Wednesday, June 2, 2010

Risk mismanagement

On the one hand we get a message that the nurses want my sons fit reaction protocols redrafted (6 pages of protocol) as they think they may be interpreting them differently from one another. On the other hand, when we check what the protocols say, we discover that the last one we got changed officially three months ago, hasn't been updated in any of his files.

I'm not so annoyed about the failure to update the files as you might imagine. What really irritates me is that we have to have these prescriptive, fine detail protocols in the form we do. They are the ultimate in 'nursing by numbers' and in my view, take away the discretion nurses have to act in the patients best interests. These are after all, fully trained and registered nurses with accepted qualifications as well as a battery of specialised training competencies. I don't have a problem with written guidelines, but when what nurses can do is spelt out in such fine detail, I can't help feeling that it's less for patients benefit than to protect the commissioners etc. from being sued. It doesn't even protect the nurses particularly, but it does give the authorities someone to blame if an error occurs. It all seems to be part of the beaurocracy of 'protection' and 'risk aversion' that prevents anyone from using their own judgement and taking any responsibility for their actions. Authority no longer seems willing to trust the people it employs. And the reality is that life carries on in spite of it.

CRB checks are mandatory but take three months to come through and don't actually prevent anyone wanting to abuse vulnerable people from doings so. Risk assessments get used to exclude disabled people from doing anything remotely exciting or interesting. Nurses have to comply with detailed protocols even though simple admin errors mean the protocols are actually out of date and incorrect. These things don't actually help to provide better care - but they do make it easier to find a scapegoat when things inevitably go wrong. Things do go wrong in life - shit happens. The aim should be to avoid the obvious blunders, recover the mistakes and trust people sometimes.


  1. You have a brilliant insight into the tick-box culture that pervades every action in healthcare - all of which is detrimental to your dear son and for those who endeavour to provide care outside of your good self.

    The world has gone mad in its pursuit of health and safety to the point were it is counter-productive and health is compromised. This may be a ridiculous prophecy, but maybe one day those working in the health services will not attempt to treat those whose prognosis is unfavourable for fear of failure and resulting litigation.

    You have my heartfelt sympathy and total admiration. Love to your son and your good self and to all that care for him.

  2. Thanks for encouragement. It's going to be a slow job but we have to change the culture of trusting no one to take any responsibility for anything. It doesn't encourage good, responsive care, it devalues the professionals giving it and it creates an unhelpful layer of administration that has little relationship to real life. This blog is my attempt to do a little to change some attitudes.