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Emerald Group Publishing Limited
Copyright © 2009, Emerald Group Publishing Limited
Patients feeling safe
Article Type: Editorial From: Clinical Governance: An International Journal, Volume 14, Issue 4
Like John Wright, I too am leaving the editorial seat and in the tradition of ageing cardiovascular physiologists, this self-confessed old clot will be making way for new blood. When I took on the editorial role some eight years ago clinical governance was still a relatively new concept setting out the moral compass of effective health care practice. A whole industry was created; new jobs, extended roles, new sources of advice and guidance and additional powers for statutory and regulatory bodies. After ten years of travel I perceive clinical governance is coming back to basics. The two key questions every health professional has to ask of their practice are: is the patient safe and does the patient feel safe? This isn’t a new role or an additional responsibility for a few, it’s every health professional’s business.
Much is said about how the reliability of science or the absence of critical analysis can impact on patient safety, where an adverse event causes or may cause harm. The literature is awash with the evidence of hospital acquired infection, medication errors and untoward interventional incidents. Over the last eight years over 30 per cent of our published papers have been related to such patient safety issues.
Less has been said about patients not feeling safe, where a concern for self or others may lead to a complaint. An analysis of complaints against health professionals is illuminating. According to The National Patient Safety Authority (NPSA) patients are most likely to complain about “processes, exclusion of ideas, poor communication, disempowerment, isolation and lack of leadership”. Many incidents relate to a lack of cultural awareness or communicative competence. The Health Care Commission tells us what patients expect from such complaints and their expectations are quite modest:
33 per cent want an explanation;
23 per cent expect a service improvement;
10 per cent require an apology; and
only 8 per cent seek action against staff.
Such complaints vary significantly by profession:
1.8 per 1,000 at The Health Professions Council (HPC);
21 per 1,000 at The General Medical Council (GMC); and
24 per 1,000 at The General Dental Council (GDC).
It is somewhat reassuring, however, that 45 per cent of these actions are brought by employers often acting on professionals’ concerns about the performance of others and only 24 per cent by patients themselves. The key question we have to constantly ask ourselves, according to the NPSA, is “Are we always open when things go wrong?” and it’s the simple things that are important. Communicating effectively with patients and their carers is a vital part of dealing with errors or problems in their treatment. Saying sorry, providing an explanation and keeping them informed will help patients and their families to cope when things have gone wrong. This can lessen the trauma suffered by patients and potentially reduce complaints.
Less than 10 per cent of our publications over the last eight years have been about complaints. We now appear to link more effectively with people and communities to monitor the care provided by services and this is certainly addressing the communication and empowerment agenda.
So hopefully the new editors will see more evidence in the coming years that patients are feeling safe because, at the end of the day, that is what Clinical Governance is all about.