Patient Safety - Health Committee Contents

Examination of Witnesses (Question 680-689)



  Q680  Chairman: You mentioned "it is in the book".

  Captain Hirst: It is in the book.

  Q681  Chairman: I am not sure if the NHS has a book.

  Captain Hirst: There is not a book, but maybe there should be.

  Q682  Chairman: There may be books or pamphlets or something. Is it possible to have a book?

  Captain Hirst: Yes, of course it is. I have talked with them at the cardiothoracic unit at Great Ormond Street and there are certain critical events in neonatal heart surgery where they could develop protocols where the same language is used each time—at absolutely critical times use consistent language, so there can be absolutely no confusion. I do not see why that could not happen. It could be developed in each hospital.

  Q683  Chairman: Is there a gap there?

  Captain Hirst: I think there is, yes.

  Dr Taylor: I was going to ask you about bad apples but you have already answered that. Really, I would just like to make a comment. I have often been called a medical dinosaur and he is coming close to me!

  Dr Stoate: Humbug!

  Q684  Dr Taylor: Non-technical skills were not even thought of when I trained. Looking through the list now it is absolutely marvellous that they are now being actively trained. I hope people are being trained how to diagnose as well as being trained about the non-technical skills. My question has been answered.

  Captain Hirst: For instance, there is a lot of exposure at the moment about checklists, the NPSA and the World Health Organization, and it is a wonderful idea. We have had checklists in aviation since the 1930s. Nobody knew about human factors training and understanding about communications until 20 years ago in aviation. It is no good saying "use a checklist", people have to understand it has to be sympathetically introduced with the right sort of training to know why you are using it, how you are using it. I do not think just saying, "Use that, everything will be okay", will work. I am concerned that in some hospitals we go to they are bringing in sensible programmes to introduce it and in others it is almost by email, "From next week you will use a checklist" and I do not think that will work. That is my concern, that a "from on high" downwards diktat is not the way to really get serious change. What you need to do is get people in the critical areas in the hospitals who adopt and really believe in these ideas and they will transfer them to their colleagues and the bad apples will be the only people who are not doing it the same way as everybody else and it will either bring them in line or—

  Q685  Dr Taylor: Hopefully the bad apples are going to be exposed by their juniors.

  Captain Hirst: We do not want a snitch culture but as a patient, which I have been, I would hope if there was someone who was completely out of kilter there were people who would do something about it.

  Q686  Chairman: It is part of a doctor's professional code of conduct, if you like. The regulator would say they have a duty and a responsibility to report a fellow doctor under those circumstances. Could I just go back a little bit with you. You mentioned the issue of the threat of litigation that may be one of the things that is not altering the culture in medical care as it does in aviation. What about the other issue about the media? You have obviously spoken to a lot of people who do work in teams. Do they feel that the media is an individual threat or a threat to the institution or the wider team? What do you feel?

  Captain Hirst: I think people are always concerned about the media. Pilots are concerned about the media. Sometimes a story that everything has gone well is not good news, is it? I have a very close friend who is a news editor on one of the main stations and I keep saying this to him and he said, "Well, we can't tell them boring things like everything was successful in the hospital today". There is a perception that healthcare professionals are concerned about the media. Whether that is a right perception I cannot really comment. All of these things are a concern, but the fear of it is probably worse than the actuality, if you know what I mean. We did some training recently at a hospital and a certain consultant surgeon said he had been most impressed by this idea of briefing and debriefing. It had seemed anathema to me when I walked into the operating theatre for the first time and nobody got the team round and said, "This is what is going to happen today. We can expect that and, by the way, that list has changed the order". It all happened by luck rather than judgment. The surgeon I mentioned earlier said he could not have understood the benefits of briefing and de-briefing without actually doing it. At a lot of theatres we visit we are told, "We have got a really busy list today, we haven't got time for a briefing beforehand because we have got to get the list started". Our view from practice as well and research is that if at eight o'clock in the morning people have five minutes together, they know each other, they are not as in awe of the consultant perhaps and may feel happy to speak up if they have spotted a potential for error. It is all those things of, if you like, lowering the power gradients and such like that we feel is part of introducing a safety culture. They are only little things, we are not talking about a zillion pound robotic computer but almost not quite commonsense, the sorts of things we do in everyday life.

  Q687  Chairman: A football manager's culture.

  Captain Hirst: Yes.

  Q688  Dr Naysmith: Could I ask a question about air safety, it has nothing to do with the National Health Service. What did you think about the guy who came in and landed on the Hudson River?

  Captain Hirst: One of my jobs these days is I am ITN's sort of expert on aviation and they asked me live on the lunchtime news a couple of weeks ago and I said I thought he did a sensational job, however it was not only him, it was his colleague, the cabin crew and the air traffic controller, and benign conditions, there were no waves and no ferries in the way. A lot helped him, but I think it was stunning because it was the first time it ever happened that somebody landed on water.

  Q689  Dr Naysmith: What will they do about birds then?

  Captain Hirst: They do it at Heathrow. If you ever pass Heathrow on the Bath Road you will see the odd flash and it is not 5 November, they fire flares up to frighten them away, but that is as far as the technology has gone. Do not worry about it, it does not happen very often.

  Chairman: We have practically got the network back on time now. Could I thank the three of you for giving evidence at this second session. If you have anything to add in view of what you have heard here this morning, please feel free to get that to us. Thank you very much.

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