By John Tingle
As part of its patient safety strategy, the National Health Service (NHS) in England has created the first system-wide patient safety syllabus, training, and education framework.
Education and training are fundamental prerequisites for creating a patient safety culture in any health care system. This new patient safety syllabus is both innovative and reflective, combining systems and human factors thinking.
The key domains in the patient safety syllabus are:
- Systems approach to patient safety
- Learning from incidents
- Human factors, human performance and safety management
- Creating safe systems
- Being sure about safety.
A curriculum consisting of discrete learning modules will follow from this syllabus.
Patient safety and the law
Domain 1 of the syllabus includes section 1.6: medico-legal education and professional responsibilities. Issues to be discussed include:
“The ethical and clinical issues involved with patient care, including the withholding or withdrawal of care, and with the rights of the patient to refuse care.”
“The legal issues surrounding clinical negligence, compensation and the accountability of individual practitioners.”
The law is a mechanism of transparency and accountability in patient safety, and, as such, occupies a pivotal role. The syllabus recognizes the importance of the relationship between the law and patient safety, and establishes a firm link between them. It considers legal issues such as clinical negligence litigation and consent to treatment.
One of the main problems with patient safety in the NHS is the failure of some staff to learn lessons from past patient safety errors. Clinical negligence case law provides essential practical context through which staff may view the dynamics of patient safety. By making explicit reference to clinical negligence in the new syllabus, NHS staff will be directed to explore reported cases and to analyze professional responsibilities through this lens.
New guide to learning from clinical negligence claims
A new, valuable supplement to this syllabus — a best practice guide to learning from clinical negligence claims — was recently published by the GIRFT (Getting It Right First Time) program and NHS Resolution.
This guide offers excellent advice and contains some best practice examples: case studies from NHS hospitals.
“Clinical negligence claims are an ever-increasing burden in the NHS, with the annual cost of harm amounting to £8.3 billion in 2019/20,” the guide states. In addition to the financial cost to the NHS, there is also a human cost to clinical negligence: the cost to the injured patient. Money is a poor compensator for the loss of a faculty or amenity, or the loss of a life. There are also incalculable emotional costs for all those involved in a clinical negligence case from the health care providers involved, to the injured patients, and their families.
The guide stresses the importance of collaboration between clinical teams and hospital legal teams:
“Clinical negligence claims should be discussed regularly in meetings attended by clinical staff (e.g.) clinical governance or multidisciplinary meetings) led by senior clinicians with support from trust legal teams.”
The impact of claims learning on clinical practice also is discussed in the guide. It states that a significant proportion of clinical negligence claims are directly related to the consent process, especially in surgical specialties:
“It is vital that the consent process is a journey that starts from the moment the patient is first seen for their presenting symptom rather than an isolated event that takes place prior to the proposed procedure.”
The guide also discusses the importance of having good clinical documentation and records, as well as timely access to diagnostic investigations and safety checklists.
Patient safety education and training in the NHS England has made a bold and welcome step forward with the publication of the new NHS patient safety syllabus. The syllabus will help direct the development of patient safety culture in the NHS.
The GIRFT and NHS Resolution best practice guidance to claims learning adds a useful resource to the patient safety field of literature and will form an essential teaching and learning resource for the new NHS patient syllabus and curriculum. The advice in the guide is practical and reflective, and will enable positive learning to take place.