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This page is part of the learning materials to support our Raising and acting on concerns decision tool

Back to the Raising and acting on concerns flowchart - Can you escalate your concerns to a higher level within your organisation or elsewhere locally?

Escalating patient safety concerns

Background

Dr Sinclair is an associate specialist and covers the neurosurgical high dependency unit (HDU). Due to staff shortages, he also does a neurology on-call.

The neurology departmental policy says all new ward admissions should be seen by a doctor within two hours. But it is difficult for Dr Sinclair to achieve this, due to the extra demands attending to HDU patients.

Scenario

He asks the HR department for a copy of the hospital's policy on how to raise concerns about patient safety issues. He raises concerns with a group of other doctors at a meeting with the senior consultant in charge of the neurology ward. The senior consultant agrees to pursue the issue with the Clinical Director. The rota vacancies persist for some months, despite regular enquiries about progress.

What the doctor did 

Dr Sinclair and other doctors on the rota agree that the continuing inability to meet the two hour assessment standard is compromising patient safety. The Clinical Director, Ms Singh, meets with the group to discuss their concerns.

She meets with the Medical Director, Mr Todd, who then writes to the doctors about the actions to fill the rotas as quickly as possible. Several weeks later, the rotas still have significant gaps and they haven't heard anything about recruitment plans, rotas, or any other changes.

In that time, there have been two significant near misses, due to long delays in the patients being assessed by a neurologist after admission.

The doctors in the neurology department formally write to Mr Todd about their patient safety concern, suggesting some short terms measures to improve the situation. Dr Sinclair doesn't feel confident that action will happen quickly enough to address the risks.

He goes to see Mr Todd to discuss his concerns. Mr Todd angrily shouts at Dr Sinclair that he has raised the issues before and matters are being dealt with. He has concerns about Dr Sinclair's attitude and his team's performance, and that they are failing to manage the rotas.

He is considering instituting an audit of Dr Sinclair's team. Dr Sinclair is shaken and feels that this response is an attempt to bully him out of pursuing his concerns any further. He leaves the office shocked and angry.

Not sure what to do, he calls the Medical and Dental Defence Union of Scotland. The adviser asks him about his hospital's whistleblowing policy. Dr Sinclair confirms he read the policy and raised his concerns with the relevant people.

The adviser says if he didn't get a formal response from Mr Todd, in reasonable time, addressing the issues, he and the other doctors should raise their concerns with The Independent National Whistleblowing Officer (INWO) and Healthcare Improvement Scotland.