Table 1

Key recommendations and action points for implementation at individual, departmental and national levels

CategoryDepartments and individualsUniversities and national bodies
CultureEstablish a positive organisational culture with clear standards and expectations of behavioural norms from all members of the cardiovascular teamNational bodies should develop a positive organisational culture and ensure that similar standards of behaviour are expected of its members
ReportingEncourage individuals to report inappropriate behaviour locally and to escalate using the recommended model outlined/appropriate model agreedEstablish a cardiology reporting strategy to provide an overview of regions/hospitals/departments with ongoing cultural issues related to inappropriate behaviour. Summary information from this reporting should be made easily available
RespondingEnsure clear policies, practices and procedures in respect to inappropriate behaviour are in place, iteratively reviewed and included in induction and staff handbooks. These should be informed by HR practitionersIncorporate Freedom to Speak Up Guardians into the reporting and responding strategies within NHS Trusts
LeadershipDesignate and provide training for a behaviour lead who is given a formal remit to act as a central person to whom members of the cardiology team can report inappropriate attitudes, language, or behaviour. This could be an individual from outside the department who can provide an external perspective and an objective arbiter when allegations of inappropriate behaviour are made. There should be support (which may be formal or informal) from a HR professionalNational bodies should include an individual tasked with promoting professional standards on their committees
Funding, promotion and recognitionWhen considering promotions and leadership roles, departments should consider any incidences of inappropriate behaviour in the selection processFunders and universities should include incidences of inappropriate behaviour as a key consideration when allocating funding and advancement within cardiovascular research.
National bodies should take into account past inappropriate behaviour when considering individuals for roles within their organisation, at meetings, or the presentation of awards
FeedbackMake routine use of multi-source feedback where evidence of both good and inappropriate behaviour can also be raisedUniversities should ensure that appropriate mentors and advisors outside of the direct supervisory chain are available to everyone taking part in cardiovascular research
TrainingProvide mandatory training for all on:
  1. Workplace culture (as a team) including recognising and dealing with inappropriate behaviour at work

  2. How to give and receive structured feedback, including addressing suboptimal outcomes and/or performance

  3. Unconscious bias training to improve awareness of the drivers of inappropriate behaviour

  4. Cardiology-specific human factors training

National bodies should work to develop appropriate training packages to improve accessibility to departments/individuals. They should ensure that they are priced at a reasonable level and included in study budgets where available