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Inevitably, the delivery of health care in conflict means not everything goes the way you would like or plan, even when you have done everything right.
How do you manage a sense of failure e.g. a patient death or a missed diagnosis?Specific Topic(s): dealing with adverse events or outcomes in healthcare.
Key references:
‘Ethical principles of health care in times of armed conflict and other emergencies’ – Health-care personnel shall at all times act in accordance with relevant international and national law, ethical principles of health care and their conscience.
Geneva Conventions: not applicable
Ethical principles: WMA DECLARATION ON GUIDELINES FOR CONTINUOUS QUALITY IMPROVEMENT IN HEALTHCARE at: https://www.wma.net/policies-post/wma-declaration-on-guidelines-for-continuous-quality-improvement-in-health-care/
Discussion:
Review of the question: this question recognises that unexpected and adverse outcomes from health interventions may occur, in spite of the best efforts of a clinical team. This can be a very difficult issue that can have an impact on individuals and the clinical team.
Interpretation of the principles/policy from the references: a healthcare workers’ primary duty is to their patient and to ensure that their clinical practice is competent and safe. This includes contributing to clinical safety systems that aim to improve quality in healthcare. It should be expected that these systems will find opportunities for improvement. It should be expected that clinical teams will review of high impact adverse outcomes (e.g. death, major disability, complaints) – so called Morbidity and Mortality (M&M) Meetings. The style and culture of these meetings are often an indicator of the commitment of the team to organisational learning. It is also important to create an environment of internal honesty and mutual support so that the team supports individuals who are adversely affected by poor outcomes for patients.
These subjects are usually covered by professional guidance – see the links to the UK General Medical Council as an example.
Framework for answering the scenario/question:
• What are your systems for internal and external quality improvement?
• What is the culture and level of commitment to individual and team learning from these systems?
• How does the team support itself and individuals when adverse outcomes happen?
• How are concerns about poor clinical performance addressed with the team and individuals?
Further issues for consideration:
• How does your team manage complaints? – are these an opportunity for learning?
General Medical Council (UK). Good Medical Practice. Domain 2: Safety and quality. Respond to risks to safety. At: https://www.gmc-uk.org/ethical-guidance/ethical-guidance-for-doctors/good-medical-practice/domain-2----safety-and-quality?#paragraph-28 accessed 11 Jun 2020.
Jennifer J. Robertson, Brit Long. Suffering in Silence: Medical Error and its Impact on Health Care Providers. Journal of Emergency Medicine. 2018;54(4):402-409. https://doi.org/10.1016/j.jemermed.2017.12.001.
Cathy Donaghy, Rachel Doherty, Terry Irwin. Patient safety: a culture of openness and supporting staff. Surgery (Oxford) 2018;36(9):509-514 https://doi.org/10.1016/j.mpsur.2018.07.005.