To be honest, I lost an entire day yesterday to one tweet a wrote comparing healthcare to aviation. And my only focus was on the impact of relative candour levels. I'd really prefer not to lose any more time to it. I'll stay focussed on healthcare, I think. Thanks though.
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Replying to @C7RKY
I agree. I have worked in aviation for half my life, and sometimes (voluntarily) in healthcare safety, and am a patient and father/husband/son of patients. I see ~few similarities.
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Replying to @StevenShorrock
I'm not trying to directly compare the two - honest! I just find it impossible to conceive that candour isn't playing a role in healthcare safety, in a way that aviation doesn't suffer from. Personal survival is a powerful drive, but can provoke v different behaviours in each.
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Replying to @C7RKY
One big difference could be this. Candour is much easier when no-one has been harmed or died, and your future is not on the line, and ‘just culture’ is defined in EU law (e.g., EU Reg 376/2014). E.g., in ATC candour is about mostly losses of separation between aircraft.
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Replying to @StevenShorrock
John Clarke Retweeted
Sorry for the delay. That may be true, I agree. But I think there's a little more to the dynamic surrounding candour than just that, in the world of healthcare. It's a genuine and very serious problem. https://twitter.com/DrNHS2018/status/948209781977812994 …
John Clarke added,
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Replying to @StevenShorrock
Indeed it is and indeed it does. Any threat to your planned career is a serious one, when you start out with a £50k+ student loan. It's not the healthiest environment for candour to thrive. Or patients, for that matter.
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Replying to @C7RKY
It seems that the problem is, the system is set up for retributive justice first, not restorative justice. Both have a role, but in most cases of unintended harm, restorative justice must at least come first, and be fully embraced.
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Replying to @StevenShorrock
I'd say you're right. There's an argument to suggest a contradiction between professional guidelines and the law, when it comes to candour in medicine. Robert Francis recognised that and recommended a fix. Sadly, the fix we actually got was perverted by gov so as to be useless.
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Replying to @C7RKY
‘Fixes that fail’ - very common in social systems. https://en.m.wikipedia.org/wiki/Fixes_that_fail … It sounds to me like some protected time and space is needed to apply some restorative justice.
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We certainly need something. Not sure that Wikipedia definition is ideal for this situation? Seems to describe a fix that starts out working, but later fails? This fix never worked - as intended.
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Replying to @C7RKY
Problem, as with checklists, is failure in implementation. Inadequate analysis of context and how a fix affects (or does not account for) the context to create secondary problems or just embed problem further.
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Replying to @StevenShorrock @C7RKY
Like Plan-Do-Study-Act cycles...often forgotten that this is only implementation phase. Study-Plan-Do cycle would be simpler, work better, and remind everyone to study the problem situation and context deeply first, from multiple perspectives.
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