On 12 May 2011 our healthcare team provided a joint seminar with Verita, who like us, specialise in conducting independent investigations. Our discussion forum provided a unique opportunity for both healthcare providers and advisers to discuss the best way to manage the process of independent investigations.

Commissioning an independent investigation

What is the commissioner’s role?

  • Setting the scope of the investigation
  • Balancing budget/cost, timescale and scale of the investigation
  • Drafting terms of reference
  • Appointing the right people
  • Establishing regular dialogue with investigators to avoid surprises
  • Assuring the quality of the final report
  • Making sure recommendations are implemented
  • Publishing the final report where appropriate

Terms of reference:  what should they cover?

  • Details of who is commissioning the investigation
  • Details of who is conducting the independent investigation
  • Outline purpose of the investigation
  • Description of the scope of the investigation
  • Description of the clinical/organisational and policy issues to be reviewed
  • Methodology to be used
  • Timescale for completion
  • Outline the need for a written report and measurable, sustainable recommendations
  • Details of who will authorise the report and sign it off
  • Details of what will happen to the report once it has been completed

Selecting the right investigative team:  what do you need to look for?

  • People with the appropriate experience, authority and credibility
  • Independence
  • Capacity
  • Ability to work with all stakeholders including families
  • Ability to write clear concise plain English

Preparing and supporting those affected

Prior to Investigation

  • Contact family and treating clinicians at early stage
  • Rapport should be built with those affected in an attempt to reassure
  • Explain that the investigation process is a fact finding process, not a process to attribute blame
  • Make those affected aware of parameters of investigation
  • Remind those affected that their evidence should constitute fact not opinion
  • Listen to any concerns so that those affected know they are supported
  • Provide copies of medical records and policies in advance to refresh memory
  • Forewarn about amount of time required to provide evidence
  • Remind treating clinicians that statement is their statement and they should be entirely happy with it before it is signed off
  • Discuss suitability of location for interview so as to ensure those affected are comfortable
  • Answer any queries or concerns

After Investigation

  • Support must be ongoing
  • Provide update on outcome of investigation
  • Make referral for additional support, if required

Learning lessons

Developing SMART recommendations

  • Work closely with the those involved in implementation
  • Goals must be realistic and not a general wish list
  • Limit change to those areas that need it

Communicating the outcome

  • Identify those actions which require local attention and those which require more general or national dissemination
  • Develop a database to ensure recommendations are recorded and do not duplicate  

Ensuring sustainability i.e. making sure that the new way of working becomes the norm

  • Need ownership and “buy-in” from those to implement
  • Board level involvement in process
  • Identify champions for the cause and use them to spearhead change and make it sustainable

Auditing/monitoring progress

  • Adopt a system of regular review to ensure changes are maintained

Communications

Why should we communicate with victims and their families?

  • Communicate at the outset to:
    • ensure understanding of the purpose of the independent investigation and why it is being done
    • manage expectations – it is as important to explain what the investigation will not cover as what it will
    • provide the opportunity to comment on the terms of reference
  • Communicate throughout the investigation to explain any delays/agreed changes to processes
  • Communicate on completion to:
    • explain findings and recommendations
    • answer questions
    • provide support if necessary
  • Communicate six months after completion to explain progress in implementing recommendations

What factors need to be taken into account when deciding whether to publish the report?

  • Need to restore public confidence
  • Severity of incident/relevance to other healthcare providers and need to share lessons more widely (possibly through the royal colleges)
  • Level of media interest before and during the independent investigation
  • Level of political interest before and during the independent investigation
  • Level of family involvement and the likelihood of them actively engaging with the media
  • Involvement of campaigning groups/campaigners
  • Other/ongoing investigations, particularly criminal investigations

Preparing for publication: what are the priorities?

  • Prepare detailed plans to brief and support where appropriate:
    • victims/families
    • staff immediately involved in the incident
    • board members/governors
    • all staff
    • other stakeholders (PCTs/SHAs/Monitor/other agencies etc)
    • local opinion formers
    • the media
  • Timetabling briefings to minimise risk of leaks

Managing the media: what makes a successful outcome more likely?

  • Early involvement of your communication team
  • Preparation – a carefully co-ordinated action plan is essential
  • A united front (journalists love conflict so do not give it to them)
  • Short, simple, consistent messages about improvements with supporting examples - agree three key messages and stick to them in all briefings
  • Plain English – no jargon
  • A credible spokesperson who combines authority with compassion
  • Saying sorry