Examination of Witnesses (Question 680-689)
DR JO
BIBBY, DR
OLGA KOSTOPOULOU
AND CAPTAIN
GUY HIRST
5 FEBRUARY 2009
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 timeat 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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