Incident reporting: a necessary evil?

I did something out of the ordinary today. I filled in two incident forms.

This may not seem groundbreaking to some of you. Perhaps you are the sort of person who regularly fills out incident forms and sends them off to the risk manager. Or maybe you are of the type who assumes that incident forms make no difference at all, and are not worth the paper they are written on?

Well, I am some way between the two… I appreciate that it is important to report near misses and failings to ‘the system’ so that data can be collected, collated, patterns noted, and steps taken to reduce systematic failings. However, I am also busy, and filling in incident forms when they seem to have a negligible impact feels like a waste of time, and the forms themselves seem to have little to commend them, not least because of the details required: (junior doctors do not often know which department they work for… This is not a joke, the groupings of specialities in different trusts is so random as to make keeping up with who you work for a pointless task)

So, what prompted the strange enthusiasm for incident forms?

Strangely, one I think was probably not a appropriate use of an incident form, and the other was absolutely required. What I found most interesting was that the form I thought least worth produced the greatest result, and the other remains stuck in the cogs of the risk management system.

I went to work quite early this morning, and reviewed a couple of patients. On one ward I saw some staff behaving dreadfully in front of some vulnerable patients. This wasn’t putting the patients in danger, or at risk, and did not affect the course of their illness. However, I thought the behaviour was not becoming of health professionals, and said so, to those involved, and to the nurse in charge of the ward. Later in the day I was requested to fill in an incident form as the ward Sister was incandescent that this could be going on on her ward. Given how seriously my complaint was being taken, I couldn’t really do anything except oblige, and record my concerns officially.

In contrast, the other report was about a serious clinical failing. I learned throughout the day that this incident had already been reported, but 4 weeks down the line, despite being one of the key players in the incident, I had not been contacted for my version of events.

So, the clinically less relevant incident yielded an almost instantaneous response, with immediate input from the leader of the clinical team, whereas the more important (in my view) in incident has progressed very little since it was submitted.

I suppose there are a couple of lessons for me here:

Challenge inappropriate behaviour.

It is not breaking some sort of moral code, but in fact is vitally important to challenge bad behaviour when we see it, and contrary to what one might think, you are likely to be supported if your stance is a justified and balanced one.

2. Incident reporting needs to be, and seen to be more responsive.

If clinicians are going to be involved in incident reporting in any meaningful way, it is vital that their concerns are listened to.

Consumer and service industries have learned that silence in response to trouble is not effective (see how Blackberry scored a massive own goal with a media silence when their servers went down earlier this year. ) and does not lead to satisfied users.

The immediate feedback, and promise of effective action as a result of my actions earlier today encouraged me that there can be real value in incident forms. Sadly the second experience still leaves me wondering of I should bother again in the future.

NHS organisations need to learn. The only way they can learn is through knowledge about what is really going on on the ground. If incident reporting is to be a useful tool, I then there needs to be less of the low level complaining. ( I think my first form today could have been dealt with at a ward level, with no recourse to the official system)

Instead, a far greater, urgent and powerful response to incidents which really do reflect significant systematic, or individual failings should be evident, and preferably the lessons learned publicised.

At the moment, there is sadly little incentive for the eyes and ears of the system ( the juniors ) to report incidents. Until it feels like it does some good, I suspect that they won’t want to spend time on this key responsibility, to the detriment of the system as a whole, and ultimately to he detriment of patient safety.


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