Aims Traditionally, undermining and bullying in the workplace have been tackled on an ad hoc basis. We tested a structured continuous surveillance system to improve and sustain workplace culture in our children’s hospital.

Method Over 12 months (October 2015 to September 2016) our intervention was a monthly online questionnaire survey to all trainees (n=40–50) in a large tertiary paediatric hospital. A senior trainee was appointed guardian to maintain confidentiality and to collate results. Primary outcome was a composite endpoint of whether any trainees reported 1) being subjected to bullying, 2) being subjected to undermining behaviour or 3) witnessing any of the above. An intervention graded pathway was formalised to manage reports in a timely and fair process. We also collected qualitative data with free text and at feedback focus groups.

Results Our composite endpoint rates fell steadily from maximum 14 in the second month to 1 per month in September over 12 months with a total of 60 incidents. 60% (n=33) events took place in areas of greatest intensity and pressure (PICU, acute admissions and A and E). These areas paradoxically also had higher positive feedbacks. 90% of reported perpetrators were at consultant level. Of 29 reported perpetrators, only 3 people were named more than once.

Conclusion We have demonstrated that implementing a continuous quality improvement infrastructure can improve workplace culture in a busy children’s hospital. Positive strategies should be targeted at high intensity areas as they are also the areas with high feedback satisfaction.