To err is human : an exploration of the implementation of the Duty of Candour

Aim of the study: to conduct qualitative research that considers the impact of the Duty of Candour legislation within healthcare. Background: the concerns and complaints raised by a persistent group of patients and families, linked with increased mortality rates led to the Mid Staffordshire Inquiry (Francis Report, 2013). This inquiry found a catalogue of failings that included preventable deaths, incidents that had led to patient harm, and a culture that did not foster open and honest discussions with patients and families when something had gone wrong within the services provided at Mid Staffordshire NHS hospitals. The findings from this inquiry led to Sir Robert Francis recommending a statutory ‘Duty of Candour’ (Health and Social Care Act, 2008 amended 2014) across all healthcare services in England. The Duty of Candour is the formalisation of the processes of being open and honest when a notifiable safety incident has occurred. Dalton and Williams (2014: 2) state that “put simply, candour means the quality of being open and honest”. Methods: a grounded theory methodology was used to help guide the research design and process. Specifically, the grounded theory developed by Kathy Charmaz (2012) became the theoretical framework used to analyse findings. 5 in-depth interviews were conducted with clinicians who had reported a patient safety incident that met the criteria for the Duty of Candour to be applied. Findings: a number of key categories emerged from the analysis of interviews, these were hybrid professional – managerial roles, organisational culture, organisational practice and organisational change. Conclusions: a number of key categories emerged from the analysis of the interview transcripts. Each of these key categories could be seen in isolation, however it is a much more powerful to see these findings as a collective discourse that links to the impact of the neoliberalist narrative on public healthcare provision in the UK. The need for the Duty of Candour is seen as the necessary response to ensuring NHS Trusts are responsive and transparent when things go wrong. However when a human factors theory lens is applied to the responses given in interviews it is apparent that issue such as lack of time, fear of reprisal, dual and often conflicting roles lead to dialogue with patients and families that is sometimes not personalised. From the interviews with the participants in this study there was a sense that they felt that in fulfilling their professional duty to enact the Duty of Candour requirements that they were simply fulfilling a bureaucratic task; rather than being enabled to take a person centred approach and an opportunity to learn from incidents and events.