11.14 Monitoring
Ishall now consider how the implementation of clinical governance schemes is to
be monitored. The Commission of Health Improvement, set up in September
1999, aims to support organisations and will conduct rolling reviews of all Trusts
and primar ycare trusts. One of the main wa ys that the provision of health care is
monitored in practice is through the adoption of clinical risk management pro-
grammes ,CRM) [2]. It is the responsibilit yof the health care professional to
promote the welfare of individual patients and ensure that the yreceive the best
care. In this section I examine how such schemes can be used to create an
environment which makes it easier for professionals to carr yout their ethical
duties in practice, looking at the issues of near-miss reporting and professional
competence.
11.14.1 Near-miss reporting: an ethical environment
One aspect of CRM that can be used as an important measure for preventing harm
to patients is near-miss reporting and notifying of adverse events. For example,
ever y year 28 000 written complaints are made about aspects of hospital treatment;
£400 m has been paid out in settlement of clinical negligence claims; and 15% of
hospital infections ma ybe avoidable and cost the NHS nearl y£1 billion [16]. To
rectif ysuch problems:
`The NHS needs to develop: a unified mechanism for reporting and analysis
when things go wrong [and] a more open culture, in which errors or service
failures can be reported and discussed.' [16]This could be used to create a working environment which helps the professional
to practise ethically. The hospital appoints a risk manager to compile information
on accidents or possible accidents and this forms the basis of changes designed to
protect the patient from further incidents. This mechanism can improve patient
care and is a means b ywhich CRM can promote ethical practice. As Professor
Jones says, It cannot be ethical to continue with a method of providing health care that exposes patients to unacceptable risks of having an adverse outcome' [17]. This move b ythe medical profession to examine wh ymedical accidents have occurred is a ver ypositive trend. The professional codes of conduct for doctors and nurses all state the ethical duties of the professional in terms of the duties to the individual patient. The UKCC Professional Code of Conduct ,1992) [18] states,act, at all times, in such a
manner as to safeguard the interests of individual patients'. Doctors are bound by
similar dictates to consider the welfare of the individual patient as paramount:
`The safet yof the patients must come first at all times' [19].
Clearl yan yreduction in processes leading to patient harm, incidents of staff
incompetence and general bad practice are to be applauded. However, there could
be a potential difficult ywith this approach when one considers the context in
which it operates. Janet Lyon [20] has argued that, in order for an adequate system
of near-miss reporting to operate, the staff must be able to trust their employer to
use the information responsibly. Various cases demonstrate that this might not be
248 Nursing Law and Ethics