Foundation doctors leading the way to a no-blame culture

Lessons Learnt is the brainchild of the extremely innovative Dr Maria Ahmed. Now an academic clinical fellow in primary care, she was a foundation year doctor, like me, at the conception of her forward-thinking programme a few years ago.

Lessons Learnt (LL) is an interactive foundation doctor initiative that aims to improve patient care by promoting quality improvement projects. The sessions revolve around a 10 minute case study outlining a patient safety incident and the events prior to it, after which the group of foundation doctors break off into small groups. The groups take part in frank discussions about the factors which led to the patient coming to harm. Unlike the morbidity and mortality model most clinicians are familiar with, LL takes a ‘bigger picture’ approach. Embracing non-medical factors as contributing to the undesirable outcome means there is much less emphasis on blame so the focus  shifts to what can be learned and improved.

Lessons Learnt sessions have spread across the North West Deanery  and is now a compulsory part of our foundation teaching curriculum, there is promise that they will soon be spreading across the whole of the country thanks to the backing of Health Education North West and the Royal College of Physicians.

As an FY1 doctor, I am often the only doctor left on the busy ward as my more senior colleagues find themselves taking referrals and running clinics. The demands of the system affect all of us but it is often the foundation doctors who are left on the front line. We see how the pressures of high demand on the NHS effects patient care. Furthermore, it is often newly qualified doctors who have to carry out damage control when things do not go to plan – be that due to a system or communication error, or pressured staffing levels delaying necessary treatment.

We all entered the medical profession to help people. We fix bodies, we help to heal the mind. We work with nurses, occupational therapists, social workers, physiotherapists, psychologists, speech and language therapists, etc. to provide holistic care for the individual needs of our patients. We do not fix things by ourselves, nor are we solely responsible for patient safety incidents. We are a contributing factor, along with every other individual who comes into contact with patients. The integral systems within individual trusts attempt to limit human error, but unfortunately these systems sometimes fail.

As foundation doctors we are privileged to be there to spot when failures in maintaining patient safety have occurred. LL helps us to use our clinical experiences as a collective; to pull apart the story of the patient’s journey leading up to the safety incident. It encourages team work and enhances communication skills amongst the group. The no-blame culture offers the individual FY1 involved in the case a real opportunity to learn, it offers the system an opportunity to prevent this from happening again and most importantly protects future patients from the same mistakes.

LL is an incredible platform for sparking the imagination of the future leaders of the NHS; by discussing patient safety incidents we are identifying areas which require quality improvement. We are helping foundation doctors to integrate leadership skills into their initial years of medical practice, by encouraging audits and QI projects to be undertaken when they have the help, support and guidance of their senior colleagues.

LL has brought so much more than a certificate to my portfolio. It has helped me to reflect on my own errors and improve my own efficiency. It has also given me support from my peers, lessening guilt and stress when talking about a case I was involved in. It is such an excellent programme, encompassing so many aspects of Good Medical Practice in several enjoyable, interactive and informative one-hour sessions. I hope, as it spreads across the country, LL is embraced as positively as it has been across the North West, because it really does have the potential to improve the safety of our patients.