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