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95% of doctors think you should be allowed to advocate for a loved one.

Would you admit your mother to your hospital? How likely is it that you would recommend this service to a friend or colleague?

This is what feedback boils down to. When we get asked about the quality of a service people are often polite. The service was okay, not bad, thank you very much. But if we want to know whether it was really up to scratch we need to search closer to home: if one of our loved ones would need this service – would we admitted them to our hospital, or find another place.

The net-promoter score is one way to capture feedback where it matters. It is useful if we are thinking about new innovative services. When Atul Gawande was researching the use of checklists for catastrophic events in operating theatres he undertook a randomised controlled trial in a simulated environment. And at the end of his paper in the New England Journal of Medicine he asks the participants: “If I were having an operation and experienced this intra-operative emergency, I would want the checklist to be used?” 67 experienced anaethetists, operating room assistants, surgeons and surgical residents are being put on the spot. This is a novel intervention, it has only been used in the simulation lab. The participants have not had time to look at the results in detail. 97% of them answer affirmative given the intervention a score of 4.7/5. At face value having this tool makes sense. It gels with their understanding of patient safety, organisational culture and values.

For the last year we have been working on the graded implementation of a service for patients who are concerned about their safety or the safety of a loved one in our hospital. The new service is called ‘Call-4-Concern’. If people are worried, they contact switchboard who puts them through to our Rapid Response Team with critical care skills. Some staff members have been concerned about nuisance calls, about clinical teams being undermined. Mandy Odell from the Royal Berkshire Hospital in Reading has run this service for over 10 years. Very few patients abuse the service. And many get the help they need. It is more often relatives than patients who make the call.

When I was presenting this service model in Glasgow at the Scottish Patient Safety Programme I asked participants, senior doctors, nurses and service managers, whether they had ever been worried about a member of their family or friend while these were in hospital? And whether they had contacted the ward or a friend who worked in the department to make sure that care was safe.

Please take a look at the word-cloud: most people had and they had supported family members & friends. Call-4-Concern is novel service. It is not established in any of the Scottish hospitals. But experienced members of the team are using their knowledge and insights on patient safety to advocated on behalf of loved ones.

And then I asked the question during a meeting in my own hospital. And I asked the participants whether would like to be able to use ‘Call-4-Concern’: out of 20 participants 19 answered with ‘Yes’.

95% of clinicians in my hospital would like to be able to advocate on behalf of a patient at risk and use their expertise for the safety of a loved one. Think about that if people are questioning the next time whether patient activated rapid response is a good idea.

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