What to do when things don’t go right

An absence of openness and candour can result in serious patient harm, significantly damage the quality of services and worsen distress for families who have suffered due to care going wrong.

Amongst staff, it can also impact the overall culture of a workplace, people’s ability to ask questions or escalate concerns they have. This can lead to poor practice becoming normalised because services aren’t learning from adverse incidents.

We have joint guidance with the NMC on Openness and honesty when things go wrong: the professional duty of candour. The purpose of this guidance is to support you to meet the professional duty of candour.

Your organisation has a duty to support you to report adverse incidents and near misses routinely. If you do not feel supported to report, and in particular if you are discouraged or prevented from reporting, you should raise a concern in line with our guidance on Raising and acting on concerns about patient safety.

It’s also important to be aware of Patient safety incident response framework (PSIRF) in England and Patient safety incident reporting & management in Wales. In England, any recorded patient safety incidents can be considered to decide whether a response is needed to generate learning. Similarly, the process in Wales relates to learning from incidents that could have or did lead to a patients being harmed. Both policies highlight the need to engage compassionately with those affected by the incident.

If you have a leadership role or management responsibilities

If you are in a management role, you have a responsibility to report incidents and near misses, to encourage openness and honesty and create a culture of learning and improvement. Leading by example and role modelling these behaviours is important. Always make sure that individuals who raise concerns are protected from unfair criticism or action.

It’s also important to be aware of the impact that incidents may have on staff and provide them with appropriate support. The Royal College of Obstetricians and Gynaecologists provide a framework for the prevention, identification and treatment of post-traumatic stress symptoms for staff in these settings.

You can find a case study from a doctor about the professional duty of candour on the NMC website.