10 May 2013

Scottish Academy Trainee Doctors’ Group/
Royal College of Physicians of Edinburgh
Press Release

10 May2013

RADICAL NEW APPROACH TO IMPROVING STANDARDS OF PATIENT CARE IN SCOTTISH HOSPITALS
Tayside pilot study offers potential to improve the quality of patient care nationally

A leading Scottish expert in the field of clinical quality improvement 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.

Prof Peter Davey, Lead for Clinical Quality Improvement, University of Dundee, 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 [1]. The conference has been organised to provide a focus for discussing how doctors, including trainee doctors (the next generation of consultants), 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;
  • the culture within the NHS discourages doctors from reporting errors for fear of having blame apportioned (data from the National Patient Safety Agency shows that only 10-15% of UK adverse incidents are reported by doctors).

In contrast, an innovative pilot study has been undertaken by the University of 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. This 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 adverse incidents 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 (as an example between 1994 and 1999 the number of incidents reported by British Airways increased from 5000 to 8000 per year and the total number of medium and high risk events fell from over 130 to around 20 per year over the same period);
  • led to a dramatic increase in medical students’ attitudes towards incident reporting ( 69% of the 126 medical students who participated in the study 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);
  • already led to the University of Dundee and NHS Tayside making incident reporting a core activity for all final year medical students and Foundation Year trainee doctors in Tayside;
  • 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.

Prof Peter Davey, Lead for Clinical Quality Improvement, University of Dundee, 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. 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.  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, Lead for Doctor as Professional, Medical School, University of Dundee (and who will be co-presenting with Prof 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 interprofessional 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”.

Contact Graeme McAlister on 0131-247-3693 or 07733-263453

ENDS

Notes to Editors

[1] ‘Trust Me, I’m a Doctor: professionalism and excellence in modern medicine’ will be held at the Royal College of Physicians of Edinburgh, 9 Queen Street, Edinburgh on Friday 10 May 2013, from 9.30am – 4.00pm.

The Scottish Academy Trainee Doctors’ group is a sub-committee of the Academy of Medical Royal Colleges and Faculties in Scotland and contains trainee representatives from the medical and surgical specialties.