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News and opinion

Under the influence

MPS Medical Director Dr Rob Hendry reminds doctors of their unique opportunities to influence and inspire those working around them

Doctors are often surprised how influential they are within their teams and organisations. The things they do and say and the way they conduct themselves is increasingly being recognised as central to effective healthcare.

Most medical care is now delivered by teams rather than by individual healthcare professionals working in isolation. When teams work well the results can be spectacular, but when teams are dysfunctional, patient care can suffer. Stories in the press about “failing hospitals” are, in fact, often actually about failing teams.

Sadly at MPS we frequently see members getting into difficulties with their employers and their regulators, not because of their lack of specialist knowledge or poor technical skills, but because of the way they interact with their colleagues.

When relationships break down in healthcare teams not only do things go wrong more often, but when they do the impact on everyone involved is usually much greater.

One of the characteristics of being a professional is taking responsibility for one’s actions. Often, choosing to turn a blind eye to problems within a team can lead to problems becoming magnified and intractable.

Product liability and MPS

Issues with product liability have made the headlines in a number of countries around the world recently – notably the DePuy metal on metal hips in South Africa and Ireland, and the PiP breast implants in the UK. These issues arose from faulty products, where normally responsibility lies with the manufacturer or supplier of the product.

However, in both cases, attempts were made by claimants to include surgeons in the claims – in the DePuy hips case, the justification given was that the surgeons had failed to properly fit the prostheses; with the PiP implants, the insolvency of the manufacturer was the motivation for involving the surgeons in the claims.

In both situations, whilst MPS is not providing an indemnity for product liability, MPS is supporting members with these cases by doing whatever is possible to prevent the development of litigation targeting clinicians, when other more appropriate sources of compensation (the manufacturer or supplier) are no longer available.

In the meantime, members can take steps to protect themselves in the event of a claim for product liability, by retaining documentation relating to:

  • Evidence of purchase.
  • Where possible, the serial number of the item in question – it can be used as evidence of the batch of goods obtained.
  • Terms and conditions.
  • Express warranties and guarantees.
  • Instructions and packaging.
  • Correspondence regarding product specification and any alteration.
  • Where whole goods are transported by an external logistics company, relevant contracts/terms/correspondence.
  • Complaints history relating to product and similar products (if relevant).
  • Order forms, emails, faxes.

Clinicians should also take care regarding any verbal statements made to patients regarding a product. Statements that erroneously imply a lifetime guarantee, for example, can make a clinician liable in the event of a related allegation or claim.

Open for better care

Dr Janice Wilson, Chief Executive of the Health Quality and Safety Commission, unveils a new campaign

In May 2013 the Health Quality and Safety Commission (HQSC) launched a new national patient safety campaign aimed at reducing harm for patients at hospitals and within the wider health system.

Open for better care challenges healthcare workers to be open to acknowledging mistakes and learning from them, open to working closely with patients and consumers, and open to change, improvement and innovation. It will run until mid-2015 and will be measured by quality and safety markers developed in consultation with clinicians.

The campaign focuses on four key areas where evidence shows we can reduce harm: falls, surgery, infections and medication safety. Each topic will be rolled out sequentially, with falls the first area of focus.

The reasons for the campaign aren’t that we’re doing a bad job of keeping our patients safe. Lots of good safety work is happening within health services, but people are sometimes still being injured through falling – and infections, surgical errors and mistakes within medicine still happen more than they should.

While these adverse events can be devastating to hospital staff, they often have serious and long-term impacts for patients and their families, so a single event is one too many.

Open for better care is so named because it seeks to foster an open culture where it is safe to acknowledge that mistakes have been made, to question practices that may be unsafe, and where adverse events are transparently reported. This sort of culture is critical to both avoiding mistakes and to learning from them so they don’t occur again.

Teamwork will also be essential. Teams working together, sharing their knowledge and their partnership with the patient can make all the difference in providing a safe environment in which to work, recover and receive treatment. And teams need leaders who will step up and take responsibility so their team can talk about mistakes, learn how to move forward and find new and better ways of doing things.

We are looking forward to engaging with New Zealand health professionals over the next few years. It’s going to be energising and challenging. There will be plenty of debate along the way and, yes, the campaign itself is open to change.

Find out more about the campaign at www.open.hqsc.govt.nz

Education update, The risk of working with others

Dr Mark O’Brien looks at reducing risk from professional interactions 

While poor patient communication has long been established as a major risk factor for complaints or claims, Dr Priya Singh, Executive Director, Professional Services, MPS, notes: “It is important members know that ensuring high quality verbal and written communication between doctors has been identified by MPS as an important strategy to reduce the risk of patient harm and action against members.”

MPS has increasingly identified communication between doctors as a significant source of risk in two critical areas.

Referrals and handovers

Patient care is often passed between doctors, whether in the form of a referral or a handover. In these instances, poor communication can lead to:

  • Abnormal investigations not acted on
  • Wrong diagnosis made or wrong investigation and treatment undertaken
  • High risk treatments not effectively monitored
  • Predictable complications not recognised
  • Significant co-morbidities not taken into account
  • Unnecessary investigation and treatment.

Disagreements between colleagues

Disagreements between clinicians are common and poor communication between doctors in this situation can contribute to patients believing they’ve received poor care.

Disagreements between clinicians are common and poor communication between doctors in this situation can contribute to patients believing they’ve received poor care

Helping you to reduce your exposure to these risks

These challenging situations are explored in MPS’s Mastering Professional Interactions workshop. This half-day workshop is offered free of charge to members, as a benefit of membership.

For more information, including forthcoming dates, locations and online booking, please visit our workshops page.

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