Exploring Local Rationality and Performance Influencing Factors:Analysis of clinical negligence claims and complaints against GPs to the Irish Medical Council

Suzanne Creed, Paul Bowie

Keywords: Human Factors, Patient Safety General Practice, Clinical Negligence Claims & Complaints

Introduction:

Approximately 2-3% of General Practice (GP) consultations result in a Patient Safety Incident (PSI). Severe patient harm occurs in 4% of PSIs. Irish GP has 29 million consultations annually. It is likely that there is significant, potentially avoidable, patient harm occurring in this setting. Learning from PSIs is key to delivering high-quality safe patient care. Understanding local rationality (exploring the complex care system situation and focus of attention at that time), and applying a systems approach to analysing PSIs are promoted as a more meaningful way to understanding PSIs in complex systems. This may improve related learning and avoid unwarranted individual clinician blame.

Method:

A systems-based documentary analysis of randomly selected, clinical negligence claims and complaints in Irish GP from 2019 was undertaken, informed by the Systems Engineering Initiative for Patient Safety( SEIPS) framework.Aims
1. Explore the extent to which Local Rationality and Performance Influencing Factors (PIFs) are considered in clinical negligence claims and Irish Medical Council complaints against GPs
2. Illustrate how the application of a ‘Systems Thinking’ approach to analysing clinical negligence claims and complaints could potentially enhance learning, improve patient safety and reduce clinician risk.

Results:

Local rationality was not explicitly explored in claims or complaints. Patient factors were considered in all 19(100%) claims and 14(100%) complaints. The GP qualifications and training were considered in 3(16%) claims and 7(50%) complaints. Most other PIFs were not routinely captured.

Conclusions:

Understanding human behaviour and local rationality supports a richer understanding of PSIs. This may reduce hindsight bias, while promoting, supporting and embedding a ‘just culture’. Local rationality is not routinely captured in claims or complaints. Embracing systems thinking is fundamental to providing meaningful insight into understanding PSIs in a complex system. This may enhance patient safety, improve clinician learning and reduce clinician risk.

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