Raising concerns at work a guide for foundation doctors produced by stfs trainee representative
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Raising Concerns at Work A guide for foundation doctors Produced by STFS trainee representative. GMC Guidance. “ 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.

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Raising Concerns at Work A guide for foundation doctors Produced by STFS trainee representative

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Raising Concerns at WorkA guide for foundation doctorsProduced by STFS trainee representative


GMC Guidance

“ 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.

http://www.gmcuk.org/guidance/good_medical_practice/working_with_colleagues_conduct_and_performance.asp


GMC Guidance

“ 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.

http://www.gmcuk.org/guidance/good_medical_practice/working_with_colleagues_conduct_and_performance.asp


GMC Guidance

“ 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.”

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

System failures

Negligence

Bullying

Concerns

Incompetence

Violence

Illness

Discrimination

Inappropriate doctor-patient relationships

Patient welfare in clinical trials

Alcohol/Drug misuse


How to raise concerns

Gather information

Ensure patient safety

Discuss your concerns with the colleague

Inform Consultant

Documentation

Support colleague


How to raise concerns

Gather information

Ensure patient safety

Discuss with the colleague your concerns

Inform Consultant

Documentation

Support colleague


Alternative Contacts

Foundation Programme

Co-ordinator

Your Clinical / Educational Supervisor

Their Clinical / Educational Supervisor

Any consultant within department

Foundation Programme Director / Clinical Tutor

Clinical Director / Medical Director

Senior manager / Chief Executive

Foundation School Director


Scenario 1: Systems Failure

You handwrite “Actrapid 6U” on drug chart. Nurse administers 60 units actrapid. Patient  hypoglycaemia  coma


Scenario 1: Systems failure

Gather information

Why did nurse administer 60units?

Due to Dr’s poor handwriting she thought it read “60” not “6 units”

Ensure Patient Safety

Treat patient’s hypoglycaemia & stabilise patient


Scenario 1: Systems failure

Resolving 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

Outcome

Hospital policy that all insulin prescriptions should have “units” written and not “U” otherwise nurses will not administer


Scenario 2

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

Gather 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 1

Ensure 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 1

Resolving 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 1

Resolving 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

NCAS/GMC

Liaison with:

HR/ Med Staffing/OH

etc

Concern


Examples from Audience


Summary

Gather information

Ensure patient safety

Discuss with the colleague your concerns

Inform consultant

Documentation

Support colleague


Resources (add NCAS)

http://www.bma.org.uk/images/Whistleblowing_tcm41-156406.pdf


(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


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