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Risky business

Dr J Eltora Bennett and Dr June Samuel explain how they are managing risk in their organisations

Dr Bennett works at a private hospital in Barbados where risk management is governed mainly by the medical staff committee, of which she is the Chair.

In the Caribbean people are becoming more litigious, and as a result medicine is becoming a little more defensive, which can have a negative impact on patient care. Dr Bennett said that increasing economic hardship is one of the factors that is causing the system to be more litigious, along with news on television showing patients around the world suing and complaining about doctors and other healthcare staff.

I’d hate to see us getting to the point where our first thought in choosing an option of management is, "Am I going to be sued?”

In such difficult times, when patients and lawyers are waiting to pounce on any perceived mistake or oversight, good risk management is more important than ever. Dr Bennett focuses on a number of areas in order to ensure as safe an environment as possible for clinicians and patients. However, she is careful to prioritise care, compassion and the best interests of patients over fear of litigation.

She says: “We still try to do what we believe will be best for the patient. I’d hate to see us getting to the point where our first thought in choosing an option of management is, am I going to be sued?”

To help manage risk in the hospital, Dr Bennett introduced sign-out sheets for staff working out-of-hours; she started using the new policy with her surgery team and it was then expanded to be used as a general policy for the hospital.

Raising concerns

Doctors have a professional obligation to raise concerns, particularly where patient safety is at stake. Dr Bennett prefers to call whistleblowing “notification”.

She said: “I think that being open and speaking up is very important, but I think it is equally important for those staff members speaking up not to think of it as whistleblowing but to recognise the importance of notification, and to see themselves as an important member of the team – that is working for the greater good of the patient and the institution.”

Dr Bennett believes strong leadership is essential and that staff are more comfortable when they know they have got a leader who has set high standards, and who will also be fair and will look out for the cause of the patient. Having supportive management in place supports doctors when they need to raise concerns.

Managing resource

Doing more with less is becoming increasingly common for doctors across the world given the global economic situation, so healthcare professionals have to ensure that limited resources have minimum impact on patient safety and quality care. How do they do this?

We have always been accustomed to doing more with less [...] We do that without dropping standards; we’re just very cost conscious
“Coming from the Caribbean we have always been accustomed to doing more with less,” explained Dr Bennett. “We do that without dropping standards; we’re just very cost conscious and try to look for methods to achieve the same level of excellence without necessarily, for example, relying on new machines or equipment. We actually sit and rationalise and discuss whether new equipment will bring anything to the surgery – will it enhance patient safety? Will it shorten procedures?”

Risk in the BVI

At the British Virgin Islands (BVI) Health Services Authority (HSA), there is a risk manager who is responsible for spearheading their new risk management programme. Managing Director Dr Samuel sits on the risk management committee, which is made up of senior administrators for the whole authority, and together they target staff across the board, explaining what risk management is and each staff member’s role in the process.

Dr Nancy Boodhoo, MPS’s Head of Operations (Caribbean and Bermuda), helped them get this programme off the ground, and to put in place an incident reporting system to help manage risk.

Dr Samuel said: “Dr Boodhoo helped us put staff at ease about reporting incidents as they were a bit sceptical at first about what the implications would be. She said to avoid making it mandatory to report; instead taking a different approach – ensuring staff know how much of an issue it is if you don’t report a concern.”

The team have also developed an open disclosure policy that they are about to roll out to all staff, covering how the HSA manages significant adverse outcomes and how it is important for doctors to apologise and admit when they’ve done something wrong. They have a team set up that will respond and manage incidents within a specific timeframe.

Dr Samuel and the team are looking at budgeting and financing and ways of increasing efficiencies within the organisation. They are working on a number of initiatives to ensure doctors and nurses have the resources they need – one option is a procurement arrangement with another organisation to save on costs.

All leadership must be strong in terms of where we go and bringing about a culture shift in quality and safety
With a new CEO on board, Dr Samuel explained that the HSA is anticipating the benefits of strong leadership from the top. “We have a small community in the BVI of 27,000 people, with one public hospital, so we tend to be under a lot of scrutiny. The patients have very high expectations, because we are close to US territories and patients very often will have had the experience of accessing healthcare in the US. All leadership must be strong in terms of where we go and bringing about a culture shift in quality and safety.”

Over the last five or six years in the BVI they have received more documented complaints, but Dr Samuel thinks this is partly due to the fact they have a system in place whereby if a patient isn’t happy with their service they can complain. In order to improve their services, the HSA has been having community meetings in order to get feedback from people in the different communities about the standard of local healthcare.

Dr Samuel wants to see a shift from the doctors seeing themselves as independent providers to them being team players who provide a service together.

“With the shift focusing on quality and patient safety especially, it can’t be a one-man show anymore; it has to be a team approach. We need to see the patient as a customer who we are serving and who has a right to indicate what type of care they would like to get.”

Words by Charlotte Hudson 
Interviews conducted by Sarah Whitehouse and Rachel Seddon

With thanks to Dr J Eltora Bennett, Managing Director of CariGES Inc in Barbados, and Dr June Samuel, Managing Director of the British Virgin Islands Health Services Authority.
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