Risky business

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?

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.

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