Staffing levels, availability of services, equipment, and beds are some of the top drivers of medical decision making – rather than patient health, according to a new survey of healthcare professionals.
The survey from JMW Solicitors was conducted by YouGov and offers insight into how medical professionals are making decisions and dealing with mistakes. It follows numerous comments by the Government on the ability of the NHS to improve the quality of care and how litigation affects patient care.
According to the survey, 54% of UK healthcare professionals say factors other than patients’ best interests play a role in their day-to-day medical decision-making.
Factors impacting decision making
Aside from patients’ best interests, the top factors driving medical decision-making are staffing levels (31%), availability of services such as testing, referrals (20%), equipment (16%), and beds (12%). Fear of being sued is not significant with only 10% believing it is a main consideration in their decision-making.
Nicola Wainwright, Clinical Negligence Partner, JMW Solicitors, said: “Most patients would expect their best interests to be paramount when decisions are being made about their care and it is extremely worrying that it is not always the case. The factors that impact on decision making, such as staffing levels, need to be addressed to improve patient care and safety.
“The Government suggests that if litigation were reduced that would help improve care, but our survey shows litigation is not actually even in the top factors affecting the care that is given.
“Moreover, litigation is often the only way for patients and their families to get answers. As several recent cases, such as the case of Elizabeth Dixon have shown, sadly, hospitals are not always open and honest when things go wrong, without families taking action themselves.
“Instead of targeting the rights of injured or bereaved people trying to get justice the Government should be focussing on funding, increasing staffing levels, and ensuring access to services, beds and equipment. It should also look at correcting the blame culture that affects the ability of the healthcare sector to learn from previous mistakes.”
83% of healthcare professionals identified factors that play a role in preventing staff admitting mistakes which could be learnt from. 42% believe a ‘blame culture’ where colleagues and management blame others when things go wrong, plays a top role.
Wainwright added: “Blame culture has been identified by governments and health secretaries over many years as a problem when it comes to learning from mistakes, but there is still no resolution in sight.
“It seems to be accepted that a ‘blame culture’ exists in the NHS, but it has not yet been dealt with, even though it, rather than families fighting for justice, is what would seem to prevent a more open approach where the NHS accepts mistakes can and will happen. For patient safety to improve a transparent approach is needed where medical staff can discuss and learn from mistakes.”
Maternity scandals
After a number of scandals in maternity units, such as those at Shrewsbury & Telford Hospitals NHS Trust and East Kent Hospitals University NHS Trust, the Government is currently carrying out an inquiry into how to improve maternity care.
These statistics confirm which factors are playing a role in decisions made about the care provided to mothers and babies. Most babies in the UK are born in NHS hospitals and many mums have midwifery-led care. 68% of nurses and midwives said at least one factor other than patients’ best interests plays a role in their day-to-day medical decision-making, with staffing levels cited as having the most impact (46%). While 36% of healthcare professionals in NHS hospitals also said that aside from patients’ best interests, staffing levels has the most impact on their decision making.
When it comes to the factors that prevent staff from admitting mistakes in maternity care, half of nurses and midwives (51%) and 45% of staff in NHS hospitals say ‘blame culture’ plays the greatest role.
Wainwright said: “More staff and more funding is needed to improve maternity care. Rishi Sunak’s recent announcement of nearly £10m for training NHS maternity staff is a good start, but it’s nowhere near enough money to make a difference.”
