Content from National Patient Safety Agency material http://www.nationalarchives.gov.uk/doc/open-government-licence/version/2/

The Incident Decision Tree…

Content from National Patient Safety Agency material http://www.nationalarchives.gov.uk/doc/open-government-licence/version/2/

Culpability

Individuals can be:-• Accountable for error• Responsible for error

...but need not always also be: -• Culpable for error

Peter Pronovost

Content from National Patient Safety Agency material http://www.nationalarchives.gov.uk/doc/open-government-licence/version/2/

“The single greatest impediment to error prevention is that we punish people

for making mistakes”

Dr Lucian Leape, Harvard School of Public Health

Content from National Patient Safety Agency material http://www.nationalarchives.gov.uk/doc/open-government-licence/version/2/

The Incident decision tree

An electronic interactive tool designed for NHS managers dealing with staff who have been involved in an incident

• Supports managers considering action and alternatives to suspension

• Encourages fair and consistent treatment across the NHS

• Aims to avoid Hindsight bias and Outcome bias

Developed by NPSA, NCAA, NHS Confederation,

Royal Colleges and Trade Unions

Content from National Patient Safety Agency material http://www.nationalarchives.gov.uk/doc/open-government-licence/version/2/

Concerns about suspensions

• Longstanding concerns about number and duration of staff suspensions in NHS.

• Seen as by-product of ‘blame culture’.

• Concerns borne out by NAO report 2003.

- available on their website www.nao.gov.uk

Content from National Patient Safety Agency material http://www.nationalarchives.gov.uk/doc/open-government-licence/version/2/

“The Management of suspensions of clinical staff in NHS hospitals and ambulance Trusts in England”

NAO Report November 2003

• April 01 - July 02, over 1,000 clinical staff suspended

• Average length of suspension = 47 weeks for Doctors =19 weeks for other staff

• No returning to work = 40% doctors / 44% others

• Cost per suspension = £188,000 on average per doctors = £ 21,400 for other staff

• Cost to NHS = £11 million per year

Content from National Patient Safety Agency material http://www.nationalarchives.gov.uk/doc/open-government-licence/version/2/

Anecdotal findings from studies

• Authority to suspend widely devolved.

• Nurses more likely to be suspended than other staff groups.

• The less experienced the manager, the more likely they are to suspend.

• Most incidents involve protocol violation.

• Widespread confusion re: ‘formal suspension’ and sending home in immediate aftermath.

Content from National Patient Safety Agency material http://www.nationalarchives.gov.uk/doc/open-government-licence/version/2/

How the IDT works

Structured questions move through 4 ‘tests’

• The Deliberate Harm Test

• The Physical and Mental Health Test

• The Foresight Test

• The Substitution Test

Content from National Patient Safety Agency material http://www.nationalarchives.gov.uk/doc/open-government-licence/version/2/

Content from National Patient Safety Agency material http://www.nationalarchives.gov.uk/doc/open-government-licence/version/2/

Content from National Patient Safety Agency material http://www.nationalarchives.gov.uk/doc/open-government-licence/version/2/

The IDT can be used:• By any manager dealing with staff involved in a patient safety incident• For any employee, whatever their professional group

The IDT should be:

• Step by step and electronically

• Separately for each person being considered

www.npsa.nhs.uk

The IDT must be used:

• Revisited and updated as info. is gathered to assist decision making

Content from National Patient Safety Agency material http://www.nationalarchives.gov.uk/doc/open-government-licence/version/2/

Key Points – IDT

Aim is to encourage:-

Fair, objective, consist approach to error

Consideration of systemic and organisational issues

Consideration of alternatives to suspension.

Open reporting of patient safety incidents.