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‘Tick box’ legislation no match for culture change

Mid-Staffs sounded sirens for change, which have been ringing through Parliament ever since. This came to a crescendo with the government’s response to the Francis report that it would place a statutory duty of candour on providers.

MPS has long lobbied against a statutory duty of candour and we are relieved that Jeremy Hunt is not going to hastily decide on a statutory duty of candour on individuals. But legislation of any kind does not encourage clinicians to communicate with their patients. While the government continues to consider the scope of the statutory duty on providers and whether this will extend to individuals, we continue to put forward an alternative – creating a culture of openness.

Legislation is no match for a culture where there is real communication and learning, leading to the best quality of patient care. Despite the understandable appeal of a legislated duty, the risk in creating this ‘tick-box’ mentality is that it does not support the intensely sensitive, personalised and patient-centred conversations that should happen with patients and their families when something has gone wrong. Sincerity and empathy should be at the heart of healthcare and this can only be achieved through a cultural shift.

Other parts of the world have tried to mandate disclosure and legislate for openness with mixed results. Going back to basics, we need to create a culture where healthcare practitioners inform patients and colleagues of errors not because legislation tells them to, but because they feel supported and it’s the right thing to do.

But we can’t afford to wait, changes must be made now to prevent further failings and healthcare providers must make steps to improve the culture of their organisations.

A further problem with legislation is that you exclude opportunities for improvement – for example legislation whereby patients and their families are only informed when there is a serious injury or death would also fail to address the learning opportunities from near misses, which are free smoke alarms for patient safety.

I’m pleased to see that the government is undertaking more work with regulators to encourage healthcare professionals to be candid with patients at all times. We know from a survey of our members that 70% said they received no or limited support when a mistake was made. Improving a manager or clinician’s understanding of error as an inherent risk will help to achieve an environment where openness and learning is the norm.

We also know from our members that they lack confidence in the process for reporting concerns. However daunting the process might be, we have to remember that the alternative – doing nothing – is putting patient safety at risk and could lead to more organisations facing scrutiny like Mid-Staffs.

I paid a visit to Hong Kong last year where I saw first-hand the culture of open disclosure that exists in hospitals there. I came away thinking how they successfully managed to put the focus for staff on listening and learning, without fear of repercussions, and that is exactly what we have to do here in the UK. We need to make raising concerns an integral part of providing health and social care.

This change has to come from the top. Strong leadership will pave the way for a change to a culture of openness, where raising concerns becomes second nature to all healthcare professionals. Good governance and effective leadership goes hand-in-hand with achieving a culture of learning and improvement.

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One Response to “‘Tick box’ legislation no match for culture change”

  1. Malcolm Morrison says:

    An excellent article! We need less ‘law’ and more ‘ethics’ in healthcare.

    One of the items in the Hippocratic Oath is “First do no harm”. Medicine has always been, and always will be, associated with ‘risk’ – for diseases, and treatments, are both ‘dangerous’ – the ‘art’ of the doctor is to balance the risks of one against the other and to try to reduce the risk to the minimum. But ‘mistakes’ will always happen, however careful we are – but, as Dr Bown says, we must learn from them.

    The airline industry has always had a ‘culture’ of reporting errors and ‘near misses’; we must aspire to their heights!

    When Dr Bown says “This change must come from the top”, this depends on how one defines ‘the top’! I would suggest it is the DOCTORS – particularly the consultants – who must lead the way and must educate the managers and politicians – and, maybe, even the lawyers!

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