Medicine and Science from The BMJ

The blame game

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.

Learning to listen

In previous episodes of Doctor Informed, we've talked about the importance of speaking out, and how to do that better, but as you progress through your medical career, you will become the person to whom those with problems will turn.
In this episode we will explore listening. As a senior clinician, how can you make the space in your work to be a good listener, when what you hear might not be what you want to hear?
Our guests;
Megan Reitz is a professor of Leadership and Dialogue at Hult Business School.
John Higgins is research director at The Right Conversation.
Reading
Speaking truth to power: why leaders cannot hear what they need to hear
https://bmjleader.bmj.com/content/5/4/270

Talk Evidence - isolation periods, openness, and environmental impacts

In the first Talk Evidence of 2022, we'll be asking about the evidence for isolation - now that isolation periods are being reduced, or even stopped in the event of a negative lateral flow test, we'll find out what data that's based on, and if it's appropriate.
Vaccinations and treatments for covid-19 have been the one major success story of the pandemic, but that doesn't mean we should abandon the principles of openness and transparency when it comes to scrutinising the data - we'll hear what access to the data which underlies regulatory approval could do now.
Finally, the impacts of climate change were set out in a WHO report in November last year - and recent weather seems to underline their conclusions. We'll discuss new evidence linking the environment and health, and ask what clinicians can do with that.
Reading list:
Mitigating isolation: The use of rapid antigen testing to reduce the impact of self-isolation periods
https://www.medrxiv.org/content/10.1101/2021.12.23.21268326v1.full.pdf
Covid-19 vaccines and treatments: we must have raw data, now
https://www.bmj.com/content/376/bmj.o102
WHO report: Climate change and health
https://www.who.int/news-room/fact-sheets/detail/climate-change-and-health
Ambient heat and risks of emergency department visits among adults in the United States: time stratified case crossover study
https://www.bmj.com/content/375/bmj-2021-065653
Residential exposure to transportation noise in Denmark and incidence of dementia: national cohort study
https://www.bmj.com/content/374/bmj.n1954
Long term exposure to low level air pollution and mortality in eight European cohorts within the ELAPSE project: pooled analysis
https://www.bmj.com/content/374/bmj.n1904

Why is it so hard to speak out about patient safety?

In the previous episodes of Doctor Informed, we've heard why it's so important to talk about patient safety concerns, and some of the mechanisms that allow hospital staff to raise them, but knowing why and how doesn't always make it easier to speak out.
In this episode we're exploring the concept of a voiceable concern – identifying what counts as a concern, and what counts as an occasion for voice by an individual, is not a straightforward matter of applying objective criteria- for example how do you tell if you're witnessing poor practice, or just something that lies outside your area of understanding? Or how do you know if the common practice in this particular ward is actually an outlier when looking at other hospitals?
Our guests this week;
Mary Dixon-Woods is director of THIS Institute, and a Health Foundation Professor of Healthcare Improvement Studies in the Department of Public Health and Primary Care at the University of Cambridge. Her work is concerned with generating a high quality evidence-base to support the organisation, quality and safety of care delivered to patients.
Zoe Fritz is a consultant in acute medicine at Cambridge University Hospitals NHS Foundation Trust, she is also a Wellcome Fellow in society and ethics at THIS Institute, investigating how we communicate and record uncertainty around diagnosis.
Reading:
https://pubmed.ncbi.nlm.nih.gov/34978470/
www.bmj.com/podcasts/doctorinformed/
https://www.thisinstitute.cam.ac.uk/podcast/

US Assistant Secretary of Health, Rachel Levine

Rachel Levine Trained as a paediatrician, before becoming firstly the state of Pennsylvania's Physician General, then its Health Secretary.
During president Joe Biden's administration, she was nominated to become the U.S.'s assistant secretary of health. That lead to her becoming a four-star admiral in the U.S. Public Health Service Commissioned Corps, and thus the first openly transgender four-star officer in the US.
In this podcast, we discussed the pandemic - but also wider problems affecting Americans' health, notably climate change, inequality and the opioid crisis. We also discuss the health and care of LGBT+ people, in the U.S, and around the world.
This interview was recorded on the 16th of December 2021.

Talking Christmas Evidence 2021

The BMJ has special criteria for considering Christmas research: first it should make you laugh, and then it should make you think.
In this festive episode of the Talk Evidence podcast, our regular panel of Helen Macdonald and Joe Ross are again joined by Juan Franco,
editor in chief of BMJ Evidence Based Medicine.
They’ll give you a peek into what makes for good Christmas research, and why what may seem silly on the surface has a deeper meaning.

Who is responsible for patient safety?

As clinicians, we're all taught that patient safety is everyone's responsibility - but on the ground it can be hard to know how to most effectively report concerns, especially if you're not sure how those concerns will be received.
In this episode of Doctor Informed, Clara Munro is joined by Ayisha Ashmore, and they ask "who is actually responsible for patient safety?"
To answer that we're joined by 2 guests
Bill Kirkup, independent investigator who has worked on the reports into failings in Mid-Staffordshire, and Gosport.
Henrietta Hughes - GP, and the NHS's first guardian, Henrietta championed the creation of freedom-to-speak-up guardians in the English NHS, to ensure that clinicians are able to freely speak out.

Exit interview with Fiona Godlee

Fiona Godlee is stepping down as Editor-in-Chief of The BMJ after 16 years in the position.
She was the first female editor of the journal, and over her tenure has seen a lot of changes - both to the publication she's run, and to the wider world of medicine.
To mark her departure, Helen Macdonald sat down with Fiona to ask her a bit about those early days at the journal, on her view of women taking leadership roles in medicine, on her thoughts about some of the big issues facing science, and what is coming next.
Note from the editor; apologies for the audio quality in the first half.

Covid and conflict In South Asia

In this second podcast focussing on the covid response in South Asia, we’re focussing on the intersection of conflict and covid in the region. The pandemic has highlighted the underlying weaknesses in many health systems - but could it also be used as a catalyst for change, and be a step towards easing tensions?
To discuss this, Kamran Abbasi, executive editor of The BMJ, is joined by Zulfiqar Bhutta, head of the Institute for Global Health and Development, Aga Khan University, and Arun Mitra senior vice president of Indian Doctors for Peace & Development.
To read more;
Conflict, extremism, resilience and peace in South Asia; can covid-19 provide a bridge for peace and rapprochement?
https://www.bmj.com/content/375/BMJ-2021-067384

Life Support - Being a compassionate colleague

In this episode of Doctor Informed, Clara Munro is joined by Ayisha Ashmore - and they're getting to grips with being a compassionate colleague.
While the topic might seem warm and fuzzy, there's some good hard science to suggest that compassionate leadership at every level of healthcare can make a huge difference to staff, and improve patient outcomes.
Most people innately have the skills need to be compassionate colleagues - but often the pressures of the job can make it the lowest of priorities in our everyday interactions.
Our two guests this week think that's wrong though - and say that compassionate leadership is one of the most important things to get right.
Joining us are, Michael West, senior fellow at The King's Fund and professor of Work and Organisational Psychology at Lancaster, and Bob Klaber, consultant general paediatrician and director of strategy, research and innovation at Imperial College Healthcare NHS Trust
Michael has written the book on compassionate leadership in health and social care - https://tinyurl.com/vh55mker.
You can read more about Bob's work in his blog - https://www.imperial.nhs.uk/about-us/blog/how-acts-of-kindness-can-improve-care-and-strengthen-teams
Ayisha has written about putting some of this all into practice in a maternity setting - https://bmjleader.bmj.com/content/early/2021/11/25/leader-2021-000449