Responding to safety risks
You’re no doubt aware of your professional duty to act and raise a concern if you think that patient safety is, or may be, at risk.
Working within your competence
In order to keep patient safety at the forefront of maternity care, it’s imperative everyone works within their competence.
As set out in Good medical practice, if you don’t feel competent or comfortable carrying out a task that’s been delegated to you, seek help.
Senior colleagues have a responsibility to nurture psychological safety by making sure they delegate safely, support staff wherever necessary and ensure systems are in place so that all staff feel safe and supported to ask for help and escalate concerns.
You can find case studies from several midwives and a doctor about psychological safety and freedom to speak up on the NMC website.
Ockenden review: summary of findings, conclusions and essential actions
‘When a middle grade or trainee obstetrician (non-consultant) is managing the maternity service without direct consultant presence, trusts must have an assurance mechanism to ensure the middle grade or trainee is competent for this role.’
Raising concerns about patient safety
Reviews and inquiries focused on maternity care have shown that concerns about patient safety aren't always raised for a range of reasons.
- A divide between midwifery and obstetric staff leading to fear among midwives to escalate concerns to consultants.
- Medical and midwifery staff thinking there’s no point in reporting safety issues as they believe no action will be taken by their trust.
- Instances where people have spoken up in the past and been unsupported by managers, receiving minimal, or no feedback on the concerns raised.
- Hierarchy within teams leading to members of staff feeling disempowered to speak up where voicing their opinions could be taken in the wrong way.
We recognise the fears that may be associated with speaking up, as well as the frustration of no action being taken after having the courage to raise a concern. As an experienced healthcare professional, if you have a concern about something and there may be an impact on patient care, you have a crucial part to play in putting that right. Your instinct is likely to be right. You’re also probably not the first person to have those thoughts, but you may be the first to do the right thing and speak up.
On our speaking up ethical hub page, we provide tools to support you to follow your professional duty to raise concerns. The visual guide can help you decide how to raise your concern and get the right support. We also signpost to the support we can provide, as well as external organisations and charities that can help.
The Royal College of Obstetricians and Gynaecologists (RCOG) provides an escalation toolkit. It includes the Teach or treat communication strategy to support a discussion about the clinical situation being escalated, as well as the Advice, inform, do (AID) communication tool.
If you have a leadership role or management responsibilities
Doctors, PAs and AAs who are in any form of leadership or management roles are responsible for actively creating or maintaining a positive working environment and demonstrating compassionate leadership. If you’re aware – or become aware – of barriers to speaking up, you need to tackle these. It is crucial that colleagues feel empowered and supported to raise concerns.
Being a good leader in maternity settings could include:
- encouraging staff to raise concerns about patient safety
- addressing and acting on patient safety concerns that are brought to your attention
- using your influence to create an open, inclusive, civil and compassionate culture in which staff feel supported to speak up
- providing a safe space, or route, for colleagues to share concerns or ask for advice. This could include showcasing examples where speaking up has led to improvements
- knowing routes to escalate concerns or signpost colleagues to.
Information and guidance on being a compassionate and inclusive leadership can be found in our maternity useful resources.
You can find case studies from several midwives, about making sure people get the right care at the right time on the NMC website.
The Report of the Morecambe Bay Investigation
‘Professional regulatory bodies should clarify and reinforce the duty of professional staff to report concerns about clinical services, particularly where these relate to patient safety, and the mechanism to do so. Failure to report concerns should be regarded as a lapse from professional standards.’
The professional standards
76. If you have a formal leadership or management role, you must take active steps to create an environment in which people can talk about errors and concerns safely. This includes making sure that any concerns raised with you are dealt with promptly and adequately, in line with your workplace policy and our more detailed guidance on Raising and acting on concerns about patient safety.
