The Health Service Journal (HSJ) – 8th August 2014 highlights the psychological trauma that patient safety incidents and investigations have on many of the clinicians involved.
Dr Rajan Madhok, a public health doctor and director at the NHS Clinical Leaders Network, together with a number of colleagues surveyed all nine UK-wide professionals regulators, covering all clinicians, not just doctors, and asked the NHS organisations in NW England about data on the number of suicides in relation to patient safety incident and investigations. Their study protocol can be viewed here.
They discovered, as Action for NHS Wellbeing also has, that there is very little systematically collected data on the magnitude of the problem and only about half the responding organisations were confident that they would know about such suicides. They highlight the issue that there is no lack of worthy rhetoric, policy and guidance on the importance of workforce wellbeing, yet very little on the ground reality in terms of the provision of clear and effective systemic and systematic support. They specifically site the NHS Litigation Authority’s risk management standards requiring participating organisations to have have policies to support staff involved in such incidents; at the highest level – level 3 – oarganisations are required to monitor their relevant processes “in relation to action for managers and individuals to take if the staff member is experiencing difficulties associated with the event”. At the time of their study, less than 25% of trusts were assessed at this level.
A systematic review of the overall issue estimates that between 10 and 43% of clinicians involved in incidents will suffer adverse consequences, of which suicide is but the tip of a far larger distress iceberg, termed the “second victim” phenomenon – the traumatisation of clinicians by an adverse patient event; the authors also estimate that about half of clinicians will be so affected at some time in their career. This title in itself raises the question of how and why doctors take on the role of ‘victim’ – and some would argue that they tend to do this quite readily as a result of a number of factors, including their expectations, selection and training.
The HSJ article also raises the importance of safe, sound and supportive contexts in which all expressed concerns are addressed appreciatively: “clinicians are feeling marginalised and indeed penalised for raising concerns.”
There are some really good questions raised:
- What do staff surveys and other information tell us about our culture, and is it improving?
- What other systems can we put in place to find out how staff feel about working here, and especially how safe they feel in raising concerns?
- How do we work with whistle-blowers in our organisation, however uncomfortable their message?
- How confident can we be that our support systems actually do work for staff?
- Do we have a peer support programme?
- How well do our support systems link with other providers of support?
- Do we have a policy on supporting staff involved in incidents?
- Would we know if a staff member committed suicide during or following an investigation or incident?
And some recommendations made for:
- A national confidential inquiry of suicides of healthcare professionals involved in incidents and investigations;
- The GMC to publish the report of its inquiry into suicides of doctors;
- All organisations needing to have policies on supporting staff involved in incidents and investigations;
- The effectiveness of support services offered needing to be evaluated systematically to enable learning and improvement;
- Support systems for independent practitioners needing to be examined in more detail and strengthened;
- A user-friendly directory of support to be available across organisations;
- A platform for organisations to develop their support systems and the necessary culture change, and for hosting a peer support or mentor scheme.
Dr Madhok and his team are keen to hear from others in the NHS about this issue: firstname.lastname@example.org