Reflective practice and reducing risk in healthcare

Doctors, and indeed all healthcare staff, are committed to delivering high quality, safe care and avoiding errors. But when errors do occur, as they will on occasion, it is crucial to reflect, understand why the mistake happened and do everything possible to prevent a similar occurrence again. An approach to reflective practice is set out clearly in guidance for trainees from the Academy of Medical Royal Colleges.

The Royal College of Paediatrics and Child Health wants to see robust mechanisms in place throughout the health service, to identify and reduce risk, and promote a culture where all healthcare professionals - be they trainee, consultant, nurse, allied health professional, chief executive or manager - feel safe in acknowledging mistakes, raising concerns and challenging risk. A no-blame culture in which the focus is on learning from errors and open and frank dialogue with families affected is the route we promote as the best means of improving patient care and safety. We wish to see recognition that a duty of care is also owed to health care staff, and that in many cases where things go wrong, this is the end result of failures at multiple levels that may include pressures within the healthcare system.

The role of the General Medical Council is to protect patients and maintain public confidence in doctors. However it is important that the General Medical Council understand the implications of the decisions they make and explain clearly why they made them. We would be concerned if the duty of candour and the goal of promoting a culture of reflection and learning from error were adversely affected by fear of regulatory processes and perceptions of a punitive approach aimed at allocating blame. Loss of confidence in the General Medical Council would diminish their authority as a regulator, the respect in which they are held, and ultimately their ability to protect patients.