Experiences of implementing a peer support programme for surgeons after adverse events.

Abstract

Introduction: Surgeons are profoundly affected after adverse events (AEs). Evidence suggests that surgeons want to talk in the aftermath but often speak to no-one after an AE. Furthermore, surgeons do not engage with existing support mechanisms and have been described as a “minority within a minority” in this regard. While surgeon-specific peer support programmes can be effective, only two published programmes currently exist, both of which are in the USA. In light of this, the Surgeon Peer-led Post-incident Response Teams (SUPPORT) Improvement Collaborative was launched in January 2024 to address this gap in providing peer support for surgeons following AEs in the UK. Given the lack of in-depth research focused on experiences of implementation of support programmes for surgeons, this study aims to understand surgeons’ experiences of implementing the SUPPORT programme, and specifically to qualitatively explore the barriers and facilitators to successful introduction. Methods: A total of 12 UK and Irish Trusts enrolled in the SUPPORT project, from which 55 individuals participated and set up 'site teams' at their respective organisations. In-depth semi- structured interviews were carried out online with clinicians who were part of the SUPPORT site teams. A total of 16 site team members, most of whom were surgeons, completed a semi-structured interview between January-April 2025. The interviews explored experiences of implementing the project including barriers and facilitators to the initiative, experiences of providing peer support to surgeons after adverse events and the potential impact of the SUPPORT collaborative. Reflexive thematic analysis was undertaken in order to identify broadly recurring themes across the dataset. Results: Our research found that peer support programmes are perceived as necessary in the wake of AEs, but this strength of belief stands in contrast to the operational challenges encountered in the introduction of this initiative. Overall participants' experiences of implementing the project were positive, particularly with respect to the strength of interest in the topic and the impact of the project on surgical culture. Key facilitators to successful implementation included the involvement of site team members who held managerial roles, allowing them to secure meaningful institutional support. Several common challenges were identified, including lack of time on the part of the site teams and difficulty in identifying AEs and surgeons in need of support. Conclusions: This study suggests that successful implementation of peer support programmes for surgeons requires significant cultural and organisational change. Through understanding surgeons' experiences of implementing the SUPPORT programme and specifically the barriers and facilitators to introducing it, we hope to improve support for surgeons after AEs in participating Trusts as well as to address an important gap in the literature in terms of qualitative data. However, this work also highlights the importance of a longer-term goal; that the existence of support mechanisms and the need to access them are no longer stigmatised and instead form an accepted part of surgical culture.