supporting staff during an investigation of an adverse ...15... · supporting staff during an...

Source: Trust Secretary & Head of Governance Issue date: 1st

October 2017 of 7

Status: Approved Review date: 1st October 2019 Document reference: PP(17)198

Trust Policy and Procedure Document ref. no: PP(17)198

Supporting staff during an investigation of an adverse incident, complaint or claim

For use in (clinical areas): All areas

For use by (staff groups): All staff

For use for

(patients/treatments):

All staff who are asked to participate in an investigation of their

involvement in an incident, complaint or claim

Document owner: Governance Team

Status: Approved

Purpose of this document This procedure aims to provide guidance to managers of staff involved in traumatic/stressful events and the staff themselves. Further detailed guidance is also available with the Policy to Support A Positive Mental Health Culture including the Management of Stress in the Workplace PP 149.

Contents: Page 1. Background 2. Objectives 3. Responsibilities 4. Immediate Support (Debriefing) 4. Development of the policy and procedure Appendix A: Helping Agencies

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1. Background 1.1 All members of staff may be asked to participate in investigations of some kind during their

employment. This may include practice/clinical and/or non-practice/non-clinical Incidents, Complaints, Claims / Litigation, Human Resources, or Police investigations. In addition, staff may also be asked to produce witness statements for investigations or Court proceedings and/or be asked to attend Court to provide evidence.

1.2 The Trust is encouraging a culture that is open, honest and focuses on improving practice

and service delivery, not on deficiencies and blame.

Source: Trust Secretary & Head of Patient Safety Issue date: 1st October 2017 of 7


2. Objectives 2.1 To protect our patients, make positive improvements to patient safety, and to improve the

way in which our services are delivered 2.2 To value, and protect our staff 2.3 To provide support and advice in the best interests of the staff member 2.4 To provide staff with all relevant and appropriate information and support to enable them to

have positive input into any investigative process 2.5 To maximize potential for staff to recognize that their positive input into an investigation can

lead to ongoing professional development

Examples of where staff may require support if they are directly involved or they are being asked to provide a statement or evidence:

Complaints

Grievances

Disciplinary proceedings

Claims

Police investigations

Court proceedings

Coroner’s Inquests

Incident investigation, including serious untoward incidents.

2.6. To ensure staff are fully aware of how and when support is available during an investigation

3. Responsibilities 3.1 All staff are expected to co-operate fully with any investigation or proceedings, however,

ongoing support and advice will be made readily available by Line Managers. It is acknowledged that some staff will find the process worrying. Managers must remain non-judgmental and impartial when providing support and be available to discuss any concerns the staff member may have about the investigation. This support will continue throughout the process.

3.2 Managers

3.2.1 Managers must be aware of and sensitive to the needs all staff involved in an event with the potential to lead to anxiety or stress. This covers staff of all grades and

professional/role.

3.2.2 Timescales need to be monitored for the investigation process with special reference to interviewing members of staff and producing the final report to minimise anxiety for all concerned. However, the Trust is mindful that a thorough investigation cannot be compromised by a time deadline.

3.2.3 An investigation may be particularly traumatic for a member of staff, for example when an unexpected death has occurred. This situation will require a de-briefing session to be undertaken within 24-48 weekday hours after the incident by a senior manager or clinician to identify any concerns, highlight good practice and discuss learning opportunities(see point 4.0). Immediate and proportionate staff support must be offered,

including referral to Occupational Health if appropriate.



3.2.4 The Manager, with Occupational Health if appropriate, must ensure that the member of staff is appropriately supported to the conclusion of the event or as long as the member of

staff requires. This may involve multiple strategies, such as:

Team Support, Team meetings can be an effective forum for discussing work issues

and finding solutions to any problems

Manager Support, Regular planned meetings between individuals and their line

manager

3.2.5 If staff continue to experience difficulties following the conclusion of the event, ongoing support must be made available making appropriate use of the Occupational Health and

Human Resources services.

3.2.6 Change to work environment

It may be that following assessment by the Occupational Health Department or if the member of staff is finding it challenging to work in the same environment, and/or with others who have been involved in the event, that consideration must be given to temporary

redeployment or to a restriction of duties.

Further information and advice about how to support staff members during the investigation process can be obtained from the Trust’s Governance Department, Trade Union

Professional Association Representatives or the Human Resources Department.

3.3 All staff

3.3.1 All members of staff have a duty to bring to their line manager’s attention if they feel that they are struggling to cope with the difficulties associated with a traumatic event.

3.3.2 Written guidance and a template relating to producing a statement can be found within the Trust’s Incident Report and Management Policy (PP105) and should be referred to prior to producing a statement. Managers will be able to provide advice about how to write a statement and will read and comment on the statement if requested to do so by the staff member. Further support can also be obtained through the Trust’s Litigation Manager. Managers will permit staff to take a reasonable amount of time off work to attend any such

appointments.

3.4 Occupational Health Service

3.4.1 The Occupational Health Service provides a confidential service to both members of staff

and Managers, including:

Provide first line counselling for members of staff experiencing stress related problems

Make recommendations regarding work adjustments

Refer members of staff to other experts/counsellors as appropriate

3.5 Litigation Manager

3.5.1 The Trust’s Claims Manager can provide advice and information on all aspects of legal proceedings, including response to allegations of negligence and potential legal

proceedings (see Clinical Negligence and Personal Injury PP061).

3.5.2 The Litigation Manager is able to arrange:



Checking of statements

Legal representation.

Advice and support on preparation to be a witness

3.5.3 Where a staff member is involved in an allegation of negligence there is the potential for a high level of anxiety and it is important to ensure that support is provided according to the same process as described above for staff involved in, but not implicated in adverse events. If an allegation is subsequently not proven there may need to be an extended level

of support offered to the individual following closure of the negligence claim

3.5.4 Although the Trust has vicarious liability for its employees, an individual may wish to discuss the investigation with his/her own medical defence society or professional

organisation.

4.0 Immediate support

In the event of serious incidents being identified the Executive Lead/Lead Investigator will identify the appropriate line manager to ensure all staff have had a key person of support identified. In the majority of cases the line manager will be identified as the key person to provide support for the staff within their team. The support of senior staff / Consultants will need to be considered on an individual bases depending on the incident raised. The confirmation and any concerns that have arisen in relation to the allocation of key persons and completion of the debrief, will be required for the Day 5 investigation meeting.

4.1 Immediate debriefing

In all cases, as soon as managers become aware that one of their staff has been involved in a potentially traumatic or stressful event, they should offer immediate support and reassurance to them. Much of the reassurance required by the member of staff can be provided by the manager informing them of the process and referring them to appropriate internal or external resources.

It is very important that the manager provides close support in the immediate aftermath of an event. This is a vital opportunity to help the individual involved in the situation keep the issues in perspective and not feel or become isolated.

The manager should ensure that the:

Debrief takes place in a suitable environment.

Member of staff is given time to talk and is listened to and feels supported

Arrangements are put in place for the staff member to receive any required medical assessment or treatment. For example, if they are in shock or suffer from a pre-existing medical condition that may have been exacerbated by the event.

Opportunity for referral to other sources of support is discussed and appropriate arrangements commenced, if required.

Advice is offered concerning any requirement to write a statement. This may be provided by: the manager; a member of the information Governance or Clinical Governance Team; or representatives of the professional body to whom the staff member belongs. Trade Union or staff side may also be able to provide assistance.



4.2 Debriefing within 24 – 48 hours

This debriefing provides an opportunity to go over an event in a calm and rational fashion and also provides a further opportunity for the member of staff or a group of staff to explore their concerns. A group debriefing is sometimes useful when there are several members of staff who would value such a discussion. Such a session requires strong chairmanship to avoid an atmosphere of recrimination or blame. These should be led by an Executive Director/Senior Clinician with experience in these situations. It can usefully be based

around a presentation of the case and a reappraisal of the options, judgments and decisions that were made or could have been made. It must have primarily an educational focus. It is particularly helpful for it to take place as soon as possible following the event. Group debriefings do not substitute for individual care and support for the parties concerned As with the immediate debrief, this meeting should be used as an opportunity to plan further supportive meetings and to identify any other people with whom the members of staff should discuss the events.

4.0.3 Ongoing support

Managers should remember that, in the initial stages following an event, they or a staff member may be unaware of the impact of that event on their well-being or ability to undertake their full range of duties. For this reason, it is essential that on-going support is provided. This should involve a one to one meeting no later than 2 weeks after the event. At the meeting any follow up arrangements, for members of staff still experiencing difficulties should be put in place as a matter of urgency, if this has not already been commenced

It should be remembered that a complaint, claim or court appearance may arise some considerable time after the actual event occurred. This does not alter the fact that this may be equally traumatic for staff and support may be required at this stage

5.0 Development of the policy and procedure

Author(s): Trust Secretary & Head of Patient Safety

Other contributors: Executive Chief Nurse, Risk Manager, Governance Coordinator

Approvals and endorsements:

Risk Management Committee Audit & Governance Committee

Consultation:

Issue no: 5

File name: S:\Governance strategies and policies\PP(08)198 Support for staff during an investigation of an adverse incident, complaint or claim.doc

Supercedes: Version PP(15)198

Equality Assessed Yes

Implementation This document will be widely circulated within the Trust, including all heads of department and ward managers and will be made availability on the Trust’s Intranet and Internet sites. Relevant changes will be brought to the attention of staff during circulation.



Monitoring: (give brief details how this will be done)

Implementation, compliance and effectiveness of the policy will be monitored by the Risk Management Committee according to the agreed frequency of the policy review. This will be achieved through reporting against defined key performance indicators as part of the policy review process (these KPIs are detailed in Appendix A).

Other relevant policies/documents & references:

Incident reporting and management PP105 Risk Management policy and procedure PP093

Additional Information: This policy is based on documentation from Portsmouth Hospitals NHS Trust ,Bedfordshire & Luton Mental Health and Social Care Partnership NHS Trust



Appendix A: Helping Agencies Support is available from the following:

External helping

agencies

General Practitioner

Professional bodies

Medical Defence

Union

Trade Unions

Medical Protection Society

General Medical Council

Nursing and Midwifery

Council

Postgraduate Deanery

Internal helping agencies

Occupational Health and Safety Staff

side/Trade Union reps

Chaplaincy

Colleagues Clinical Governance

Team

Other managers

Line Manager

Operational Human

Resources

Staff Counselling

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