How do we achieve a culture of candour in our organisations and services?
Dr Umesh Prabhu Medical Director at Wrightington, Wigan and Leigh NHS Foundation Trust speaks at today’s Applying and monitoring Adherence to The Duty of Candour conference on:
applying the duty of candour at the bedside
supporting all involved in the incident
how can we support frontline staff to implement the duty at the bedside?
accountabilities and reporting requirements
During his presentatioj, Dr Prabhu discussed:
"Stats – 15% doctors performance is affected due to ill health
1 in 17 doctors drink excessively or take drugs during life time as a doctor
5% behave so disruptively that it puts patients and staff at risk – rude, arrogant etc
1-6% of doctors have problems with their performance.
48 doctors have been charged with manslaughter
22 doctors have committed suicide, 80 died."
"Could have been prevented by better practice."
"In his hospital, 84% redcuction in ‘total harm’"
"Leadership is about inspiring people, duty is to create a culture where staff and patients are happy, where we are ‘fond of the NHS’"
"Umesh has delivered a programme to improve his hospital in all measures."
"Even so, we still get incidents, but that’s not necessarily a bad thing as candour is accepted part of culture."
"Success – our values. Listen to the staff."
"Patient at the heart of everything we do."
"Learning culture – duty of candour, honesty with staff, patients, board members."
"Appointed value based leaders and managers – not blame culture"
"Why is candour important – doc/patient relationship based on mutual trust and respect, patients trust us with their lives, patients tell doctors more than even their family members."
"Docs must always be trustworthy"
"Who do the public trust? 89% docs, 91% nurses. Politicians 17%"
"Medical Errors – to err is human, not to learn from it is not acceptable (or we keep on making mistakes), to cover it up is a crime."
"Medical director takes responsibility for complaints/investigations because there is anger, etc and he is one step removed from the actual doctor involved which diffuses things, but also supports the medical staff."
"Support for family and staff – reassure there is no cover up, take external advice and share with family, tell staff and support as far as possible but must hold staff to account."
"Staff support – don’t under-estimate importance (they will be feeling fear, guilt, anger) must support through process."
"If you have a blame culture, people will cover up to avoid punishment, takes a lot of courage to be a whistle blower."
"Danger of name in media, reputational damage, livelihood gone, prolonged psychological damage."
"Applying duty of candour bed side – staff must tell MD when any patient has been harmed, be involved from the outset."
"Promote cultural change – fair and open, supportive and learning. Otherwise they may feel ‘why bother’?"
"Disciplinary action – discuss and audit regularly all cases."
"Patient safety should matter to us, quality of care should matter to us."
Umesh Prabhu’s Biography:
Medical Director, Wrightington Wigan and Leigh NHS Foundation Trust (April 2010 to date)
Consultant Paediatrician, Bury NHS Trust (1992 – 2010)
Clinical Director Paediatrics, Bury NHS Trust (1992 – 1998)
Medical Director, Bury NHS Trust (1998 – 2003)
Board Member, National Patient Safety Association (2001 – 2003)
Clinical Adviser, Health Care Commission
National Clinical Advisory Service (2003 – 2014)
Member or Ex-Member of the Black and Minority Ethnic Advisory Committee/Equality and Diversity Committee of the British Medical Association/General Medical Council/National Clinical Advisory Service/Department of Health
National Vice Chair of the British International Doctors Association
Previous National Vice Chair of the British Association of Physicians of Indian Origin
Following my own mistake in 1992, I developed a keen interest in patient safety, medical errors, clinical governance, why doctors make mistakes, organisational governance, culture, leadership and institutional racism.
I have given nearly 100 lectures and conducted 70 workshops on various aspects of patient safety, professional regulation and governance.
I joined Wrightington, Wigan and Leigh NHS Foundation Trust, and by working with the Trust Board and Chief Executive have completely transformed Trust values, value based leadership, culture and governance.
Today 450 less patients die in our Trust compared with 2008. All 22 quality measurements have improved, we made a £4m surplus in 2003/14, we have 170 patient safety champions and robust governance.
Future conferences of interest:
Investigating Incidents and The Duty of Candour
Tuesday 15 March 2016
Hallam Conference Centre, London
8 February 2016