What to do when things go wrong. Dr Rhona Siegmeth MBChB Bsc (Hons) FRCA MML Perth, December 2017
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1 What to do when things go wrong Dr Rhona Siegmeth MBChB Bsc (Hons) FRCA MML Perth, December 2017
2 What to do when things don t go as expected Dr Rhona Siegmeth MBChB Bsc (Hons) FRCA MML Perth, December 2017
3 We live in a vulnerable world Medicine is a vulnerable world
4 We live in a vulnerable world Medicine is a vulnerable world We are imperfect beings
5 When things go wrong, the natural human tendency is to hope, firstly that it s not your fault and secondly that it will all simply go away if you shut your eyes for long enough. Both hopes are wrong and do untold damage Alistair Campbell Winners and How They Succeed
6 Objectives Avoiding doing untold damage By knowing how to behave By understanding shame and guilt
7
8 Clinical negligence
9 Multiple jeopardy
10 A Tale of Fatal Distraction
11 Multiple jeopardy
12 Lessons Don t listen to surgeons.obviously Be open and honest Apologise Be human and humble
13
14 Be Human You got the sense that the lawyers took over and got in the way. When a crisis happens there is a tendency to go to corporate speak when actually what is needed is the human face. Crisis is the time for more humanity not less John Browne
15 Healthcare crisis no different Be human.forget the lawyers
16 Do not underestimate the power of an apology Dr Lucian Leape
17 When it goes wrong.
18 Say Sorry and Mean it
19 Say Sorry and Mean it Avoid the false apology
20 GMC
21 The curse of the i-pad..
22 Our licences to practice : our most precious asset
23 The Trends 10, 000 complaints / year Investigate approx 1/3 Clinical competence or conduct
24 Reflect and Remediate
25 Why remediation so important? Are you fit to practice moving forward? Have you learned any lessons? What is the probability of the same thing happening again??? (Cohen v GMV, Azzam v GMC, Cheatle v GMC)
26 Disaster salvage Do not ignore letters from the GMC Do not send them ranting letters / s Get on the phone : Medical Defence Organisation Get a portfolio together
27 Seek support: family and colleagues
28 Seek support: family and colleagues GIVE support
29 Shame resilience Key to surviving an adverse incident
30 Shame Resilience
31 Shame Resilience Recognise it Speak about it Critically aware of it Reach out for help with it
32 Reflection and remediation
33 Incubators of Shame Fear Blame Judgment
34 Instead.. Empathy Compassion
35 Doctors in trouble: type 1 Incapable of guilt (I made a mistake) Don t feel any degree of shame (I am a mistake) Incapable of insight ( none of this is my fault) Sociopaths: incapable of courage, compassion or empathy
36 Doctors in trouble: type 1 Incapable of guilt (I did something bad) Incapable of shame (I am bad) Incapable of insight ( none of this is my fault) Pyschopaths: incapable of courage, compassion or empathy
37 Doctors in trouble : type 2 Riddled in guilt (I did something bad) Riddled in shame (I am bad) Paralysed with feelings of vulnerability
38
39 Black box thinking
40 See it as an opportunity to improve
41
42 The Mercedes Benz approach.. See it as an opportunity to improve
43
44 Outcome We note that you have openly discussed this incident with colleagues and have taken steps to improve the consent process We note that you have reflected on this incident and introduced a number of changes to your practice Taking into account your self-reflection we will not be taking any further action at this time
45 Your management of this incident has been exemplary. You have benefitted not only personally but also professionally. There has been widespread benefit to our hospital and our patients as a result
46 Get Good out of Bad : GGOOB
47 Vulnerability is not weakness
48 Vulnerability takes pure courage
49 Health Doctors are human We are fallible We get sick Please seek help
50 And finally We are just people We are human We make mistakes We are fallible We are not perfect We have feelings
51 And finally We are just people We are human We make mistakes We are fallible We are not perfect We have feelings Have insight and ask for help Be strong enough to stand alone, be smart enough to know when you need help and be brave enough to ask for it Mark Amend
52 Saves lives & licences
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