Tuesday, June 16, 2015

Should it take a law?

The Telegraph reports on these comments by Sir Robert Francis about the NHS:

“I have learned from my son, and from other trainees, that we can learn a lot from the fresh eyes and idealism that doctors and nurses have when they start out. It is so important to exploit that, and not to crush it.” 

Sir Robert believes that many of the worst failings in the NHS occur when clinical staff become powerless — are left “shrugging their shoulders” rather than challenging poor care. 

He was encouraged, he says, by changes introduced by the Government to improve openness and transparency, including an overhaul of NHS regulation, ratings for hospitals and improvements to training of staff. 

But he feels more should be done. 

In particular, the leading QC wanted changes in the law to put the onus on staff to speak out if patient care is at risk – specifically a legal duty of candour to be placed on health professionals. 

“We do need to protect individuals by making sure they feel safe to report things to their employers,” he says. “I felt a statutory duty would have assisted that — too often those who raise concerns about things that go wrong become unpopular with colleagues and they need some form of protection.” 

I am not one to challenge Sir Robert's judgment on such matters, but what a shame that it should take a statutory solution to derive the result he seeks.  Around the world, there a few hospitals in which there is an environment within which such call-outs are encouraged.  These are the leading institutions in quality, safety, process improvement, and transparency.  They required no statutory approval to become learning organizations, in which all staff--regardless of rank or position--are encouraged and empowered to speak out when the situation arises.

Admittely, the majority of hospitals fall into the other category.  How many patients have been preventably harmed in those institutions? I suppose it is for the employees of those for which Sir Robert seeks regulatory protection, but what a tragedy--in the deepest sense of the word--that it should be necessary. 


Anonymous said...

In the USA a similar law would just open another very large revenue stream for the "ambulance chasers".

Maybe we need a way to make HEROES of the whistle blowers?

A new non profit institution supported by the major hospital associations, professional medical groups etc that honors whistle blowers each year?

Maybe tracks the whistle blowers over their careers to ensure they are not harmed and to the contrary helped in their careers.

Aren't leaders those who will speak up when needed? Maybe help train whistle blowers in administration, if they so desire, and guide them to plum leadership assignments?

Change the medical culture to make the whistle blowers "Heroes in Medicine"

Just a thought


SD said...

I think its naïve to think that staffers are willing to speak up when they see poor care being provided. In my experience, its the exception not the rule. As I travel to hospitals across the country (and recently in So Africa), poor care and the sequela it often produces is regularly cited to me by case managers. They admit that its rare that they would say anything to the provider in question or report their observation to anyone else. Responses from supervisors, managers or administration has perpetuated a culture of silence among the front line practitioners and the patients continue to suffer. Despite the push for a 'just' culture, the fact is, in my view, many patients are lucky to get out of the hospital in better shape than when they went in.

Tom said...

I feel the same way about physician dress codes and behavior standards. It is a shame that these have to be written out and signed. Says volumes about the lack of professionalism in some of our providers.

HP said...

Unfortunately, Right to Work Laws, a lack of labour unions, and a genuine disregard for employee rights in the USA almost guarantee silence amongst hospital staff, particularly during the fallout of a national recession. I was an RN whistleblower in NC. I do not believe the setting in which I found myself would have happened in my native Canada due to the protections identified above. No desire--none--to work in US healthcare again--for-profit or not-for-profit. They are the same.

Stephen Thornton ‏@Thornton_health said...

From Twitter:

If made a law I fear masses of false positives as a result of defensive practice.

Carole said...

Whistle blowers are "Hero's in Medicine" just imagine the amount of courage it takes to stand up and speak out for others who have been wronged knowing what it can cost them. Those told on who seek revenge on that honest and brave person should be punished to the fullest extent of the law. Truth and Transparency is fair, just and proves integrity. I can't express enough how pleased I am in these replys so far. Just honest to goodness down to earth people.

Anonymous said...

Don't think protecting whistle blowers "Hero's in Medicine" needs to be done at a national level.

Major health institutions like the Mass Hospital Association, the Mass Medical Society etc, could work together to do something in Massachusetts.

Or, if there were other like minded organizations in some New England states, maybe something could be done regionally.

Prototyping this type of organization for a national roll out would be helpful.


Anonymous said...

It shouldn't but it does because the govt. is on the side of corporations, not regular taxpayers.