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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