Internal investigations & the detrimental impact
In a number of our recent independent investigations, we have been struck by the detrimental impact that some trust internal investigations have had on families. This is often compounded by the trust failing to communicate with families in a timely, open and honest way.
By the time Verita is called in, to either re-investigate the original incident or to investigate how management responded to the incident, in many instances the family has lost faith in the trust’s ability to get to the bottom of what went wrong. In a number of cases it has gone beyond this and the family believe that the trust are trying to ‘cover up’ or are deliberately keeping information from them.
During the course of our work, we often find a number of failings but these are usually attributable to a series of errors, incompetence and poor decisions. Rarely do we find evidence of ‘conspiracy’ at all levels within an organisation to try to cover up failings.
Our investigations often identify a number of missed opportunities for the trust to have engaged proactively and honestly with families following incidents. In a recent case there were multiple missed opportunities which included failure to:
- contact the family as soon after the event as possible to offer condolences and ask how they would like to be supported
- inform the family as soon as new information regarding their family member’s death came to light
- be open and honest with the family during a meeting – primarily through fear of sharing incorrect information
- investigate thoroughly concerns raised by the family about the care of their family member; and
- investigate appropriately the management response to the incident and the family’s concerns.
With such a series of failings it is understandable that families can start to think that the trust is deliberately trying to be obstructive and potentially withholding information. We found that even in the absence of evidence to support a conspiracy, the trust had done little to dispel the belief or try to improve the situation for the family.
In another case the family had accused the trust of trying to ‘cover up’ the failings which they believe led to their family member’s death. The way the trust conducted its internal investigation contributed to this belief by:
- failing to consult the family regarding the terms of reference
- telling them the incident would be investigated by a panel but was subsequently investigated by a lone investigator
- a delay in the family receiving the medical records and when they did notes were missing without explanation
- failing to interview all appropriate staff and by allowing a manager of the service to be present during some interviews; and
- the investigator presenting the family with a copy of the report and then telling them it was the wrong version and tried to take it back.
The Duty of Candour has been in place since April 2015 and it provides a framework for trusts to be open and honest with patients and families, particularly when things go wrong. So why are some trusts getting the basics so fundamentally wrong? In a number of recent cases we identified the following contributory factors:
- a culture of blame and therefore a fear of admitting a mistake has been made
- a belief that apologising is an admission of guilt
- a lack of understanding about what their responsibilities are under Duty of Candour; and
- staff not feeling appropriately supported.
Trust’s must ensure that they invest in the Duty of Candour by encouraging an open and transparent culture and by training staff so they understand and are able to execute their responsibilities under the act.