Niall Dickson, GMC’s chief executive, talks about the importance of speaking up when patient safety is at risk.
What struck me most about the findings of the Francis Report was not what doctors did do, but what they didn’t do. Their failure to cross over the ward when they saw neglect. Their failure to take or share the blame. Most of all, their failure to sound the alarm when they knew that, even when patients’ lives weren’t at risk, their comfort and dignity were being compromised.
Part of the issue at Stafford was that doctors were discouraged, either actively or by the prevailing culture, from coming forward. I acknowledge that raising concerns about patient safety or ‘speaking up’ can be a daunting prospect even for a self confident professional. Sometimes there may be doubt as to how serious the issue really is, sometimes fear of the personal consequences of seeming to criticise colleagues or superiors and sometimes what may seem unacceptable seems acceptable to everyone else. But, of course, the risks to patients of failing to act should always outweigh these concerns. And it’s one of the reasons why for the first time we’ve made explicit in the new version of Good medical practice that doctors have a duty to immediately tell a colleague or manager who is in a position to act straight away.
Our guidance demands that doctors take prompt action if they think that patient safety is or may be seriously compromised. That means if they have doubts about a colleague’s conduct, skills or knowledge they need to do something and report it. If they think patients are at risk because of inadequate premises, equipment or other resources, or policies or systems, they need to speak up and act swiftly to put it right.
And for the first time – following on from the first Francis inquiry – we’re also clear about doctors’ responsibilities when patients’ basic care needs – their comfort and dignity – are not being met. Basic care is not the sole responsibility of nurses and managers – doctors have responsibility for whole patient care – they must take the lead on this.
So where should a doctor take his or her concern? If possible the first choice should be local, so that action can be taken quickly to remedy the situation. Often this will mean raising the matter with the consultant or clinical manager responsible for that patient or department but for whatever reason – if the doctor does not feel comfortable or able to raise it within the organisation, there are a variety of different organisations, including the GMC who can provide support and advice. Some doctors will choose to go to their college, the BMA or medical defence organisation, while others can contact our confidential helpline on 0161 923 6399. We also have a decision-making tool that helps doctors map out their options when they have a concern about patient safety. On top of this, we are happy to talk through any issues, advise on how to take forward concerns in line with our guidance and, if appropriate, open up an investigation. We have issued new guidance both on how to raise a concern and for those in leadership positions, how to respond when concerns are raised.
In the long term, this is about empowerment – doctors and other health professionals have to feel they can act to protect patients without fear of it harming them or their careers. It is, of course, a duty as well – with the powers and privilege of medical practice comes responsibilities and this is one of the most crucial. As Dame Janet Smith said in her report of the Shipman enquiry: ‘The greatest patient safety device is the eyes and ears of fellow professionals’.
The initial response to our helpline is encouraging – since it opened in December last year we have received 392 calls. And these have led us to open more than 20 serious investigations. We have also seen doctors in training willing to raise concerns about patient safety in our annual survey – last year more than 2000 of them raised patient safety concerns about where they were working, all of which were followed up.
In the long term though this has to be about creating a culture within every healthcare organisation where staff feel able to challenge and discuss, where learning from experience and mistakes is actively encouraged, and where hierarchies are never allowed to stand in the way of patient safety. That is a challenge both for the local leadership of every organisation and for the leadership of medicine and it is why in the latest edition of Good medical practice we now require doctors to promote and encourage a culture that allows staff to raise concerns openly and safely.
A reluctance to come forward may seem out of kilter in the age of Twitter and Facebook but we need to accept that there is still a long way to go to achieve the open and transparent system of healthcare to which we should all aspire.
Join our Twitter chat
In that spirit, we’ll be hosting a discussion on Twitter on Friday 21 June between 12noon and 1pm to explore more about what barriers doctors are facing in terms of raising concerns, and how – or indeed if – they’re managing to overcome them.
The hashtag for the Twitter chat will be #GMCchat. You can follow us on Twitter at @gmcuk.
Good medical practice has patient safety at its heart, so do speak up – it is in all our interests that you do.