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Cultural change cannot be mandated by law

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It is just over twelve months since Robert Francis QC delivered his report on the Inquiry into Mid Staffs and his call for a change in culture in the NHS. Francis rightly recognised that standards in patient care and safety could only be improved by ensuring staff worked in an open environment where they could raise concerns and be open about mistakes.

Since then, much progress has been made. For example, new proposals for criminal sanctions for healthcare professionals who wilfully neglect their patients have been introduced and a Chief Inspector of Hospitals has been appointed to lead a team responsible for delivering Ofsted-style ratings to hospitals.

The measures appear robust. However, this focus on creating new duties, processes and imposing criminal sanctions is a concern.

Cultural change cannot be mandated by legislation and measures such as criminal sanctions, could do more to create the very climate of fear government is keen to end.

Indeed an MPS survey of hospital doctors conducted by the Medical Protection Society in November 2013 highlighted the enormous task facing the government in their bid to create the open culture the Berwick Review considered missing and needed in the NHS.

When respondents were asked to comment on the culture of their own Trust following the Inquiry into Mid Staffs, 46% of the 807 hospital doctors admitted they remained fearful of the personal consequences of raising concerns. This is despite 43% acknowledging patient safety concerns were listened to and acted upon.

More worryingly, 65% of the hospital doctors surveyed by MPS believed government’s plans to introduce criminal sanctions on healthcare professionals in cases of wilful neglect will create a culture of fear in hospitals – the very culture Berwick was keen to abolish.

Put simply, in order to create the open culture Berwick promoted, government must first ensure staff are empowered to raise patient safety concerns. This will not come through processes, duties or criminal sanctions but through training, mentoring and the development of a supportive learning environment.

The post Cultural change cannot be mandated by law appeared first on Hospital Dr.


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