MDDUS advisory teams are reporting an increase in members seeking advice on how to mitigate risk when involved in incident investigations. Such investigations can arise in a range of circumstances, including patient complaints, formal duty-of-candour procedures or disciplinary actions, significant adverse event reviews, involvement in clinical negligence claims, and coroner’s inquests or fatal accident inquiries. Often these will involve statements or reports requested from solicitors, employers or others, e.g. the police, coroners or procurator fiscals.
GMC guidance reminds doctors that their professional duty of candour extends beyond patients, stating:
"Healthcare professionals must also be open and honest with their colleagues, employers and relevant organisations, and take part in reviews and investigations when requested."
We recognise that members can feel anxious about engaging in investigations and inquiries, but it is important to respond within required timescales and to provide any statement or report in a clear, detailed and objective manner.
Take a minute
Being involved in a safety incident at work can be upsetting, eliciting fear, shock and sometimes anger at colleagues or even the patient. Acknowledging such feelings and recognising them as natural responses can help to alleviate distress. Speaking to a trusted colleague if possible can also help put the incident in perspective and avoid destructive rumination – supporting positive learning and resilience in the long term. It is particularly important to set aside emotions before drafting any statement or report.
Preparing a response
Your statement or report may be one of many being collated about an incident and so it should include your personal details, title, role and your understanding of the purpose for which the report has been requested. It is also important to ensure that any necessary patient consent has been obtained.
In drafting your response, ensure that it is directly informed by the medical records, your recollections, your usual practice and your knowledge of the patient or colleague. In most cases you will simply be asked to provide detailed facts about an incident and your involvement. You should avoid engaging in speculation. Ensure also that any opinion you are asked to provide falls within your scope of practice, expertise or experience.
A formal statement or response may be requested as part of an organisational incident reporting process but it is essential to remember that it could be shared with a patient, their relatives or other colleagues. Statements should not include personal or subjective comments about any person involved, as this is not appropriate and is likely to be inflammatory.
You should adapt the detail of your report depending on its purpose and audience. For example, abbreviations and medical jargon should be avoided and care should be taken to explain any medical terminology used in terms that a lay person can understand.
It is critical that you set aside any personal concerns about how the information you have been asked to provide will be received. This is particularly important if the report pertains to the behaviour or performance of a colleague which may be placing patients at risk, or where you are asked to give your view on an incident to determine whether a statutory duty-of-candour process should be activated. GMC guidance on Raising and acting on concerns states: “You have a duty to put patients’ interests first and act to protect them, which overrides personal and professional loyalties.”
Engage in further personal reflection
Reflective practice is an essential component in improving practice, and whilst the GMC do not ask doctors to share reflective notes in order to investigate a concern about them, these can assist in providing evidence of insight and remediation which may reduce the need for them to take action. GMC guidance on demonstrating reflection also flags guidance from the Academy of Medical Royal Colleges which suggests that: “formally documented reflection is probably better done after some consideration”. It is important to note that reflective notes are also potentially disclosable in court proceedings if they are considered relevant.
If the incident is serious or complex, it can be helpful to seek advice on the nature and content of your statement from an MDDUS adviser before submission. Records of incident investigations which are intended to provide explanations to patients, or support system learning and continuous improvement can go on to become used in further HR, legal or regulatory proceedings. Taking advice from MDDUS at an early stage can ensure you are submitting a statement or report that will act to support any such further processes.
- Establish the exact purpose of the statement/report, including its intended audience.
- Acknowledge any emotional response and seek support, if necessary, before responding.
- Ensure the report includes all necessary details in chronological order and that it is factual, based on the medical records, usual practice or your direct recollection of the incident.
- If an opinion is requested, keep within your scope of practice and area of expertise.
- Engage in reflective practice after incidents to improve practice or for your own personal development.
- Seek advice from MDDUS if you are asked to provide statements or reports on serious or complex incidents.
Liz Price, senior risk adviser, MDDUS