1. RCS Invited Reviews Ralph Tomlinson Head of Invited Reviews

2. What we do - and why we do it? 2 An invited service commissioned by Trusts to review surgical practice A partnership between the RCS, surgical specialty associations, and patients/public Identifies whether or not causes for concern exist Can provide an independent perspective on services, individuals or clinical records Demonstrates RCS’ commitment to highest standards of surgical practice and care Confidential subject to duty to report to GMC/CQC and Trust’s duty of candour Enables RCS to lead peer and patient reviews of care Ensures service improvement clinically owned RCS INVITED REVIEWS

3. How we do it 3 Review 2 Clinical Reviewers 1 Lay reviewer 1 RCS Review Manager 2-3 days Interviews and documentation Review 2 Clinical Reviewers 1 Lay reviewer 1 RCS Review Manager 2-3 days Interviews and documentation Report Team produces report Recommendations Quality control via IRM committee input Handed to Trust – Trust property Report Team produces report Recommendations Quality control via IRM committee input Handed to Trust – Trust property Monitoring 1 - 6 month follow up Take action if recommendations are not acted on Monitoring 1 - 6 month follow up Take action if recommendations are not acted on Request CEO or MD Approval by College/ specialty Terms of reference and indemnity Review planning Request CEO or MD Approval by College/ specialty Terms of reference and indemnity Review planning College support for reviewers Recruitment and training Planning/Visits/Reports Quality assurance Dedicated staff support College support for reviewers Recruitment and training Planning/Visits/Reports Quality assurance Dedicated staff support

4. Our experience 4 111 invited reviews in last four financial years 64 service reviews 19 clinical record reviews 28 individual reviews Published at www.rcseng.ac.uk /publications/doc s/improving- surgical-practice Using experience to improve understanding of problems in surgical practice Analysed sample 30 invited reviews Identified commonly recurring themes LEARNING FROM INVITED REVIEW ACTIVITY JULY 2011 – MARCH 2015

5. WHAT WE HAVE LEARNT 5

6. WHY and HOW do things go wrong? “Drift to failure” - Sidney Dekker. People very rarely set out to cause harm. Multiple clinical governance systems exist to prevent it. BUT individuals and/or teams become detached from them. INDIVIDUAL AND TEAM BEHAVIOURS ALWAYS KEY! 6

7. Our framework 17 recurring themes across 5 core areas: Working environment, Quality of delivery of surgical care, Individual behaviours / team working, Performance improvement process, Activity and outcome data. 7

8. THE SURGICAL WORKING ENVIRONMENT 8

9. 9 1. Facilities and resources 2. Raising and responding to concerns 3. Management of service change

10. THE WAY YOUR SURGICAL CARE IS DELIVERED 10

11. 11 4. Quality of care provided by surgeons 5. Standard of leadership and management 6. Quality of multidisciplinary team working 7. Process for patient consent to operations 8. Introduction of new techniques and technologies

12. INDIVIDUAL BEHAVIOURS AND TEAM WORKING 12

13. 13 9. Individual behaviours displayed by surgeons 10. Team working demonstrated by surgeons 11. Interactions with non-consultants/trainees

14. USE OF PERFORMANCE IMPROVEMENT PROCESSES 14

15. 15 12. Quality of morbidity and mortality meetings 13. Quality of surgical audit processes 14. Quality of performance appraisal 15. Learning from patient experience USING THE ABOVE TO IMPROVE PRACTICE TODAY

16. ACTIVITY AND OUTCOME INFORMATION 16

17. 17 16. Activity data 17. Outcomes information

18. SIMPLE QUICK WINS 18

19. 19 We think surgeons should: 1.Discuss performance routinely not just when problems arise. 2.Regularly review – facilities, resources, MDT, audit, M and M, patient and junior doctor experience, consent, new techniques. 3.Meet as a consultant team. 4.Have properly appointed and trained leaders. 5.Challenge poor behaviours / team working. 6.Act on concerns at early stage – don’t wait. 7.Get external advice if you need it.

20. Improving surgical practice – learning from invited reviews. http://www.rcseng.ac.uk/publications/docs/impr oving-surgical-practice 20

21. For more information rtomlinson@rcseng.ac.uk 020 7869 6223 http://www.rcseng.ac.uk/healthcare- bodies/support-services/irm 21