PEPs - Clinical Quality and Evidence

Module 1 - Clinical Quality

Healthcare culture and safety

So before we look at dimensions and definitions of Clinical Quality, let’s just consider why doctors can sometimes be cynical or avoid some aspects that we would like you to consider and even focus on!

Attachment: J Health Serv Res Policy-2007-Davies-129-30.pdf
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Davies H, Powell A, Rushmer R. Why don’t clinicians engage with quality improvement? J Health Serv Res Policy Vol 12 No 3 July 2007

The reports into care at Mid Staffordshire Foundation Trust (the Francis Reports) highlighted scandalous deficiencies in basic patient care (nutrition and hygiene) but also major flaws in managerial responses to ‘whistleblowing’ and in Government oversight.  

Teacher's Comment

Pause and consider why, in this climate, you think doctors could respond negatively to being told we ‘must change our culture’?  

A series of letters in the BMJ point to some of the reasons:


http://www.bmj.com/archive/online/2013/03-04 (Scroll down to find Letters section on the right)


Perhaps feelings of powerlessness in the face of purely financially driven ‘targets’, the need for more clinicians in senior management, or frustration at political interference in the NHS.  Our own Medical school blogs (MedLea - February and March 2013) highlight other issues.


This debate shows up significant barriers to individual and organisational learning, especially doctors’ reluctance to stand up and point out poor care – understandable in the face of a ‘blame’ culture and colleagues who are not always supportive.


The BMJ also carries an article from a ‘whistle-blowing’ former NHS Occupational Health doctor pointing out the deficient care that the NHS offers its own staff!:  


http://www.bmj.com/content/346/bmj.f1503


So these are some of hurdles you will face both now and in your professional life.  But don’t be deterred by these organisational issues or sidetracked by debates about the unintended consequences of the European working time directive! (see MMS blogs on MedLea and the BMJ module in Section 4).  As the examples from the ‘Open School’ (Introduction section) show, it’s best to focus on simple ways that students like you can contribute to high quality care.


It’s also important to look for good role models: within her MMS blog on Feedback, Dr Pip Fisher directed us to a link to a powerful 20 minute TED talk on "accepting that we all make mistakes, and moving on to allow ourselves to learn from them, so that we can continue to practice medicine as best we can.":


http://www.ted.com/talks/brian_goldman_doctors_make_mistakes_can_we_talk_about_that.html  


The ‘Open School’ Resources provides further accounts of doctors acting with transparency.