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The truth behind investigation backlogs

Nicola Salmon Verita Consultancy Ltd
Consultant

Nicola Salmon

Published 22 May 2020 More about Nicola

An interview with Chris Brougham

During the Coronavirus pandemic frontline care and services have rightly taken priority. Organisations have focused on patient care and less on the day to day governance tasks such as patient safety incident investigations. Now that infection rates are dropping, services have started to turn their focus back to the back-office functions, but healthcare organisations are aware that while their attention was turned, the work didn’t stop. Patient safety incidents have continued to be reported, but some investigations have been put on hold. This has caused an increase in investigation backlogs seen by trusts across the UK, so what can be done?

I spoke to Verita director, Chris Brougham, one of our leading investigators and head of our investigation training service, to discuss what problems an investigation backlog can cause, and how organisations can get help during this unprecedented time.

What problems can investigation backlogs cause for a healthcare organisation?

The purpose of healthcare organisations investigating incidents is to learn and improve. The problem of not investigating means that opportunities to do this are missed, and improvements to care and service delivery are foregone.

Additionally, patients and families are reliant on investigations to understand what went wrong in their treatment or that of a relative. They want to know the facts and see action taken. A backlog of investigations means that patients and families are likely to be unhappy because their incident has not been investigated promptly. They lose confidence in the organisation and are likely to complain.

We have seen relationships between families and trusts break down because of a delayed or incomplete investigation.  Sometimes this loss of confidence is accompanied by a demand for an independent investigation. Sometimes families engage others, such as their local MP, or an interested journalist to represent their interests.  Often this distrust is accompanied by families believing that organisations are deliberately conspiring to hide the truth.

Investigating harm to patients is a statutory requirement. CQC assesses an organisation’s ability to investigate under the ‘Safe’ inspection domain. We have recently worked with an organisation that had allowed a substantial backlog of investigations to develop. This included some serious safeguarding incidents. The CQC criticised the provider and assessed them as ‘requiring improvement’.  It will take a substantial effort on their part to clear the backlog, while also dealing with new incidents that need investigating.

Why do healthcare providers have a backlog of investigations?

 

There are several reasons why backlogs develop.  Two obvious ones are:

  • Increased reporting of incidents in recent years accompanied by more investigations
  • Frontline staff & patient safety teams struggling with the demands of the investigative work

Investigating a patient safety incident is time consuming and difficult.  And, as we all know, frontline staff do it on top of their day job. Also, healthcare has no standardised way to investigate and often local guidance can be basic and unclear.

The head of quality compliance at a multi-site acute trust recently told us that he had no way of knowing how many investigations were currently underway, and no way of monitoring them. This highlights the problems that organisations have managing this important work.

The new Patient Safety Incident Response Framework (PSIRF) published by NHS Improvement in March 2020 is encouraging organisations to do fewer investigations but investigate serious incidents comprehensively. We hope this reduces the burden of investigating, whilst focusing key resource on learning promptly from incidents that need to be analysed and understood.

Do you think backlogs will have grown during COVID?

Without doubt, COVID-19 will have put further pressure on trusts in relation to backlogs. We have clients where most of the patient safety team have been re-deployed to clinical duties. However, patient safety incidents have continued to be reported so as the first wave of COVID-19 abates, there is a significant additional workload facing them.

Is it easy to work through an incident backlog?

Having your investigation teams back from the managing the pressures of COVID-19 means that work can resume. However, reducing the backlog while dealing with new incidents is an onerous task.

Can organisations outsource their backlog?

We have two clients who we routinely assist with their investigation backlogs.  One a large teaching hospital and another a large mental health trust. We use our Eva investigation application to do this work. They send us between 10 and 20 investigations at a time, and we get our experienced investigators on the case. Using the Eva technology means that we have a standardised approach to investigations, using the same analytical tools and format.  Everyone’s investigative work is peer reviewed, regardless. It is an important part of our quality assurance.

Our serious incident investigation backlog service helps take the pressure off the patient safety team in a healthcare organisation so that they can focus other work, confident that the backlog is being dealt with.

Can technology help?

At Verita, we believe that modern technology is the answer to good quality investigating.  Our Eva technology enables an incident to be analysed thoroughly using the NPSA-recommended tools.  For example, the chronology timeline feature in Eva is a visual tool to help the investigator see what happened.  No more need for Post-It notes! Furthermore, the analysis section of Eva guides the investigator through each care management problem, identifying the underlying factors by using the contributory factors framework. This means that the causes of an incident are properly understood.  Recommendations can then be made confident in the knowledge that an investigator really understands the incident.

Read more about Eva here.

If people want to use our service, what do they do?

They can contact me at: [email protected]. I would be delighted to talk to them.

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