Fiona Pathiraja: Putting a price on safety

Fiona PathirajaIt’s the first week of August and in the NHS that can only mean one thing. Changeover has arrived and thousands of newly qualified doctors are let loose on the wards.

For decades, patients and doctors alike have joked that it is best to avoid a hospital stay in August. Lately, this myth has been gathering evidence with suggestions of increased mortality around the changeover period. [1] Whilst by no means conclusive, the trend shouldn’t be ignored.

In an era of targets, safety, and patient-centred care, it is strange that the NHS has failed to tackle the changeover issue. The solution seems simple enough. New doctors need an efficient corporate trust induction that welcomes them to both the trust and the NHS. [2] Induction needs to be delivered alongside high quality ward-based shadowing that comprehensively covers vital first day competencies.

Paid shadowing and induction periods have demonstrated some improvement in safety, quality, and confidence of new doctors. [3] At present, this doesn’t happen uniformly across the country. A significant proportion of Foundation Year 1 doctors are starting jobs in unfamiliar hospitals, without a handover of patients and no understanding of the ward.

As with most things, the issue can be distilled down to money. Paying 7,000 new doctors for a week of shadowing and induction prior to starting their jobs is a hard sell in difficult times. But with more evidence trickling in to support a national shadowing period, I don’t think we can put a price on safety.

In the words of a newly qualified friend who started this week: “I’m running around like a headless chicken, trying in vain to be resourceful, annoying the nurses by asking them everything and praying that no-one gets really sick without the registrar being around.” Not really the best advert for safety, is it?

Fiona Pathiraja is navigating a medical portfolio career. She has worked as a junior doctor, management consultant, entrepreneur and most recently as clinical adviser to the NHS medical director at the Department of Health. Follow her on Twitter @dr_fiona

1. Jen MH, Bottle A, Majeed A, Bell D, Aylin P. Early in-hospital mortality following trainee doctors’ first day at work. PLoS One 2009;4:e7103
2. Stanton E and Lemer C. The art of NHS induction. BMJ Careers, February 2010
3. Pathiraja F and Outram C. Making the case for shadowing. BMJ Careers January 2011