What do whistleblower campaign networks seek from regulation to improve patient safety?

1
What do whistleblower campaign networks seek from
regulation to improve patient safety?

• Westminster seminar

2
What are staff seeking when they raise concerns

• Transparency
• Investigations- - independent and robust into
  concerns raised about patient safety
• Improving patient care, reducing avoidable risk-
  our main focus.
• Fairness and respect for their professional
  opinion.

3
Ref Nigel Ellis Head of Investigations statement
to Mid Staffs Inquiry para 96,p27.

• On February 2008 the HCCs helpline received a
  batch of 40 letters and local newspaper reports
  which had been collected by Julie Bailey in
  respect of various patients.
• The allegations related to understaffing, and
  poor nursing care and lack of hygiene. Many of
  the concerns related to older patients and
  failure to answer buzzers, change sheets, give
  medication and change patients.

4
Closing cure the NHS statement for the mid
staffs PI

• There are also deeper questions. What is it about
  the culture of NHS hospital care that created a
  system where the voice of the individual patient
  or nurse is drowned out by political pressure,
  targets and/or processes? A culture that seeks to
  deny and defend, rather than be open and
  self-critical, whose first response to criticism
  is to seek an alternative explanation, rather
  than investigate the most likely and most serious
  cause or causes, and that fears to empower
  patients and front line workers in hospital lest
  their decisions on how to run a ward or a waiting
  list are incompatible with the latest political
  direction?

5
Professor Michael WestLancaster University

• how staff are managed is the decisive influence
  on quality and safety
• the level and nature of staff engagement is the
  best predictor of patient outcomes
• organisations with high staff engagement are
  more likely to be learning organisations with
  better outcomes

6
Transparency- relevant indicators and warning
signs

• Have we agreed this in regulation?
• What assessment of staff engagement is an
  accurate measure?
• The mortality alerts caused the Healthcare
  Commission to investigate Mid Staffs- are we
  taking enough note of such data.
• Clinical incident reports- are all of them
  investigated or logged? How do you know? Do we
  take enough note?
• Complaints- every one a gem.- verbal, email or
  formal, are they all included? How do we know?

7
Investigations.

• Regulators should investigate individual
  concerns- this is potentially crucial for patient
  safety.
• Eg waiting times for AE being manipulated to
  make it appear they are being met? should this
  not be taken as a serious patient safety risk
  issue?

8
Staff expect regulators to recognise deal with
bullying behaviour

• In the worst cases, staff raising concerns are
  explicitly told to stay quiet, threatened,
  sidelined. Most often ignored.
• All of these behaviours are dangerous for
  patients and will lead to staff leaving, ill
  health and disengagement.
• Bullying of those staff leading the way in
  speaking up needs to be urgently addressed.
• Regulators have a responsibility towards patients
  to ensure bullying is addressed.

9
Investigations into complaints about doctors

• Competent case managers.
• Understand how vexatious referrals might happen
• Be supportive of doctors and nurses mental health
  
• Ensure that all case managers understand what
  raising concerns is like , why staff do it, why
  they escalate concerns and the levels of stress
  associated with concerns
• Ensure accountability for anyone who has
  vexatiously complained about another health
  professional.

10
In the NHS, bullying is key

• Robust staff engagement and encouraging a
  culture of openness and trust are key in
  addressing under-reporting. Confidence to report
  bullying is directly related to confidence to
  report workplace concerns.

• Dean Royles NHS Employers in
• Nursing Times. 12 July, 2011

11
summary

• Regulation needs to always be patients first and
  not protecting the status quo or the
  establishment- agree key indicators do we
  really understand the issues?
• Regulation needs to be transparent
• Investigations should include investigating
  individual concerns and ensuring that patient
  safety is addressed.
• Investigations need to be transparent, involve
  the whistleblower(s), be proportionate and
  openly shared .
• Bullying of staff who raise concerns needs to be
  addressed by regulators to prevent patient harm