Trust and learning central to better NHS environment, conference hears

The importance of creating an environment of trust, learning and accountability in the NHS were the key discussion points at a BMA conference in Belfast.

Location: Northern Ireland
Published: Thursday 5 December 2019
Chaand Nagpaul in front of the We look after doctors banner

The importance of creating an environment of trust, learning and accountability in the NHS were the key discussion points at a BMA conference in Belfast.

BMA council chair Chaand Nagpaul and Northern Ireland council chair Tom Black led the Better Culture, Better Care conference, which is part of the work of the BMA Caring, supportive, collaborative project. It has demonstrated doctors across the UK work in a climate of unfair systemic pressures – where they work beyond contracted hours, and live in fear of being blamed for medical errors beyond their control.

Dr Nagpaul and Dr Black used the conference to highlight that a better environment of trust, learning and accountability in the NHS would enable the patients to be treated more safely.

They said research from across the world proves that a supportive culture, one of learning not of blame, is the only way to create a ‘truly safe system’.

The conference also saw Fiona Smith from Merseycare NHS Trust and Denise Chaffer from NHS Resolution discussing their experiences of taking ownership of a problem.

They said by clearly demonstrating and talking about the way approaches were counterproductive, they were able to create a change in workplace culture which in turn resulted in better outcomes for patients and a better working environment for doctors.


Nasty remarks

Professor Colin Melville from the GMC told the conference about the organisation’s work to support doctors in a pressurised environment and Chris Turner from Civility Saves Lives discussed the effect words and actions have on others.

Dr Turner said that when we are rude or disrespectful to colleagues it has two effects – that the cognitive function of the person who has experienced rudeness immediately declines by 61 per cent, and that those who have witnessed rudeness, the bystanders, are more likely themselves to be rude to a colleague.

It comes while the problems in Northern Ireland’s health system are acute: as well as patients waiting for planned care 140,000 are waiting for a diagnostic service, and a third of those had been waiting for more than 26 weeks. Changing how health in Northern Ireland operates has been very slow and several high-profile incidents have increased the levels of fear among doctors working there.

The conference heard from Peter McBride, chair of the Being Open subgroup of the Inquiry into Hyponatraemia Related Deaths implementation workstream. It examined the deaths of five children that occurred between 1995 and 2003. Its report was produced at the start of 2018 and found that four of those deaths were avoidable.

The report recommended that a statutory duty of candour with criminal sanctions be introduced in Northern Ireland – something that would set it apart from the rest of the UK. BMA NI has already expressed strong concerns about the introduction of an individual duty of candour and the effect it could have on developing a culture of openness, transparency and learning.

Kevin Stewart, Medical director of the Healthcare Safety Investigation Branch – an autonomous body within the NHS tasked with undertaking professional patient-safety investigations based on principals adapted from aviation and other safety-critical industries – spoke to the conference about the importance of moving away from seeing human error as the cause of workplace problems and instead treating it as a symptom of the problem. He added that the NHS can learn a lot from the aviation industry on dealing with errors and the culture of blame.