In previous episodes of Doctor Informed, we've talked about the importance of speaking out, but the culture in your organisation might not always make that easy, especially if you feel something has gone wrong and you might be blamed for it. 

Blame culture, no blame culture, just culture - there are many terms which are used to describe the environment in which individuals and teams work, the feel within a team and an organisation. In this episode we'll explore what they mean, why blame can be detrimental to patient safety, and give some tips on how to investigate problems without throwing blame around.

Our guests in this episode;

Joselle Wright - Deputy Director of Midwifery, Gynaecology and Sexual Health at Walsall Healthcare NHS Trust

Susanna Stanford, who became involved in patient safety after experience of a spinal anaesthetic failing during a c-section in 2010. She is an ambassador for the Clinical Human Factors Group.

The blame game

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With the anticipation of a new government in the UK, shadow health secretary Wes Streeting will hit the ground running - with a winter season (and it's inevitable crisis) and ongoing industrial desputes with junior doctors. Elisabeth Mahase ask him about his plans to handle these challenges if elected.
We also find our selves in the puzzling situation of potential GP unemployment in the UK despite a high demand for primary care doctors, Helen Salisbury, GP and columnist for The BMJ explains how we've got into this situation.
Finally, Peter Doshi has been looking at the financial entanglement of FDA heads with the companies they are regulating - 9 of the previous 10 FDA heads have gone on to work for industry in some respect. He has also investigated how complex financial instruments can make these conflicts more opaque.
02:03 Anticipating a New Government and the NHS Winter Crisis10:50 The Kafkaesque Dilemma of GP Unemployment23:10 FDA Leaders' Financial Entanglements: A Deep Dive
Reading list
Workforce and winter under Labour: Wes Streeting on his plan for the NHS
Helen Salisbury: No jobs for GPs—we’ll be missed when we’re gone
Revolving doors: board memberships, hedge funds, and the FDA chiefs responsible for regulating industry

The prospect of unemployed GPs

Where next for psychological safety? Amy Edmundson is professor of Leadership and Management at the Harvard Business School. Her work on psychological safety has underpinned so much quality improvement, and she joins us fresh of the stage at the International Forum on Quality and safety in healthcare to talk about the next steps in creating a safe work place.
The BMJ has published two new investigations, looking at the alcohol and tobacco industry funding of public health and education - we’ll hear how the companies who create the problems, are now styling themselves as the solution. Rebecca Coombes joins us to explain what The BMJ has found, and May van Schalkwyk, a researcher from the London School of Hygiene & Tropical Medicine, explains how commercial conflicts are shaping the wrong education tactics.
And finally, our NHS commissioners have more recommendations - this time on workforce issues. Mary Dixon-Woods, director of THIS institute at the University of Cambridge, and Matt Morgan, intensive care consultant in Cardiff, tell the NHS to get serious about staffing.
02:03 Amy Edmondson on Future Health and Psychological Safety10:24 The Impact of Corporate Funding on Public Health19:57 Addressing NHS Workforce Challenges: Insights and Solutions
Reading list;
Our new podcast - Future Health
International forum keynote -  "Learning to fail" with Amy Edmundson and Don Berwick
Investigation - Medscape caves in on courses funded by tobacco giant Philip Morris, while medics fear global push into medical educationInvestigation - Big alcohol: Universities and schools urged to throw out industry-funded public health advice
Commission on the future of the NHS - The future of the NHS depends on its workforce

Fixing healthcare's workforce problems

Hilary Cass, the former president of the Royal College of Paediatrics, has spent the last 3 years collating the evidence for treatment of gender questioning young people; engaging with those young people, their families and their clinicians - all with the aim of improving NHS treatment of this complex and vulnerable group.
In this interview, Kamran Abbasi, editor in chief of The BMJ, speaks in depth to Cass about her review - about evidence base for transitioning, but also about the way in which the siloing of care for young trans people has failed them. 
They discuss the need to support young people in their journey - Cass is clear that the NHS should allow young people to explore their gender, but that ultimately, that may not mean medical intervention at all. 
 
Reading list
The Cass Review - final report
The systematic review and meta-analyses published in Archives of Disease in Childhood
BMJ Opinion: Gender medicine for children and young people is built on shaky foundations

Improving NHS gender identity services - Hilary Cass

Derogation, the way in which striking doctors can be recalled to the ward to protect patient safety, was agreed by NHS England and the BMA. Now, new data The BMJ has uncovered shows that the mechanism was rarely used - and when it was tried, was often rejected. Gareth Iacobucci explains what that means about relations between the government, the NHS, and doctors.
Felice Jacka, director of the Food & Mood Centre at Deakin University, is one of the authors of our recent ultra-processed foods umbrella review - and joins the podcast to talk about the link between diet and health; and why goverments need to pay more attention to the food system.
Finally, John Appleby, senior associate at the Nuffield Trust, and Gillian Leng, dean and president elect of the Royal Society of medicine, have been thinking about healthcare funding, and how more stability is essential in securing the service's future.
 
Reading list
Hospital leaders warned that failure to recall striking doctors risked patient safety in some trusts, documents show
Ultra-processed food exposure and adverse health outcomes
NHS funding for a secure future
 
Chapters
00:31 Derogation and doctor strikes
06:59 Ultra processed food producers and health
13:59 Rethinking NHS funding

Derogation, an ultra processed food system, and catch up pay for the NHS

In this week's podcast:
 

How AI will affect the clinician-patient relationship? Our annual Nuffield Summit roundtable asks how the promise of tech tools stacks up against reality, and how the future of the therapeutic relationship can be protected (participants below).
 

Your code is as important as your methods, which is why The BMJ now requires you to share it - Ben Goldacre and Nick De Vito, from the Bennett Institute for Applied Data Science at the University of Oxford, explain why it's so important, and how The BMJ's new data and code sharing policy could change research transparency.
 
Nye Bevin set up the NHS when the UK was in the economic doldrums, and the public's need for care was becoming an emergency - BMJ columnist Matt Morgan has helped turn that story into a play, currently showing at the National Theatre; and reflects on the parallels between now and then.
 
1:58 Nuffield Summit roundtable
17:32 New BMJ rules on data and code sharing
29:03 Aneurin "Nye" Bevan play
 
Taking part in our roundtable were:


Rebecca Rosen, Senior Fellow at the Nuffield Trust and GP


Juliet Bouverie, CEO of The Stroke Association


Daniel Elkeles, CEO of London Ambulance Service

Neil Sebire, Professor and Chief Research Information Officer at Great Ormond Street Hospital


Reading list:
How is technology changing clinician-patient relationships?
Mandatory data and code sharing for research published by The BMJ
Scalpels and spotlights: bringing theatre to the theatre

The blame game

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