19/10/2018
Adverse events can occur in any organisation. Some attract limited attention but others can really hit the headlines. The Care Quality Commission's (CQC) latest report on the state of care in independent acute hospitals cites the Paterson scandal as an example of failure in governance and leadership. Questions remain as to how one man's abuses could have carried on for so long.
On another day, in another organisation, with a shifting political approach within regulation and the need for the CQC and others to be seen to protect and promote patient safety and public trust, such an event – or one of less magnitude – could bring an organisation to its knees.
A modern healthcare business should have a strategy for dealing with the type of event that could represent a serious threat to its integrity, reputation and ultimately its viability.
Immediate Response
Events can be uncovered in different ways: an incident report being triggered at the time of an issue occurring; a patient complaint; a whistleblower; an adverse regulatory inspection. Essentially, it doesn't matter how an event is discovered, the organisation must, and be seen to, respond immediately and decisively.
It is crucial at the outset to create the right team to lead the organisation through the various stages of a crisis. The team should have Board-level representation and be responsible for controlling lines of internal and external communication whilst ensuring the organisation’s values are not sacrificed. Those values are inevitably going to include:
- Safety
- Service user focus
- Excellence
- Being responsive
- Partnership working
- Openness and transparency
This is not the time to be insular. Money paid for good advice on clinical governance and legal issues will be well-spent. Not least, you will need to understand how competing legal obligations interact, including the need for candour and statutory reporting requirements balanced against unnecessary self-incrimination.
Devise a strategy and start acting
Your team and Board will need to decide on a strategic direction which is cemented in your overarching values and legal obligations, but flexible enough to deal with sudden changes as well as potential long periods of inactivity which can often arise. You'll need to demonstrate proactivity which can be difficult where there are competing investigations – perhaps the police or safeguarding. You'll want to avoid charges of interfering with an external investigation, but equally it is imperative to keep your organisation running. That will often mean carrying out your own investigation to ensure the organisation is a safe place.
It is of fundamental importance to know who to speak to and when, as well as what to tell them. An effective communications strategy should create the framework for you to portray your organisation as positive, proactive and able to respond and learn. It should be both reactive and forward-looking and rooted in your obligations to your key stakeholders who will need to be identified at the outset. Media training is now common but it is just as important that you know what to say behind the scenes as it is when you are in front of the camera.
An organisation's event management strategy should set out who the key people are as part of its communication, notification and continuity plan. It is really important to understand that each stakeholder will have their own agenda.
Manage your risks
Every situation is different, but an organisation's event management strategy should focus on the fallout; regulatory investigation and enforcement; civil litigation /medical malpractice; criminal exposure including corporate manslaughter; coroner's inquest and/or safeguarding; public outcry – becoming a vehicle for political gain; floodgates – whistleblowing, other individual claims; adverse media capital.
An organisation's workforce is usually its greatest asset but can also represent some of its greatest risks. Again, whilst every situation will have specific dynamics, staff must provide contemporaneous statements to capture important evidence about an event. They may need to be supported because of dysfunctional team cultures where there is a fear of speaking out against powerful individuals. Or they may need to be swiftly disciplined and removed from patient-facing activity.
Success or failure – prepared for action
Organisations should plan on the basis that an adverse event is, at some point, inevitable. By creating a strategy that promotes assurance, trust and continuity they will be better off when the worst happens. First and foremost, patients must be safe; however very close to the safety imperative is organisational survival. Organisations must have the tools and support to meet basic responsibilities but also to challenge over-reaction. In essence, a good event management strategy should enable senior management teams to be agile enough to respond effectively and to get the messaging right. It is much easier to say sorry when you know you can steer your organisation through even the choppiest of waters.
This article was originally published in Healthcare Markets Magazine - volume 22, issue 8, October 2018.
