A duty of candour

[Originally published on the Aspley Consultants website]

This article on the Telegraph website raises some issues for anyone interested in learning from the past in order to improve things in the future.

According to the article, “From April next year NHS hospitals and other providers of care will be contractually obliged to be open about when patient safety has been compromised, ministers said….Campaigners have long called for the so-called duty of candour as it is thought that fear of litigation has prevented doctors and hospitals openly admitting harming patients.”

This blog has already looked at the fear of litigation within the UK's NHS and the way it inhibits the full and frank disclosure of ‘what happened’, thereby preventing learning from taking place.
This latest article indicates how the proposed contractual duty of candour might fall short of the power and reach of a statutory one.

So, is this a welcome development or not?

The honest answer must be that this won’t be clear until we can see how behaviour changes as a result of this (if at all).  As regular readers of this blog will know, it is not enough to put measures in place – they have to work.

A further note of caution relates to the issue of rewards and punishments.  If the fear of litigation is believed to prevent open and honest examine of past mistakes, how does contractually forcing people to be open address that?  Is there not the danger that without addressing that ‘root cause’, employees’ resistance will merely increase to meet the new challenge to their position?

An approach based on systems thinking would increase incentives for people to be honest and reduce the perceived risks associated with them being so.

Learning initiatives have the best chance of success when they “go where the energy is”.  This means reducing resistance, building momentum, gaining support and picking the right moment for action.

It does not mean alienating people, forcing through change or ignoring other priorities.

It is not yet possible to judge whether this proposed ‘duty of candour’ for NHS contracts will have the desired effect.  However, the fact that such measures are being considered means that the debate about honesty and learning is in rude health which is welcome.

It is up to those that care about organisational learning to pay attention and contribute where they can.