Being open to culture change

MPS’s proposal for a culture of candour

Being open with patients – especially when things go wrong – is something that has long been strived for in the NHS.

However, where some organisations have been calling for this candour to be statutory – putting healthcare organisations under a legal obligation – we feel that a change in culture is really what is needed to achieve the relationship of openness and trust between healthcare professionals and patients.

Culture vs statute

Doctors already have a professional and ethical obligation imposed by the GMC to be open with patients when an adverse event occurs. Yet we know that many doctors worry about the legal and professional consequences; so a statutory duty could become a potential obstacle in the same vein; fear of a sanction for making a mistake, leading to a reluctance to be open and face the consequences.

Enforcing such a statutory duty is not without its practical problems. Mistakes are not always instantly apparent and it can sometimes be years before details of an error emerge.

This duty, by definition, would also exclude the “near misses” and minor mishaps that some patients want to know about and which are important in improving patient safety and trust.

Rules on their own can be meaningless; changing the way people behave and react is far more important and this is where we need to invest our energies. Actually changing culture is a challenging task but it would have real benefits for the doctor–patient relationship.

The culture relates to the whole patient “journey” – as opposed to a statute that solely covers an adverse event – and helps to shift away from the paternalistic notion of “doctor knows best”, instead championing open communication and information sharing.

How can this cultural shift be achieved?

Rather than prescriptive legislation, protective measures that allow open conversations without fear of sanction should be developed.

In addition, the government and healthcare managers need to encourage organisations to provide ongoing support, training, mentorship and investment in leadership by example. This will enable staff to effectively participate in open discussions and fulfil their existing professional obligations.