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Raising Concerns at Work A guide for foundation doctors Produced by STFS trainee representative

Raising Concerns at Work A guide for foundation doctors Produced by STFS trainee representative. GMC Guidance. “ You must protect patients from risk of harm posed by another colleague's conduct, performance or health. The safety of patients must come first at all times.

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Raising Concerns at Work A guide for foundation doctors Produced by STFS trainee representative

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  1. Raising Concerns at WorkA guide for foundation doctorsProduced by STFS trainee representative

  2. GMC Guidance “ You must protect patients from risk of harm posed by another colleague's conduct, performance or health. The safety of patients must come first at all times. http://www.gmcuk.org/guidance/good_medical_practice/working_with_colleagues_conduct_and_performance.asp

  3. GMC Guidance “ You must protect patients from risk of harm posed by another colleague's conduct, performance or health. The safety of patients must come first at all times. If you have concerns that a colleague may not be fit to practise, you must take appropriate steps without delay, so that the concerns are investigated and patients protected where necessary. http://www.gmcuk.org/guidance/good_medical_practice/working_with_colleagues_conduct_and_performance.asp

  4. GMC Guidance “ You must protect patients from risk of harm posed by another colleague's conduct, performance or health. The safety of patients must come first at all times. If you have concerns that a colleague may not be fit to practise, you must take appropriate steps without delay, so that the concerns are investigated and patients protected where necessary. This means you must give an honest explanation of your concerns to an appropriate person from your employing or contracting body, and follow their procedures.” http://www.gmcuk.org/guidance/good_medical_practice/working_with_colleagues_conduct_and_performance.asp

  5. Bad Press http://news.bbc.co.uk/1/hi/health/1443093.stm

  6. Bad Press “The doctor who blew the whistle on the Bristol heart babies scandal said he was forced to emigrate following threats and discrimination. Anaesthetist Professor Stephen Bolsin tried first to raise his concerns with colleagues, but when these were ignored he took his worries about the deaths of 29 babies and children at the Bristol Royal Infirmary to the department of health. But he said his decision to go public had led to him being forced out of the Bristol Royal Infirmary and having to move to Australia, where he is now Head of Anaesthesia at the Geelong Hospital, near Melbourne, Australia.” http://news.bbc.co.uk/1/hi/health/1443093.stm

  7. Types of concerns System failures Negligence Bullying Concerns Incompetence Violence Illness Discrimination Inappropriate doctor-patient relationships Patient welfare in clinical trials Alcohol/Drug misuse

  8. How to raise concerns Gather information Ensure patient safety Discuss your concerns with the colleague Inform Consultant Documentation Support colleague

  9. How to raise concerns Gather information Ensure patient safety Discuss with the colleague your concerns Inform Consultant Documentation Support colleague

  10. Alternative Contacts Foundation Programme Co-ordinator Your Clinical / Educational Supervisor Their Clinical / Educational Supervisor Any consultant within department Foundation Programme Director / Clinical Tutor Clinical Director / Medical Director Senior manager / Chief Executive Foundation School Director

  11. Scenario 1: Systems Failure You handwrite “Actrapid 6U” on drug chart. Nurse administers 60 units actrapid. Patient  hypoglycaemia  coma

  12. Scenario 1: Systems failure Gather information Why did nurse administer 60units? Due to Dr’s poor handwriting she thought it read “60” not “6 units” Ensure Patient Safety Treat patient’s hypoglycaemia & stabilise patient

  13. Scenario 1: Systems failure Resolving the Issue Discuss with nurse Complete an incident form Audit & present results to clinical lead/managers Liaise with other doctors, pharmacists, nurses to come up with solutions to prevent similar errors, and implement change Outcome Hospital policy that all insulin prescriptions should have “units” written and not “U” otherwise nurses will not administer

  14. Scenario 2 A senior colleague (CT, ST etc) consistently comes late to work or misses shifts. Today your team is on call including your SpR and he has not turned up. What do you do?

  15. Scenario 2 Gather information Why is the SpR not in? E.g. Is he on annual leave, ill health, childcare issues, transport Approximately how late will he be? E.g. If 20mins easier to manage then if several hours and can plan appropriately Has he already informed anyone else and arranged cover? E.g. Is another SpR going to cover?

  16. Scenario 1 Ensure Patient Safety Locate SpR bleep - is anyone holding it? - if not carry it until can give to some appropriate Contact remainder of on call team and prioritise & delegate tasks Inform switchboard, bed manager and consultant on call ENSURE YOU WORK WITHIN YOUR LIMITATIONS!

  17. Scenario 1 Resolving the Issue Subsequent to incident discuss with SpR your concerns - persistently being late/absent means more stress and workload for rest of team - support colleague E.g. May be temporary - childcare, transport - health issues - difficulties at work - explain will inform consultant

  18. Scenario 1 Resolving the Issue Documentation - keep a note of when such incidents occur, in case you are asked later - provide accurate feedback on mini-TAB, 360o assessments - incident report forms Inform consultant DO NOT DISCUSS WITH EVERYONE – BE DISCREET!

  19. Escalating Concerns NCAS/GMC Liaison with: HR/ Med Staffing/OH etc Concern

  20. Examples from Audience

  21. Summary Gather information Ensure patient safety Discuss with the colleague your concerns Inform consultant Documentation Support colleague

  22. Resources (add NCAS) http://www.bma.org.uk/images/Whistleblowing_tcm41-156406.pdf

  23. (n.b. This slide is not part of presentation) • Additional 2 slides regarding whistleblowing definition and public disclosure act • Have not included as part of presentation as tried to keep it more informal and less frightening prospect for juniors to bring up concerns

  24. Whistleblowing The British Standards Institute : “when someone who works in or for an organisation…...raises a concern about a possible fraud, crime, danger or other serious risk that could threaten customers, colleagues, shareholders, the public or the organisation’s own reputation.” http://www.bsigroup.com/en/sectorsandservices/Forms/PAS-19982008-Whistleblowing/

  25. Public Disclosure Act 1998 “An Act to protect individuals who make certain disclosures of information in the public interest; to allow such individuals to bring action in respect of victimisation; and for connected purposes.” http://www.legislation.gov.uk/ukpga/1998/23/contents

  26. Formal policies Both HESL and HEKSS have formal policies in place. For further details see: http://www.stfs.org.uk/student/whistleblowing

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