Post on 27-Jan-2016
description
Raising Concerns at WorkA guide for foundation doctors
Produced by STFS trainee representative
“ You must protect patients from risk of harm posed by another colleague's conduct, performance or health. The safety of patients must come first at all times.
GMC Guidance
http://www.gmcuk.org/guidance/good_medical_practice/working_with_colleagues_conduct_and_performance.asp
“ You must protect patients from risk of harm posed by another colleague's conduct, performance or health. The safety of patients must come first at all times.
If you have concerns that a colleague may not be fit to practise, you must take appropriate steps without delay, so that the concerns are investigated and patients protected where necessary.
GMC Guidance
http://www.gmcuk.org/guidance/good_medical_practice/working_with_colleagues_conduct_and_performance.asp
“ You must protect patients from risk of harm posed by another colleague's conduct, performance or health. The safety of patients must come first at all times.
If you have concerns that a colleague may not be fit to practise, you must take appropriate steps without delay, so that the concerns are investigated and patients protected where necessary.
This means you must give an honest explanation of your concerns to an appropriate person from your employing or contracting body, and follow their procedures.”
GMC Guidance
http://www.gmcuk.org/guidance/good_medical_practice/working_with_colleagues_conduct_and_performance.asp
Bad Press
http://news.bbc.co.uk/1/hi/health/1443093.stm
Bad Press“The doctor who blew the whistle on the Bristol heart babies scandal said he was forced to emigrate following threats and discrimination.
Anaesthetist Professor Stephen Bolsin tried first to raise his concerns with colleagues, but when these were ignored he took his worries about the deaths of 29 babies and children at the Bristol Royal Infirmary to the department of health.
But he said his decision to go public had led to him being forced out of the Bristol Royal Infirmary and having to move to Australia, where he is now Head of Anaesthesia at the Geelong Hospital, near Melbourne, Australia.”
http://news.bbc.co.uk/1/hi/health/1443093.stm
Types of concerns
ConcernsViolence
Discrimination
Bullying
System failures
Illness
Negligence
Incompetence
Inappropriate doctor-patient relationships Alcohol/Drug
misuse
Patient welfare in clinical trials
How to raise concerns
Gather informationGather information
Discuss your concerns with the colleague
Discuss your concerns with the colleague DocumentationDocumentationInform ConsultantInform Consultant
Ensure patient safetyEnsure patient safety
Support colleagueSupport colleague
How to raise concerns
Gather information
Discuss with the colleague your
concernsDocumentationInform ConsultantInform Consultant
Ensure patient safety
Support colleague
Alternative Contacts
Foundation Programme Co-ordinator
Your Clinical / Educational Supervisor
Their Clinical / Educational Supervisor
Any consultant within
department
Clinical Director / Medical Director
Senior manager / Chief Executive
Foundation Programme
Director / Clinical Tutor
Foundation School Director
You handwrite “Actrapid 6U” on drug chart. Nurse administers 60 units actrapid. Patient hypoglycaemia coma
Scenario 1: Systems Failure
Scenario 1: Systems failureGather informationGather information
Why did nurse administer 60units?
Due to Dr’s poor handwriting she thought it read “60” not “6 units”
Ensure Patient SafetyEnsure Patient Safety
Treat patient’s hypoglycaemia & stabilise patient
Scenario 1: Systems failureResolving the IssueResolving the Issue
Discuss with nurse
Complete an incident form
Audit & present results to clinical lead/managers
Liaise with other doctors, pharmacists, nurses to come up with
solutions to prevent similar errors, and implement change
OutcomeOutcome
Hospital policy that all insulin prescriptions should have “units” written
and not “U” otherwise nurses will not administer
A senior colleague (CT, ST etc) consistently comes late to work or misses shifts.
Today your team is on call including your SpR and he has not turned up.
What do you do?
Scenario 2
Scenario 2Gather informationGather information
Why is the SpR not in?
E.g. Is he on annual leave, ill health, childcare issues, transport
Approximately how late will he be?
E.g. If 20mins easier to manage then if several hours and can plan
appropriately
Has he already informed anyone else and arranged cover?
E.g. Is another SpR going to cover?
Scenario 1Ensure Patient SafetyEnsure Patient Safety
Locate SpR bleep
- is anyone holding it?
- if not carry it until can give to some appropriate
Contact remainder of on call team and prioritise & delegate tasks
Inform switchboard, bed manager and consultant on call
ENSURE YOU WORK WITHIN YOUR LIMITATIONS!
Scenario 1Resolving the IssueResolving the Issue
Subsequent to incident discuss with SpR your concerns
- persistently being late/absent means more stress and
workload for rest of team
- support colleague E.g. May be temporary - childcare, transport - health issues- difficulties at work
- explain will inform consultant
Scenario 1Resolving the IssueResolving the Issue
Documentation
- keep a note of when such incidents occur, in case you are
asked later
- provide accurate feedback on mini-TAB, 360o assessments
- incident report forms
Inform consultant
DO NOT DISCUSS WITH EVERYONE – BE DISCREET!
Escalating Concerns
Education
Deanery
Head of School
Clinical/Educational Supervisor
DME/Clinical Tutor/TPD
Employer
Medical Director
Consultant
Clinical Director
NCAS/GMC
Concern
Liaison with:
HR/ Med Staffing/OH
etc
Examples from Audience
Summary
Gather informationGather information
Discuss with the colleague your
concerns
Discuss with the colleague your
concernsDocumentationDocumentationInform consultantInform consultant
Ensure patient safetyEnsure patient safety
Support colleagueSupport colleague
http://www.bma.org.uk/images/Whistleblowing_tcm41-156406.pdf
Resources (add NCAS)
(n.b. This slide is not part of presentation)
• Additional 2 slides regarding whistleblowing definition and public disclosure act
• Have not included as part of presentation as tried to keep it more informal and less frightening prospect for juniors to bring up concerns
Whistleblowing
The British Standards Institute :
“when someone who works in or for an organisation…...raises a
concern about a possible fraud, crime, danger or other serious risk that
could threaten customers, colleagues, shareholders, the public or the
organisation’s own reputation.”
http://www.bsigroup.com/en/sectorsandservices/Forms/PAS-19982008-Whistleblowing/
Public Disclosure Act 1998
“An Act to protect individuals who make certain disclosures of
information in the public interest; to allow such individuals to bring
action in respect of victimisation; and for connected purposes.”
http://www.legislation.gov.uk/ukpga/1998/23/contents
Formal policies
Both HESL and HEKSS have formal policies in place.
For further details see: http://www.stfs.org.uk/student/whistleblowing