Working on November’s video module – Human factor risks: team communication – had me reflecting on what being available and accessible to the healthcare team actually means for a clinician. Availability and accessibility can be fairly complex issues and a lack of clinician accessibility can influence risk. In Good Medical Practice the GMC is quite clear on a doctor’s obligations relating to availability and accessibility. Paragraph 35 states that:
When you are on duty you must be readily accessible to patients and colleagues seeking information, advice or support.
Being “readily accessible” sounds straightforward enough but can in fact be more complex – not relating just to someone being physically in the vicinity at time of need. Issues of approachability can directly impact accessibility.
One obvious outcome from a clinician being unavailable or unapproachable is that another member of staff might be pressured to undertake duties outwith their skills or experience, or may be unable to contact a clinical team member when it is indicated to do so. Junior team members might also feel unable to challenge the decision or actions of a senior member: perhaps they feel they will not be listened to or may doubt their own judgement.
Specific examples of this from primary care often involve receptionists. For example, a receptionist may feel unable to approach a clinician for advice because they are worried about how their request will be received, such as asking them to do an additional consultation or visit a patient at home. There might also be unresolved conflict issues between clinicians who share patient care, which can inhibit communication.
Such scenarios are not uncommon and can impact quality and safety in patient care. Incidents in which doctors have not responded supportively – whether to direct requests for help, or when challenged – have sometimes resulted in tragic outcomes through delayed diagnoses or failure to diagnose.
An MDDUS case
An example from MDDUS case files (which I discuss in fuller detail in the MDDUS video module: Human factor risks: team communication) illustrates the potential risks.
The case involved a clearly ill patient attending the practice and wanting to see a GP immediately. The GP who was available at that time was one with whom the receptionist had a number of difficulties relating to behaviour and manner. So, despite the patient needing a doctor and one being available, the receptionist did not facilitate access as she was afraid of the GP’s reaction.
As a result the patient left and transported herself to hospital where she ended up in the ITU. A complaint resulted and the practice went through a lengthy investigatory process where their systems and culture were heavily criticised and many changes made.
This may seem like an extreme scenario but the same circumstances are often observed in healthcare teams and can present significant challenges for team members and patients. In this instance, lack of approachability led directly to lack of accessibility for the patient.
So accessibility can indeed be a complex issue relating to practice culture, individual manner, authority gradient, staff knowledge and communication style. Again we can turn to Good Medical Practice for guidance. Paragraphs 35 and 37 state:
"You must work collaboratively with colleagues, respecting their skills and contributions"
"You must be aware of how your behaviour may influence others within and outside the team"
Collaboration and mutual respect can help mitigate risk by influencing availability and accessibility for staff members and patients. Awareness and management of your own behaviours and responses can positively impact the quality of service for patients.
Are you approachable to your team? How do you ensure that team members feel comfortable approaching you when they feel the need for support or advice?