silence kills: acting on concerns

Silence kills – ‘acting on concerns’ Ian McNeill & Kim Tolley: Regional Liaison Advisers for London Dr Muj Husain: Chair - Academy of Medical Royal Colleges' Trainee Doctors Group

GMC - Regional Liaison Service

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Session snapshot

§ Who we are

§ What we do

§ Raising concerns

§ Apply it to a real case

§ Medical leadership

§ Share practical tips on how to do it

§ Online and other resources

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Our purpose

§ Our statutory purpose is to protect, promote and maintain the health and safety of the public by ensuring proper standards in the practice of medicine.

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What do we do?

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What did it say?

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Culture will trump rules, standards, and control strategies every single time. A safer NHS will depend far more on major cultural change than on a new regulatory regime.

How much more?

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Raising concerns - your duty

There is a duty on all doctors to raise concerns where they believe that

§ patient safety

§ dignity or

§ care

is compromised by the practice of colleagues or the systems, policies and procedures in the places in which they work. Confidential Helpline – 0161-923-6399

Jim’s story (courtesy of Dr Omer Malik)

Jim is 24 years old with:

§ Schizoaffective disorder

§ 5 admissions in 6 years and now under the Assertive Outreach Team.

§ Lives with his mother

§ Admitted to a surgical ward for excision of parathyroid tumour two days ago

§ Uneventful recovery

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On the Saturday evening

Jim complained of hearing voices and shouted at other patients. The surgical registrar, Miss Doprova phoned Julie Simkins; the Psychiatric liaison nurse. He was reviewed by the liaison team who accepted his transfer to the mental health unit. Dr Doprova explained Jim’s operation and the post operative observations he would need in the mental health unit. He would receive a surgical outpatient appointment in 6 weeks

(image courtesy of imagerymajestic. Free DigitalPhotos.net)

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On Sunday evening – 7pm

Jim arrived at the mental health unit. Josie, the mental health nurse, called Dr Poroshenko, Psych SHO, to clerk him. There was no accompanying discharge notes or medication charts. Jim was well known to the ward and Dr Poroshenko diligently checked his records and also double checked with Jim; prescribing accordingly. Dr Poroshenko was called away before he could do a physical examination.

(image courtesy of artur84; Free DigitalPhotos.net)

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Jim’s medication

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Monday 9am § Jim was very sweaty.

§ Josie, ward nurse, spoke to Dr

Singh, the ward psychiatrist. § Dr Singh recorded in Jim’s records

that the patient looked hot but was too busy to examine him.

§ He phoned Miss Deprova, surgical

registrar who reassured him that Jim’s surgery was uneventful.

§ She recommended that Jim is discharged after 2 days of satisfactory basic observations (PR, BP, temp).

(image courtesy of imagerymajestic. Free DigitalPhotos.net)

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Monday 9pm

(image courtesy of imagerymajestic. Free DigitalPhotos.net)

Jim was fearful, deluded, c/o difficulty breathing

On the instructions of Dr Singh,

Dr Poroshenko called the on call medical SHO, Dr Kumar who discussed Jim with Dr Walker, the medical registrar.

Jim was transferred to A & E

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A happy ending?

(image courtesy of imagerymajestic. Free DigitalPhotos.net)

Neuroleptic Malignant Syndrome was diagnosed. The patient was transferred to the Critical Care Unit and, after 2 weeks, made a complete recovery. He was discharged back to the care of the Assertive Outreach team.

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A month later

(image courtesy of imagerymajestic. Free DigitalPhotos.net)

You over hear two

nurses discussing what

happened to Jim at on

the ward.

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Group task

(image courtesy of imagerymajestic. Free DigitalPhotos.net)

Agree what actions

you will take to

prevent this

happening again?

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Put it right yourself Routine reporting Line Manager The Deanery Senior Management Regulator Make it public

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So what are my options?

Are these true?

1. The law provides protection against victimisation or dismissal for individuals who raise concerns?

2. All doctors are responsible for encouraging and supporting a culture in which staff can raise concerns openly and safely?

3. You have to wait for proof and gather evidence before reporting?

4. The GMC confidential helpline is a useful way to circumvent confusing local avenues for raising concerns?

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And finally ………

§ Document

§ Document

§ Document

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Collaborator or innovator?

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Medical leadership

‘Of the many impediments to medical leadership … one is simply that doctors have not been asked to lead … neither have they necessarily thought of themselves as leaders.’

Richard Bohmer, New Zealand-trained physician and Professor of

Management Practice at Harvard Business School

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We have the lowest proportion of clinically qualified managers of any health system

UK = 59% Sweden = 93%*

Doctors and nurses make up a minority of board members

Doctors = 14% Nurses = 12%**

Board time focusses on non-clinical issues

Clinical issues = 14% Financial issues = 19.2% Organisational issues = 27.6%***

*McKinsey: Management in Healthcare: Why Good Practice Really Matters (2010) ** Centre for Innovation in Health Management, Leeds University Business School: Clinicians in Management: Does It Make A Difference (May 2005) *** Burdett Trust for Nursing: An exploratory study of the clinical content of NHS trust board meetings, in an attempt to identify good practice (August 2006)

Leadership gap

NHS Leadership Academy

Leadership framework

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www.leadershipacademy.nhs.uk

Healthcare Leadership Model – 9 dimensions

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Leadership & culture

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Leadership in action

Behaviour breeds behaviour

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Thank you.

0161-250-683

07787 101114

imcneill@gmc-uk.org

@McNeillIan

Ian McNeill

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Influence

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Reporting matters