Staff reported problems raising patient safety concerns at half of the 14 acute trusts investigated in the Keogh review, analysis by HSJ’s sister title Nursing Times has revealed.
The findings of a review into the trusts, which all had higher than expected mortality rates, was published last month by NHS England medical director Sir Bruce Keogh.
A failure to act on information that showed cause for concern and the absence of a culture of openness were two of the problems identified across many of the hospitals, the Department of Health said.
Analysis of the reports on each of the 14 trusts by Nursing Times found seven needed to address issues around the raising of concerns or incident reporting by staff.
Sir Bruce’s investigators found a “perceived culture of blame in reporting incidents and highlighting areas of concern” at Buckinghamshire Healthcare Trust.
Their report said: “Some members of staff we spoke with… gave examples of where they had received negative personal feedback in raising incidents and areas of concern.”
In one incident a chest drain had been left unsealed. But it was not reported due to concerns a nurse considered to be “extremely conscientious” would be disciplined by the trust – instead of the systemic risk of treating patients with complex needs on non-specialty wards being addressed.
Staff also said the incident reporting system required too much information about those involved, rather than the process at fault, which created a “fear of blame and retribution”.
Investigators at North Cumbria University Hospitals Trust said discussions with staff suggested many “felt intimidated and bullied”.
“Some staff requested we shut windows when talking to them in private drop-in sessions – suggesting fear in speaking openly about issues. Others were visibly upset,” their report said.
The report on Medway Foundation Trust stated: “We met a large number of committed and concerned staff who frequently reported that they feel unable to raise patient safety concerns and when they do, little or no action is taken.
“Staff need to know that they are not only being listened to but that their concerns are being acted upon.”
Meanwhile, some staff at Blackpool Teaching Hospitals Foundation Trust “expressed difficulties in reporting incidents” and nursing staff reported that feedback could be given more consistently.
Staff at Burton Hospitals Foundation Trust felt the outcome of serious untoward incident reporting was not communicated back to them, with the exception of maternity teams.
“Some staff also did not agree that there was a ‘no blame’ culture at the trust,” investigators said.
Colchester Hospital University Foundation Trust was told to consider how it acted on concerns raised by staff. Staff told investigators about a lack of feedback when issues were “escalated upwards”.
The investigators at Dudley Group Foundation Trust heard about historical issues relating to theatre staff management, including raising concerns about quality.
All of the trusts investigated are undertaking strict improvement plans.