Can we humanise doctors’ working lives and all be safer?

NHS Hand-in: Department of Health
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The Kings Fund, new GMC chairman and Canadian researchers hope so. So do many practising doctors. With the workload pressures, lack of extra resources and retention and recruitment crisis doing nothing is no longer an option. We are very strong on patient education on our site, but no matter how smart we can be about managing our diabetes and associated conditions, there are inevitably times that we will need to see a doctor and go into hospital for some procedure. The better the whole system is running the better it is for patients.

John Toussaint, CEO of the USA ThedaCare Center for Healthcare Value, says that freeing frontline clinicians to solve problems rather than controlling or blaming them could yield major improvements in three years. Organisations should radically change their leadership behaviour, make respect for people a guiding principle and ensure that productivity improvements did not lead to employee lay-offs.”

“Redesigning care to take wasteful steps out of processes improve quality and lower costs at the same time. Leaders must act with humility, take a sincere interest in what their staff  are telling them, and build a culture of trust and systems geared to continuous improvement. Senior executives should scrap surplus strategic initiatives that are contributing to staff burn-out, focus on a few core goals, and give proper authority to clinical teams.  He said that Western Sussex Hospitals had adopted elements of his system and achieved an outstanding rating from the Quality and Care Commission. He said that the hardest part was eliminating waste in non-clinical areas such as administration, IT, human resources and finance.”

When it comes to eliminating wasteful practice,  the Quality and Outcomes framework is a good example. Payment by performance in British General Practice was a massively expensive experiment set up in 2004. In Scotland it has just been abandoned. Almost all GPs hit the desired targets for chronic disease health care identification and monitoring. 25% of GP income was tied to the targets, often of dubious value. Many GPs left or retired and it is believed that the strain of delivering QOF has put many young doctors off being GPs. A study in the Lancet however showed all this was for nothing. There was no benefit to total mortality for any of the diseases covered compared to usual care.

Terrence Stephenson is the current chairman of the General Medical Council in the UK. He delivered a lecture to the Royal Society of Medicine in which he expressed the desire that the GMC shake off the “policeman” image that they have.

“For most doctors, the GMC is known for tackling bad practice and striking doctors off the register. The GMC get 10,000 complaints a year, most of which come from the general public. Making complaints is free, easy and you can even do it online. Unfortunately it can be used in highly inappropriate ways. For instance someone complained that trees from a practice’s garden were blocking their sunlight. Of these complaints 250 are directed to a tribunal and of these 55 doctors were struck off the register.”

“ I think we need reforms to this procedure. Many complaints are erroneous. Many could be dealt with locally. Many patients would be better satisfied if they went through local complaints procedures or the ombudsman.  It is my ambition to make the GMC more focussed on patient safety. The sad truth is that medicine is a high risk profession. It is safety critical industry and people are harmed by healthcare. In any human business there will be human error that can never be eradicated but I think it behoves us to try and fix it”.

When it comes to human errors we all know that lack of sleep, overwork, interruptions, boredom, unfamiliarity with the work can all contribute. Being hungry and thirsty also impair us.

Canadian researchers suggest regular meal breaks for doctors. Many work long shifts with no guaranteed breaks. Healthy food should be available. (Not just sandwiches and crisps I hope!). Food outlets should be open 24 hours to accommodate shift workers. Staff should be able to store and eat food near to where they actually work. They also suggest that professional bodies increase awareness of doctors’ nutrition and their well-being and promote self-care for doctors.

 

Based on several articles in the BMJ 4 June 16

Ending blame culture would improve NHS care in three years by Matthew Limb freelance journalist

QOF and mortality Richard Lehman Lancet 2016 doi:10.1016/SO140-6736(16)00276-2

Fitness to practice process must change by Abi Rimmer

Five ways to help doctors eat healthily at work doi:10.1136/postgradmedj-2016-134131

 

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