Essay: Raising concerns in healthcare settings

Healthcare professionals, specifically doctors, are placed with a unique degree of trust by the public. Along with clinical knowledge and experience, they’re also expected to act professionally; maintaining honesty and integrity at all times. Although medical students have not completed their medical training, they are viewed as future doctors, and therefore must start practising professional skills, behaviours and characteristics early on in their training. During this essay, I will discuss the ideas of ‘raising concerns’ and ‘teamwork’, proving how they’re vital concepts to both the medical student and doctor.
Raising concerns
Raising concerns in healthcare settings is vital to ensure patient safety (GMC, 2017) and that practises are continuously monitored and improved. Raising concerns is covered by Domain 2 of Good medical practice (GMP) (GMC, 2014, p.10-12) “Safety and quality” with the GMC stating that all healthcare professionals, including medical students, have the responsibility to raise concerns (GMC, 2015). Professional behaviour, working conditions and patient health all contribute to patient safety, so raising concerns about any of these areas is key to the successful functioning of healthcare services.
Concerns may be raised over bullying amongst doctors or a doctor’s fitness to practice, where newly trained doctors don’t feel competent. The GMC (2014) reported that 1 in 10 new doctors feels poorly prepared to practice, potentially due to low quality training as a student. As such students don’t comply to standards set by the GMC (2017), so concerns should be raised to improve medical education and ensure doctors aren’t practicing above their limit of competence. Junior doctors must alert their superiors, to protect patients, when reaching their limit, abiding by the duty of candour (GMC, 2017).
Furthermore, one may raise concerns in medical education in regard to the health or actions of students, or standard of schooling. One reason to raise concerns is about my health or my peers’ health. Student health is particularly important and concerns should be raised to ensure that students are well and coping with the high demands of medicine and not adversely affecting patient safety. 30% of students surveyed by the BMJ (Munn, 2016) said they experienced or received treatment for a mental health condition, so concerns should be raised early to implement support networks for said students.
As a medical student, it’s my duty to raise concerns in line with the medical school’s policy (GMC, 2015) where I feel there’s a safeguarding issue or standards aren’t being met. At Birmingham medical school, ‘yellow forms’ are used to raise concerns about students (University of Birmingham, 2017). This provides a confidential approach but others may be aware a concern has been raised, leading to a fractured group with little teamwork. Concerns about other matters can raised with my year’s academic lead or to the Deanery. Staff at student services can advise as to where best to raise concerns. In a healthcare environment, a concern should be raised in line with the hospital or GP’s policy (GMC, 2012), with guidance provided by Figure 1. If a concern is raised publicly, patient confidentiality must be maintained. Knowledge of the process of raising concerns is essential due to safety issues that must be dealt with immediately. Whistleblowers disclose information alleging to misconduct of another member/s of the same organisation (Figg, 2000). Internal whistleblowers report inside an organisation whilst external whistleblowers report to outside the organisation (Dworkin and Baucus, 1998). External whistleblowers are more likely to change practices but often experience more extensive repercussions due to greater publicity (Attree, 2007). Thus, the Public Interest Disclosure Act 1998 provides legal protection for those that are unfairly dismissed for whistleblowing, protecting jobs by minimising the “high risk” (Attree, 2007) of raising concerns.
Figure 1 – A flowchart showing the process of raising concerns (GMC, 2017)
Many healthcare professionals feel there are barriers to raising concerns, including fears of retribution and repercussions (Attree, 2007). A study of doctors (White, 2004) found 8 in 10 didn’t trust their NHS trust or the Department of Health for reporting concerns, with respondents often preferring an independent system. Only 15% of serious incidents were reported, illustrating that healthcare professionals often believe their concern won’t be appropriately dealt with. With increasing trust in systems, more concerns will be raised, boosting patient safety.
As a medical student, I believe the main barrier to raising a concern is the fear of being ostracised by my peers. I feel more comfortable raising a concern that’s been supported by my M group, as it gives me a sense of anonymity and I am not solely ‘to blame’. Studies reinforce this, showing that individuals are more likely to disclose sensitive information when anonymous (Hill, Dill, & Davenport, 1988; Werch, 1990).
Concerns may be reported too late to have a positive impact on patients’ lives, such as the case of Harold Shipman. Complaints were made about Shipman but never triggered reviews of his clinical performance, even though one reached the GMC. This failure to deal with concerns has caused ‘immeasurable damage’ to the doctor-patient relationship. (The Telegraph, 2014). His malpractice meant the introduction of revalidation of doctors every 5 years through annual appraisals (GMC, 2017). An inquiry into Mid Staffordshire NHS foundation trust (Francis, 2010) found staff didn’t feel comfortable expressing concerns over the poor care they saw (NHS choices, 2013). Many staff expected others to speak on their behalf with the ‘inaction of many’ (Spence, 2013) causing multiple preventable deaths. This fortifies the need for confident whistleblowing, therefore the Freedom to Speak Up Document (Francis, 2015) was written, recommending a ‘guardian’ in NHS trusts for each staff member. Ergo, effective processes for raising concerns are needed. Nevertheless, recognising concerns leads to regulation and advancement of medical practices.
Teamwork
Teamwork is defined as “The combined action of a group, especially when effective and efficient” (Oxford Dictionaries, 2017) and is listed under Domain 3 of GMP (GMC, 2014, p.13-17) hence it’s critical to being an accomplished doctor. Teamwork, in the medical profession, aims to efficiently treat patients and ensure knowledge is on par with peers.
The sharing of information occurs during CBM and in SGTs, often as presentations. Group sessions aid the acquisition of knowledge, also improving communication, independence and information sharing skills (Wood, 2003). Continued teamwork also develops a deep learning approach where more knowledge is retained (Senge, 1990). During SGTs, I often take forward roles in my group. I feel I am a good leader as I try to involve other group members to approach tasks from multiple viewpoints, but both myself and the group would benefit from allowing others to take on responsibility by being leader. This develops their leadership skills and taking a step back will allow me to critically evaluate other’s comments and improve my listening skills.
Multiple factors lead to effective teamwork, quantitatively assessable using the mayo high performance teamwork scale (Malec et al., 2007). Some key factors are honesty, trust and communication. Teamwork can have a negative impact if there’s an overbearing leader or insufficient communication as emphasised by the Morecambe Bay case. (Kirkup, 2015) Poor communication underpinned the bad working relationships that developed between doctors and midwives resulting in 11 unnecessary neonatal deaths and highlighting how raising concerns was important to identify the poor cooperation that compromised patient safety. This then lead to improvement in teamwork at Morecambe Bay.
Teamwork saves the healthcare service time, resources and money. Time is saved when sequential processes carried out by individuals occur simultaneously in a team (Myer, 1993). When primary healthcare teams and physicians care were compared (Sommer et al., 2000), findings showed that primary healthcare teams lowered hospitalisation rates and cut physician visits. Thus, a secondary effect of teamwork is to decrease strain on resources and so it is imperative teams work in the current NHS.
As a doctor, teamwork is important in continuity of care to ensure patients receive correct treatment and all individuals involved understand how best to treat patients’ conditions. The two key elements of continuity are ‘care of an individual’ and ‘care over time’ (Haggerty, 2003), with the doctor-patient relationship important in primary care. This presents a new example of teamwork, with the doctor facilitating care pathways for the patient, whose role is to adhere to agreed treatments and update the doctor if they have concerns. Their autonomy should be respected, so involvement is crucial in a productive doctor-patient relationship.
When shadowing doctors, I witnessed multiple examples of teamwork. This was specifically noted at handover meetings where I saw healthcare professionals work in collaboration with consultants as a united multidisciplinary team (MDT) to meet patient needs. Effective communication occurred when everyone’s opinion was heard, raising concerns from each specialty, leading to holistic care (Jefferies and Chan, 2004). MDTs have led to higher cancer survival rates (MacDermid et al. 2009) proving that teamwork can improve patient outcomes.
Both teamwork and raising concerns are fundamental ideas within medicine. Raising concerns underpins patient safety along with the regulation and advancement of medical practice and education with teamwork providing the necessary means for effective treatments. The two continuously overlap, and are required in conjunction with other skills, specifically honesty, to allow the doctor to care for their patient. During my medical training these are two of a wide variety of concepts that I will grow to appreciate as they will form a cohesive base allowing me to prioritise patient care and safety.