Q Exchange
Psychological Safety in the Effective Clinical Governance of Doctors
- Proposal
- 2024
What is the challenge your project is going to address and how does it connect to the theme of 'How can we improve across system boundaries?
Psychological safety is an important element of clinical governance as it encourages transparency, openness, and learning. The absence of psychological safety leads to perceptions of a blame culture that will ultimately end in a failure to capitalise on improvement opportunities.
A local audit suggested that in 108 incidents involving an identifiable doctor, less than 2% were named within the incident reporting system. This prevented them from being able to reflect on the incidents in their appraisals and have opportunities to learn and develop their practise.
The project will aim to boost the culture, capabilities and structures needed for learning and improvement by exploring the methods of introducing psychological safety across our local systems.
By utilising the network of Responsible Officers and their support teams, the project will look to develop upon areas of good practice and scope new approaches for implementing psychological safety for the effective clinical governance of our medical workforce.
What does your project aim to achieve?
1: To collect the lessons and principles of good practice across our local systems
2: To develop a set of principles and procedures that can be adopted to implement/verify psychological safety within clinical governance processes
3: To establish a process for sharing learning/improvement in a way that is psychologically safe and empowering to organisations
4: To capture data that demonstrates an improvement in the number of incidents being shared with clinicians to reflect upon during their appraisals
5: Develop recommendations and research that would contribute to the improvement of governing body guidance (e.g. GMC Guide to Good Clinical Governance for Doctors)
How will the project be delivered?
The project will focus around a research proposal delivered to scope and deliver answers relating to psychological safety and its role/impact on clinical governance.
By utilising the Responsible Officer network, we would use a peer reviewer methodology to gather data. The outputs will focus on the organisational approach to psychological safety in clinical governance as well as collecting individual lived experience to produce key themes and patterns that lead to successful or unsuccessful applications of good clinical governance.
Following fieldwork, the desired output would be to develop a set of principles/recommendations that contribute/underpin psychological safety that can be used to implement/verify a psychologically safe approach to clinical governance.
After publication, we would then look to implement the findings locally and measure the impact; specifically, how much improvement there is in the reporting/sharing of incidents that inform part of the doctors’ appraisals/governance processes.
How is your project going to share learning?
- Through development/publication of a research paper and recommendations that can be shared with the Q community and presented at regional events.
- Poster presentation and local/regional clinical governance forums
How you can contribute
- - Examples of previous data collection in this area
- - Examples of areas with good practice in regards to apply the GMC Good Clinical Practice guide
- - Comments and suggestions for further development of this idea
Plan timeline
| 1 Jul 2024 | July 2024: Establish methodology and agree proposal |
|---|---|
| 2 Sep 2024 | September 2024: Data collection/Fieldwork |
| 1 Oct 2024 | October/November 2024: Analysis and data processing |
| 1 Nov 2024 | November/December 2024: write-up/findings |
| 2 Dec 2024 | December 2024: submission |
Comments
Michelle Beattie 14 Feb 2024
I think this is a great idea Jason. I used to facilitate root cause analysis in a health board when the outcome of an adverse event was serious. It always came back to sharing the learning (too often others listen but say "this wouldn't happen on my ward/team etc"). So creating the culture is key. I wonder if you can separate out a supportive pathway from the appraisal process? My thinking is the latter requires a judgment to be made about performance but the latter is more supportive reflection. I know they are both related but I think splitting them would help create a culture of openness and avoid complexities of the system that requires things like malpractice to be managed from supportive reflection and learning. Just some thoughts. Wondered about your timeline be so soon if outcomes wont be known for funding until July. Good luck
Jason Watson 15 Feb 2024
Thank you for taking the time to comment Michelle your ideas have prompted a lot of thought on my side and I will adjust the timelines :)
Hilda Campbell MBE 11 Feb 2024
I think this is a great idea. If people do not feel safe to explore what did not go as planned then there is a risk whatever that was will be repeated as nothing has been learned to avoid it happening again.
Creating a no blame culture requires a different style of leadership as often what can happen is 'blaming' someone else to avoid the 'blame' being put on you. This can be either the 'leaders' being blamed for not creating the right conditions for safety, or the team being blamed for not following procedure.
My professional background is nursing, not medicine, however, the approach which was part of my leadership training was to understand the motivation behind the action which did not go as planned. Was it to make life easier for the service deliverer/couldn't be bothered etc, or was it with the intention of what was best for the recipient of care, but this did not go as planned. The focus was on was the 'patient' the priority. This may sound obvious that of course they are the priority, but with high demand, reduced resources, increased pressures to account and report, sometimes it can be hard to remember why we are doing what we do and for whom.
There are times when further action does need taken due to professional negligence and being mindful of procedures matters to avoid harm, however, a balance needs to be struck between, no matter what happens its fine there is an explanation for it, and not admitting when things don't go to plan for fear of accusations of professional negligence, responsibility and accountability need to be in balance.
There is no simple answer to this, which is why I think this is a great idea, as it offers an opportunity to explore what is happening where, how it works/could work better and arriving at a place of improved incident reporting, support and supervision.
I am not sure if my comment is helpful, except to say, I hope your idea is successful as we do need a safe space for people receiving care, we also need a safe space for people offering it as when people don't feel safe, in my view, there is actually more risk of something not going to plan.
Kind regards
Hilda
Hilda Campbell MBE 14 Feb 2024
You are very welcome Jason, I hope your application is successful as it is so important for learning and also for staff wellbeing as fear is not a healthy emotion to experience in work and yet, so many systems can induce this sense of fear, which can actually lead to inaction. I hope also this crosses boundaries, I know from experience, the rhetoric of not working in silos is present however, the reality in practice often means talk, but no change, and while talk can lead to change there does come a point when it needs to move from talk to action. We have limited resources and increased demands, so makes sense to stop reinventing the wheel just so we can put our logo on it :-) again, hope it goes well as I think its a great idea and one I hope others learn from one in motion
Jason Watson 13 Feb 2024
Thank you Hilda, your comments were very helpful. I myself am a Nurse by background but currently work within the Medical Directors office supporting the Chief Medical Officer and Responsible Officer. Though the focus of this idea is to impact the clinical governance of medical staff, I would not be surprised to see that any findings would be easily transferable/scalable to other professionals impacting care quality and safety.
I believe your suggestion to incorporate motivational theory into the research is very helpful and I will ensure this is included in any revisions/development of this idea moving forward.
Given my current role deals a lot with risk, behaviours, clinical judgement, and conduct, your comment around balancing accountability resonates with me. My main passion and drive for this project stems from seeing clinicians not being given the opportunity to explore/reflect on situations which others have already seemingly formed an opinion on. I have also seen a number of reports suggesting that feedback had been provided to clinicians to develop their practise only to learn that this had not actually happened.
As you quite rightly mentioned above, exploring the motivations of these practices is of great importance to me and how we can then use this information to influence leadership styles, to those more accommodating for good clinical governance.
I am sure many have explored similar ideas but as another group has already mentioned on this idea's page: improvement often occurs in silos. I would like to utilise this opportunity to explore how we can co-ordinate good practices to impact safety and learning.
Thank you so much for taking the time to comment,
Jason
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