UK. Discussion document from the BMA on patient safety and clinical risk

Citation

(2003), "UK. Discussion document from the BMA on patient safety and clinical risk", International Journal of Health Care Quality Assurance, Vol. 16 No. 2. https://doi.org/10.1108/ijhcqa.2003.06216bab.006

UK. Discussion document from the BMA on patient safety and clinical risk

UK

Discussion document from the BMA on patient safety and clinical riskKeywords: BMA, Clinical risk management, Healthcare shortage, Patient safety

In December the British Medical Association (BMA) published a discussion document, Patient Safety and Clinical Risk, which puts forward a new framework to address clinical risk in order to improve patient safety.

Dr Vivienne Nathanson, the BMA's Head of Science and Ethics said that it was important to move away from a blame culture towards a system where the whole team (doctors, nurses, patients, managers, policy makers) share the burden of responsibility when things go wrong. She said that the discussion paper aims to put forward ideas for doing this. She added: "We're not saying doctors who make mistakes should be let off. The BMA supports organisations like the NICE and CHI and the revalidation process. However we need to look at why mistakes happen so we can learn from them and reduce clinical risk to patients."

The discussion paper suggests that the risk of errors and adverse events occurring with the health system can be divided into the following five areas:

1. 1.

   The risk of individual clinical incompetence or malpractice: doctors who make mistakes and whose errors of judgement or incompetence cause serious health problems or even fatalities to their patients.

2. 2.

   The risk of systems failure: when systems and procedures breakdown the health of individual patients can suffer. For example cuts to cleaning budgets in hospitals can lead to hygiene problems and ultimately can lead to the spread of MRSA infection.

3. 3.

   Risks imposed by cost constraints: chronic shortages of healthcare staff or junior doctors working excessive hours and suffering from tiredness and sleep deprivation can create pressure in the system, reducing safety margins and its capacity to cope with unexpected events.

4. 4.

   Patients' perception of risk: this area covers patients who have unrealistic expectations of the health service. For example believing screening tests are 100 percent accurate, that drugs have no side effects, that there is always a cure. This category could also cover "the worried well" – patients who are so heavily influenced by media health stories that ultimately their anxiety adversely affects their health. Equally it could cover patients who ignore signs of ill health and delay seeing a doctor.

5. 5.

   Risks inherent in clinical procedures: even if the previous levels of risk did not exist, no patient undergoing treatment could ever do so entirely free from risk of an adverse outcome. This innate risk is due to the inherent disruption caused by having to undergo an operation and the effect of the personal characteristics of the patient, for example their age, gender, and clinical condition at the time of treatment.

The paper says that if risk is analysed in the five categories above then patients, healthcare professionals, managers and governments may be able to define the most effective way of managing it both generally and in relation to individual cases as well as identifying where the responsibility for different levels of risk should lie. Managing and reducing risk are both most effective when they follow careful analysis of where risks occur and the factors that can affect their frequency and severity.

While doctors must remain accountable for their own errors they should not have to be responsible for risks over which they have little or no influence.

Whilst the paper has been issued by the BMA, they stress that it is a discussion document, and does not represent BMA policy.

Further information: the paper, Patient Safety and Clinical Risk is available on the BMA Web site: http://www.bma.org.uk/ap.nsf/Content/patientsafetyclinicalrisk