On the 17th of October David Behan, Chief Executive of the Care Quality Commission, launched the independent regulator’s State of Care 2013/14 report for health and social care in England. It provides some uncomfortable reading. Five basic questions were asked of all the services which were inspected: Are they safe? Are they effective? Are they caring? Are they responsive to people’s needs? Are they well led?
The report leads on the “widespread unacceptable variation in the quality of care,” with “differences in quality from one trust to another, from hospital to hospital within trusts, and between different services within hospitals”.
Basic safety and leadership are identified as key issues. “Variation in basic safety is a serious problem, particularly a lack of effective safety processes,” and “a lack of a culture that truly learns from mistakes and near misses.” Of the first 82 NHS acute hospitals rated 10% were assessed as being “inadequate for safety” with 70% requiring improvement. This means that only one in five were considered “good” against these criteria. None were given the “outstanding” rating in terms of safety.
The CQC states that it is “calling time on unacceptable variation in the quality of care” insisting that providers must “act swiftly as one system to protect people from poor care.” At the same time they encourage the public to use the “reports and ratings to make decisions about your care and the care of those close to you”. The way forward for the providers and patients is clear.
What is the individual doctor’s role in addressing this safety issue?
The thought provoking quotation, “There is no more neutrality in the world. You either have to be part of the solution, or you’re going to be part of the problem.” is attributed to political activist Eldridge Cleaver and it could be argued that this sentiment applies here.
One of the key steps toward improving safety which we regularly discuss during ourAdvanced Team Communication Skills Course for Doctors is the successful implementation of and utilisation of Shift Handovers. There are many challenges here: tired/hungry participants who are wanting to go home; immediate patient care needs to be maintained; physical space to be able to hold this handover; the sheer quantity of information transfer required. These are all obstacles to success which cannot be ignored and there are many more. However many treatments will not take true effect until mid-way through the following shift, a great deal of time can be lost in trying to comprehend what steps a previous doctor has taken and the following doctor may well be following an entirely different train of thought to yourself. These are only a few points which illustrate the importance that the shift handover has to play in improving patient safety.
So how successful are the shift handovers related to your practise? What actions are you taking to ensure that they are as effective and consistent as possible?
