CHFG position document on ‘safe space’ practice and legislation in the NHS

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CHFG position document on ‘safe space’ practice and legislation in the NHS

In October the Department of Health set out a consultation seeking views on providing a ‘safe space’ in healthcare safety investigations, click here to view the consultation.  The CHFG have been working with James Titcombe, Carl Macrae, Scott Morrish and Murray Anderson-Wallace and consulted with world class experts in patient safety, investigation and human factors to ensure that our contribution to the consultation is as evidence-led as possible and appropriate.

The consultation closed on the 16th December, to view our submission please click here

By | 2017-01-24T11:40:16+00:00 13th December, 2016|Learning Resources, Policy and Research|7 Comments

7 Comments

  1. Sally East 13th December 2016 at 12:16 pm

    Yes this is all good. I wonder if more reference should be made to whistle blowing in a safe environment too?

  2. Matt Hill 13th December 2016 at 1:13 pm

    I think that it should be clearly explained what we mean by “learning” i.e that this isn’t just about doing the investigation and understanding what went wrong, but that it is about putting in place improvement projects to stop it happening again, and creating the space for teams to do the improvement. These may be based around any aspect of what comes out of the investigation from human factors intervention to pure systems based process.
    At present all the energy goes into the investigation aspect and very little into the improvement aspect and I believe that this should be emphasised and adressed.

  3. Narinder Kapur 13th December 2016 at 1:33 pm

    In addition to protection for whistleblowers, there should also be reference to changing the current NHS culture of unjust and unfair disciplinary procedures which can readily be used to victimise staff who speak out. These procedures are riddled with conscious and unconscious bias, and are intellectually and morally bankrupt. Patient safety will continue to suffer unless the current procedures are radically overhauled.

  4. H Gallei 13th December 2016 at 6:13 pm

    I think it is an admiral project
    1) culture difficult to change, i think it is changing but will take a long time to evolve and requires patience which seems limited in a workplace obsessed with quick fixes. Culture also varies from trust to trust. We conform to the behavoiurs seen in our surroundings the “normalisation of deviance”.
    2)This year there was an article in the BMJ when material taken from “reflective practice” from a trainee protfolio was used in some form of tribunal “against” said trainee. This does not engender trust, this does not create openness.
    3) gossip and information governance is an issue, i remember as a trainee overhearing conversations about other trainees, about job application. I have also given what i thought was confidential feedback only to be caught offgaurd by a trainee asking me to discuss my comments when neither the timing or place was appropriate for such discussion. Those who have access to info in the “safe space” need to be managed in some way and if breach confidentiality need to be seen to be responsible even reprimanded to create trust in the system.
    4) Education in HOW TO REPORT & HOW TO INVESTIGATE i have reported incidents and received conclusions that do not answer the issues i highlighted, almost like they chose to answer different questions. I have also seen great reports but the actions never followed, like so much time was taken by investigation non was given to the solution.
    5) very rarely is an incident formally debriefed. If we do debrief it is in the immediate aftermath, however, i find once i have had some time out, away from the acute “stress” i gain better insights or generate questions but then there is never opportunity to discuss these. If we got better at debreifing incidents, discussing the strengths & weaknesses in performance of our selves, our teams and our systems at the debrief we would get better at reporting.

  5. Suzanne Shale 14th December 2016 at 10:34 am

    Thank you for publishing your draft. I applaud the spirit of collaboration and openness behind it. I strongly oppose your para 7 the extension of HSIB safe space to local investigations “on a case-by-case basis, when the Chief Investigator (CI) of the HSIB is satisfied that: (a) the local investigation warrants and would benefit from safe space provisions; and (b) the local organisation leading the investigation demonstrates the appropriate leadership, culture, competence, capacity and intentions..” 1) A legal and moral objection: it would be quite wrong to give power to an employee of the NHS (which the CI is) to deprive citizens of their legal rights on a case by case basis according to his discretion (the deprivation of legal rights is access to information that could be sought through disclosure in legal proceedings but would not be subject to disclosure in the safe space). 2) A practical and ethical objection: I cannot see that the CI as the an employee of the NHS can be expected to make a credible and trustworthy judgment about the appropriateness of “leadership, culture, competence, capacity and intentions..” of another NHS organisation.

  6. Julia Riley 14th December 2016 at 6:09 pm

    There is one absolute pre-requisite for safer practice and I know I am speaking to the converted in the CHFG -the top people must make safety their first priority and must properly understand human factors.
    Sadly it is far too easy to ‘hold accountable’ front line clinicians who are simply not able to work safely due to service pressures, inadequate secretarial support, and lots and lots and lots of bureaucratic process.
    James Reason and others have described this beautifully for decades – the person on the front line so often inherits the error, and many of the factors leading up to it were probably not in his or her control.
    So often we still see incident investigations which I would paraphrase as follows:
    1. this incident happened
    2. we sat down and discussed it
    3. we said don’t do it again and we shared the ‘learning’
    Human Factors has all the answers – why would (usually very reasonable and competent) front line clinicians not do what was correct at the time?

  7. Martin Bromiley 15th December 2016 at 10:37 am

    Hi everyone, thank you for your comments which have been debated and used in some cases to amend the final submission which is now prepared and we’ll share alongside a newsletter at the start of next week.
    I agree about the wider system issues such as “learning” and the role of safety and human factors, we’ve made reference to that at the start of our submission although I’m conscious that it’s not the meat of the submission and too many words may impact how it’s read. I’ve also made clear the difference between “safe space” as defined in the submission and “safe space” for whistleblowers etc which I’ve now stated clearly is critical, but is outside of the DH consultation. (It also confused a few MP’s this week in the House). Finally I have made clear our desire for HSIB to be ultimately independent of the NHS to avoid potential conflicts of interest in judging other organisations in the NHS. Thanks again, we’ve had world class people working on this and your views have been read and been really useful, and in many cases used.

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