When investigating patient safety incidents, it is vital that this is done in an open and honest manner, without apportionment of blame. The Healthcare Safety Investigation Branch (HSIB) has operated since 2017 but what should you do if you become part of an investigation? Sarah Pickering, advisory case manager at Medical Protection, finds out

In medicine, it is vital that adverse incidents and near misses are reported and investigated in an open and honest manner, to enable lessons to be learned and any necessary changes to be implemented. Doctors have a professional duty to be open and honest with patients following an adverse incident, as outlined by the GMC and NMC in their guidance Openness and honesty when things go wrong: The professional duty of candour. In addition to this there is also a statutory duty to take certain steps when a “notifiable incident” has occurred.

In some cases, independent bodies may be instructed to conduct investigations into these incidents. This is becoming more frequent in NHS hospitals, particularly in relation to maternal and neonatal death cases – the HSIB was instructed in April 2018 to undertake maternity investigations into cases that fit the “each baby counts” criteria.

The HSIB came into operation in April 2017 and, although funded by the Department of Health and Social Care and hosted by NHS Improvement, it conducts independent investigations into patient safety incidents across NHS-funded care in England. Its ultimate aim is to identify contributory factors and make recommendations to reduce risk and improve safety. Its work brings it into contact with patients and their families, and healthcare staff.

If you are meeting with the HSIB

Medical Protection has taken a number of calls from members concerned about having been approached by the HSIB to assist with their investigations. The HSIB requests practitioners to attend an ‘interview’ to discuss a particular case, as opposed to requesting a statement. Member calls to Medical Protection have also expressed concern that these meetings will be recorded.

It is commonplace for HSIB to ask for consent to record these meetings and, although this may at first appear daunting, a recording will ensure that there is an accurate record of any information given, and it would be more accurate than a minute taker. The HSIB are amenable to interviewees taking along a work colleague for support if required; it is advisable to let the HSIB know who that will be prior to the meeting. The HSIB will conclude their investigation with a report, and a draft version will be sent to those involved to check for factual accuracy before it is finalised.

The nature of the investigative process means that preparation is everything, and there are a number of other important points to bear in mind that will help during the meeting:

• Be familiar with the relevant medical records and your own report (if you have drafted one), and take copies to the meeting so that they can be referred to when required.
• Ensure that any information you provide is factual, and explain where the information you are giving has come from – for example, your recollection or from the medical records.Ensure you explain any clinical terminology in layman’s terms to assist the HSIB.
• Do not comment or speculate on the actions of others and limit your comments to an explanation of your involvement only.
• You might find elements of Medical Protection’s “Giving evidence” factsheet helpful to assist you with your preparation.

Writing a report

The HSIB usually holds an interview instead of requesting a report, but you may wish to prepare for the meeting by drafting a report regarding your involvement, which you can refer to during the interview and even provide to the HSIB. The GMC states the following regarding report writing in paragraph 71 of Good Medical Practice:

“You must be honest and trustworthy when writing reports, and when completing or signing forms, reports and other documents. You must make sure that any documents you write or sign are not false or misleading.

a) You must take reasonable steps to check the information is correct.
b) You must not deliberately leave out relevant information.”

Medical Protection also provides the following advice:

• Consider using a professional report template for your report. Medical Protection can provide you with an example of this to give some structure to your report.

• You should state in the report who requested it and for what purpose. This can affect whether it is subject to disclosure in any subsequent legal proceedings, or if requested by anyone identified in it.
• It is good practice to start professional reports with an opening paragraph that includes an overview of your experience, qualifications, current role (and your role at the material time of the incident if different) and time in post.
• Your report should outline how you have prepared the report, eg by a review of the medical records, your recollection and your usual practice.
• The main body of your response should be a factual chronology of your involvement and should include dates and times.
• Refer to any colleagues by name throughout your report.
• Explain any clinical terms in your report.
  
• Ensure that your final statement is signed and dated.
• Review your report for typographical errors before submitting.
• Consider having your report reviewed by Medical Protection before the interview.

More information on report writing can be found in the Medical Protection factsheet. If you have any other queries or concerns about meeting with the HSIB or would like Medical Protection to review your report prior to the interview, contact the Medical Protection advice line on 0800 561 9090.