and they can’t all be in the operating room at once.”

‘People want to work here’

Despite the negative publicity the division has received in recent years, which has included the former division chief unsuccessfully suing the health authority over his removal from the post, Darling is not concerned about recruitment efforts, which include bringing in more specialized nurses.

“This is a very highly respected division of cardiac surgery, always has been, and I think they will be successful,” said Darling. “People want to work here and that hasn’t changed.”

The surgeons in the division have come together, she said, and “all those little things that were reported are actually ancient history, and they were ancient history even when you reported them.”

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