In the high-pressure, fast-paced environment of perioperative practice, clinical excellence must be matched by behavioural integrity. It is not enough to have the skills and knowledge to care for patients undergoing surgery; we must also create a working culture that is safe, respectful, inclusive, and supportive.
The Association for Perioperative Practice (AfPP), the UK’s leading membership organisation dedicated to hospital theatre practitioners and improving perioperative care, has recognised this through its new Behaviours Charter. The Charter is a comprehensive framework grounded in the belief that civility, empathy, and professionalism are just as vital as clinical proficiency. Centred around the ethos of Signed Up for Civility, the Charter sets clear expectations for how perioperative professionals should interact with patients, colleagues, and the wider surgical team.
Endorsed by the Centre for Perioperative Care and Civility Saves Lives, the Charter calls on all perioperative staff to commit to a behavioural standard that ensures the highest quality of care while fostering a psychologically safe and collaborative workplace.
“Civility saves lives,” says Oliver Tierney, President of AfPP, adding: “When people feel respected, listened to, and valued, they perform better. Patients are safer, teams are stronger, and morale improves. This Charter is not just a list of dos and don’ts; it’s a commitment to creating a culture we can all be proud of.”
A Charter rooted in shared values
The AfPP Behaviours Charter outlines a series of personal and workplace behaviours that promote a culture of trust, safety, respect, and excellence. These principles are grouped around five key commitments:
- Commitment to Safety
- Respectful Communication
- Professionalism and Civility
- Team Collaboration and Support
- Continuous Improvement and Learning
Together, these commitments aim to ensure that all perioperative practitioners feel empowered, supported, and motivated to deliver outstanding care, while also safeguarding their own wellbeing and professional growth.
Commitment to Safety
At the core of the Behaviours Charter is an unwavering dedication to safety; not just for patients, but for all members of the perioperative team.
Accountability
Every team member is expected to take ownership of their actions and decisions. Accountability isn’t about blame; it’s about honesty and integrity. When something goes wrong or an error occurs, it must be acknowledged and addressed in a transparent, supportive way that prioritises learning and risk mitigation.
Safety as a Priority
In practice, this means following protocols, adhering to checklists, and always putting the patient first. Whether it’s ensuring instruments are properly counted, monitoring sterility, or raising concerns about a colleague’s fitness to practice, every action should centre on keeping people safe.
Risk Awareness
Situational awareness is crucial. Staff must remain alert to environmental risks; slips, equipment malfunctions, wrong-site surgeries, and speak up when hazards are identified. The Charter encourages a proactive stance on risk management through clear communication and prompt reporting.
“When we embed safety into every behavioural standard,” says Alex Duke, Chief Executive Officer of AfPP, adding: “We reinforce that every single team member has the power, and the responsibility, to make a difference. The safest teams are those that act with intention, vigilance, and mutual respect.”
Respectful Communication
Effective communication is the foundation of any high-performing team, and even more so in the perioperative setting where time is limited and stakes are high.
Listen Actively
Listening goes beyond hearing; it’s about being present, seeking clarity, and valuing others’ input. The Charter encourages perioperative professionals to pause, ask questions, and acknowledge the contributions of all team members, regardless of hierarchy.
Clear and Concise Language
With lives on the line, there is no room for ambiguity. Clear, respectful, and jargon-free communication with patients and colleagues ensures understanding, prevents errors, and supports smooth workflow.
Confidentiality and Privacy
Patient dignity must be upheld at all times. The Charter reiterates the importance of discussing patient cases only with those directly involved in care, and doing so in private, respectful settings.
Constructive Feedback
Feedback should be timely, respectful, and focused on improvement, not criticism. A team that embraces constructive feedback fosters professional development and stronger collaboration.
Professionalism and Civility
The Charter strongly advocates for civility in all aspects of perioperative practice. It recognises that toxic behaviours, whether subtle or overt, can be deeply damaging.
Use Empathy
Empathy is essential in managing stress, de-escalating conflict, and strengthening team dynamics. Whether it’s comforting a nervous patient or recognising when a colleague is overwhelmed, empathy humanises healthcare.
Be Inclusive
Inclusivity is more than representation, it’s about actively valuing diverse perspectives and creating space for all voices to be heard. It includes challenging microaggressions, recognising cultural sensitivities, and fostering equality.
Beware and Callout the Three B’s: Bitching, Backbiting and Bullying
One of the most distinctive and powerful messages of the Charter is its call to “Call out the Three B’s.” This direct appeal to stop gossip, sabotage, and bullying addresses the very behaviours that corrode team trust.
Creating a civil workplace involves zero tolerance for these behaviours and a shared agreement to report and address them when they arise.
Address Incivility
Incivility can be as damaging as overt aggression. Disrespect, eye-rolling, dismissiveness, or inappropriate humour can create psychological distress. The Charter asks staff to hold each other accountable and support those affected by incivility.
Team Collaboration and Support
No single individual can ensure patient safety and quality care; it’s a team effort. The Charter outlines key behaviours that contribute to a high-functioning and cohesive team.
Reliability
Reliability means being prepared, punctual, and consistent. Reliable team members show up fully engaged and ready to contribute. This builds mutual respect and keeps the team running smoothly.
Teamwork
Supporting each other, recognising every role, and sharing in successes and challenges forms the backbone of perioperative practice. Collaboration means stepping in when someone is struggling and celebrating when goals are achieved.
Psychological Safety
One of the most significant indicators of high-performing teams is psychological safety; the belief that you can speak up without fear of ridicule or retaliation. The Charter promotes a culture where practitioners feel safe to express concerns, admit mistakes, or challenge unsafe practices.
“We want our teams to feel empowered, not intimidated,” explains Oliver Tierney. “Mistakes should be learning opportunities, not moments of shame. The more psychological safety we build, the more we prevent harm.”
Continuous Improvement and Learning
Healthcare is constantly evolving. To provide the best care, perioperative professionals must remain committed to learning, innovation, and self-reflection.
Reflect
Reflection supports personal and professional growth. By examining our own behaviours and attitudes, we become more self-aware and better able to adapt. Team reflections and debriefs also enhance collective learning and performance.
Embrace Innovation
The Charter encourages openness to new ideas, technologies, and methods that improve efficiency and patient outcomes. This includes adopting evidence-based practices, participating in training, and being curious about emerging trends.
Share Knowledge
Knowledge sharing fosters team development and resilience. Whether mentoring junior colleagues or introducing a new piece of equipment, shared learning builds capability and confidence across the workforce.
From Words to Action: Embedding the Charter
To be effective, the Behaviours Charter must become part of daily culture, not just pinned to a noticeboard. This means leadership buy-in, peer-to-peer accountability, and structural integration into appraisals, CPD, and team meetings.
Practical strategies for embedding the Charter include:
- Incorporating the Charter into staff inductions and mandatory training
- Reflecting on Charter principles during team huddles and debriefs
- Recognising and rewarding positive behaviours aligned with the Charter
- Using the Charter in conflict resolution and performance reviews
- Encouraging staff to ‘check in’ with each other about wellbeing and morale
“This isn’t about ticking boxes,” adds Alex Duke. “It’s about transforming how we show up for each other, every day. When people feel safe, respected, and included, the quality of care improves. That’s the future we’re building.”
A Charter endorsed and empowered
The Behaviours Charter is formally endorsed by the Centre for Perioperative Care and Civility Saves Lives, reflecting its importance not just at the organisational level, but within the wider surgical and patient care community. This endorsement highlights that behavioural standards are as critical to perioperative outcomes as technical or procedural ones.
It aligns with broader NHS efforts to improve staff wellbeing, retention, patient safety, and service delivery, particularly in a post-pandemic landscape where pressures on teams are higher than ever.
From words to action: launching the Charter at the AfPP Annual National Conference
The AfPP Behaviours Charter will be officially launched at the AfPP Annual National Conference at the University of Warwick 8-9 August, 2025, a landmark event in the perioperative calendar that brings together professionals from across the UK. The conference, known for inspiring thought leadership and professional development, offers the perfect stage to introduce a Charter grounded in values that unite the profession.
At the conference, every attendee will be invited to formally sign up to the Charter, signalling their personal and professional commitment to civility, collaboration, and safety. This moment will serve as a public declaration of shared purpose; a powerful act of unity that reaffirms the strength of the perioperative community.
“We want delegates to walk away not just with knowledge and inspiration, but with a renewed sense of ownership over the culture we are creating,” says Oliver Tierney. “By signing the Charter, each practitioner is pledging to be an active contributor to safer, kinder, more effective theatres.”
Visual displays and sign-up stations at the conference will bring the Charter to life; showing what it looks like in action and inviting meaningful discussion around real-world implementation.
“The conference is more than just a launchpad,” adds Alex Duke. “It’s a chance to engage, reflect, and collectively raise the bar on how we treat one another in practice. This Charter will shape conversations and conduct long after the event.”
A culture we all own
Creating a safe, respectful, and collaborative perioperative environment is everyone’s responsibility. The AfPP Behaviours Charter provides a clear, practical roadmap to help us get there; one that holds up civility, empathy, safety, and learning as cornerstones of professional excellence.
The launch of the Charter at the AfPP Annual National Conference will mark a turning point: not only will it raise awareness, but it will also galvanise a nationwide commitment. With hundreds of delegates pledging their support, the movement for civility and cultural transformation will grow stronger, louder, and more impactful.
By committing to the Charter, perioperative practitioners are choosing to lead with integrity, champion inclusion, and prioritise both patient and staff wellbeing. The impact is far-reaching: fewer errors, healthier teams, and better experiences for those we care for.
This is more than a Charter. It’s a movement, and it starts with each of us.
For more information about the AfPP Behaviours Charter or to get involved with the Signed Up for Civility campaign, keep an eye on the AfPP website at https://www.afpp.org.uk/about/afpp-behaviours-charter/.
Picture shows the new AfPP Behaviours Charter.