9 May 2013
Tayside pilot study offers potential to improve the quality of patient care nationally
A leading expert in the field of clinical quality improvement from the University of Dundee will today advise that the NHS in Scotland must adopt a radically different approach if it wishes to learn from medical mistakes and improve the standards of care provided in Scottish hospitals.
In particular, he will present the new findings of a pilot study in Tayside which offers potential for trainee doctors and medical students to report errors positively to drive change in the NHS and to improve the quality of patient care nationally.
Professor Peter Davey, Lead for Clinical Quality Improvement at the University, will be speaking at a conference on Professionalism and Excellence in Modern Medicine organised by the Scottish Academy Trainee Doctors' Group and supported by the Royal College of Physicians of Edinburgh.
The conference has been organised to provide a focus for discussing how doctors, including trainees, can influence improvement in all aspects of medical care within the NHS including non-clinical areas such as communication with patients, leadership and professional development.
During his presentation Prof Davey will highlight that the current systems for monitoring patient safety in Scotland and the UK are not working in a manner which enables lessons to be learned and future standards of care to be improved. Furthermore, he will say that the culture within the NHS discourages doctors from reporting errors for fear of having blame apportioned.
In contrast, an innovative pilot study has been undertaken at Dundee in which trainee doctors and medical students have been actively supported and encouraged to record adverse incidents of varying levels of seriousness and to reflect on and review these with senior colleagues.
Professor Davey said, "What we are talking about here is a radically different method of improving the quality of patient care. Traditionally, clinical advice has been cascaded from senior consultants down to trainee doctors and medical students and the culture within the profession and the NHS has not encouraged the open reporting of mistakes. This model turns this on its head and is about the tremendous positive potential for trainee-led, or bottom up, quality improvement.
"Currently it is estimated that about 85-90% of medical mistakes are unreported. As a result of our work in Tayside we achieved a 17-fold increase in the open reporting of adverse incidents by Foundation doctors over a 6 year period. This has presented a significantly increased opportunity for us to learn from these mistakes and to reduce the likelihood of them recurring."
The pilot's approach provides a non-judgemental and positive means of learning from these incidents with a view to reducing the likelihood of these mistakes being repeated.
New data from this study to be presented today will highlight that this approach has led to a dramatic increase in the number of adverse incidents reported by Foundation Year trainees in Tayside, from around 5 in 2005/06 to over 90 in 2011/12. Evidence from other sectors has shown that as reporting of all adverse incidents increases, the number of serious adverse incidents decreases due to learning from these mistakes.
Of the medical students who participated in the study, 69 per cent believed this approach had positively changed their attitude towards incident reporting and would make them more likely to openly report adverse incidents once becoming trainee doctors. As a result of the study, the University of Dundee and NHS Tayside have made incident reporting a core activity for all final year medical students and Foundation Year trainee doctors in Tayside.
Professor Davey will also show how the pilot has created greater understanding about the impact of adverse incidents on patients. Historically, the main emphasis with regard to incident reporting has been on serious incidents as a result of which patients could come to major harm. However, it has been recognised that lesser incidents can still have an adverse impact on patient care and recovery.
By reviewing and reflecting on all incidents medical students and trainees are developing a greater understanding about the impact of all of their actions on patients and encouraged to carry this through into their future dealings with patients.
"This potential for improving both the quality of patient care and patient safety has recently been recognised in Tayside where, as a result of our work, incident review has now been incorporated as a core activity for all final year medical students and Foundation Year trainee doctors," continued Professor Davey. "We believe this approach has much wider potential and should now be replicated nationally in Scotland.
"The Francis Report into the events in Mid Staffordshire made harrowing reading, highlighted the negative culture within the NHS, the need to put patients at the centre of care and the need for a range of quality improvements. The Royal College of Physicians of Edinburgh has recently highlighted the potential for these events to be repeated in any hospital in the UK, including Scotland, and called for the NHS to refocus on the quality of patient care.
"Trainee-led quality improvements as demonstrated in Tayside offer an innovative and potent method of doing this and it is important that the NHS engages and harnesses the potential of these doctors if we wish to improve standards of care."
Dr Kerri Baker, Chair, Scottish Academy Trainee Doctors' Group and lead organiser of the conference, said, "Today's trainee doctors will be the consultants of tomorrow and the future of patient care in Scotland. As such, it is essential to instil in them the values, standards and practices that both patients and doctors aspire to for healthcare in Scotland. We must also aim to treat patients in a way that we would expect our own families to be treated when receiving care.
"As a doctor, being a professional is about more than just the standard of medical care provided. It is about putting patients at the centre of care, respecting them and their distinct needs and preferences, recognising them as individuals and communicating with them in an open, supportive and engaging manner.
"Similarly, trainee doctors must strive to keep their skills up to date and seek to positively influence the delivery of healthcare where they can. Leadership does not always come naturally, but can be learned, encouraged and supported. As shown by the work in Tayside there are real opportunities to deliver trainee-led improvements to the NHS and we hope that today's event will provide a stimulus for other activity of this nature."
The work undertaken in Tayside has also sought to understand and break down some of the professional barriers which can exist between different groups of professionals involved in providing health care (doctors, nurses, allied health professionals etc.), which have historically arisen due to the professionals undertaking their undergraduate study and postgraduate training in isolation. In particular interprofessional learning has been piloted through shared teaching in which medical, nursing and dental students have had to work together in the planning and delivery of lessons in local schools.
Dr Fiona Muir, who will be co-presenting with Professor Davey at today's event, said, "Effective modern healthcare requires care to be delivered by efficiently working teams of multi-disciplinary staff.
"The creation of inter-professional learning opportunities at an undergraduate level has demonstrated great potential for increasing interprofessional understanding, communication, team working and for breaking down the barriers which have historically existed and impeded more effective team working".
For media enquiries contact:
Grant Hill
Press Officer
University of Dundee
Nethergate, Dundee, DD1 4HN
TEL: 01382 384768
E-MAIL: g.hill@dundee.ac.uk
MOBILE: 07854 953277 |
