Hospital Dr News

Safety lies in common sense clinical governance

Complacency, resistance to change and a failure by managers to understand the rationale for clinical governance are to blame for problems with patient safety in the NHS, claims a doctors’ think tank.

Safety systems and incident reporting have failed to evolve in the NHS over the last two decades as it has done in the airline industry, argues the commentary by the Doctors Policy Research Group, which is linked to Civitas.

“How is it that over a decade of events, public inquiry reports and media exposés have highlighted endemic problems with safety in parts of the NHS? It will be no surprise to anybody working within it that these problems are widespread. It is clear that the NHS needs to move further towards a clinically-led, safe system,” says the report.

Managers tend to talk in platitudes such as “we need more audits” but fail to state what these audits might measure, say the authors Dr Christoph Lees, consultant in obstetrics and fetal-maternal medicine, Dr Mark Slack, head of urogynaecology at Addenbrooke’s Hospital, Cambridge and Dr Paul Charlson, a Yorkshire GP and portfolio doctor.

Similar statements such as “patient safety is our first concern”, “quality is not negotiable” and other clichés are frequently used by NHS managers but it rare that these comments are backed by any substance, they say.

Another hurdle to providing clinical governance at the basic level is the significant event reporting system which the paper describes as “so long-winded and detailed that only the very motivated would not be deterred from reporting anything”. Health care managers often fail to understand that it is good for a diverse range of incidents and numerous significant events to be reported.

“When an event is reported, this is often seen as a criticism of an individual and the first response is a disciplinary sanction rather than treating the report as a learning opportunity or a systems issue. This is more likely to deter rather than encourage further reporting,” argues the paper.

The authors call for an end to the “bullying culture” frequently experienced by clinicians. “Such an environment simply leads to an unhealthy cycle of despondency, poor performance and an air of resignation and detachment from providing quality patient care,” they say.

They also warn that the call by the Francis report to make failing to report significant events a criminal offence would create further sanctions for a process that should be voluntary.

Another bugbear is inspections which focus on patient information sheets, hand washing and guidelines while ignoring clinical outcomes. “Many inspections lead to the generation of reams of meaningless papers that are frequently too generic to be appropriate. We have all experienced the sudden appearance of files of protocols and posters just prior to inspections”, says the report.

Part of the solution to the current “malaise” would be to introduce an inspection regime focused on clinical environments, feedback, event reporting and audit, carried out by experts in the relevant fields. There should be a return to the “common sense” approach of the hospital inspections that used to be conducted by the royal colleges before they were axed a decade ago by the Department of Health.

To achieve a safer system NHS management must understand how the tools of clinical governance work and empower clinicians to use them, concludes the paper.

Patient safety could be improved by:

Learning from the airline industry about the importance of safety gains;

– Introducing a more substantive approach to clinical audits;

– Introducing a more learning-oriented attitude towards significant events;

– Encouraging voluntary reporting of significant events rather than criminalising the process;

– Returning to hospital inspections focused on the clinical environment led by the royal colleges.

Bookmark and Share

Post a Comment

Enter this security code

Submit Comment for Moderation