This is a superb book. I can strongly recommend it to all doctors, to medical students, to other clinical staff and to managers who have to try and make sense of the chaotic complexity of healthcare. Your practice of medicine will be safer and more effective as a result of reading the ideas contained in this book, and even more so if shared with colleagues, discussed and selectively and sensitively adopted. If you will accept this summary then buy this book now and get on with reading it.
That's a strong opening and I had better now justify it.
Reading this book felt like I was reading the book I should have read alongside basic medical textbooks such as Davidson's Principles and Practice of Medicine: With STUDENT CONSULT Online Access (Principles & Practice of Medicine (Davidson's))
or Kumar and Clark Clinical Medicine
. Sadly it was not written when I was a student (I graduated 1989) One of the author's key ideas is that doctors should devote as much energy to understanding the systems within which they work as they do to learning to understand the various biological systems they will be treating in their patients, and the longer I go on in medicine the more I am coming to agree with this perspective.
The ideas in this book have always been present within medicine, but they have developed and become a formal, organised and significant body of knowledge over the last twenty years or so. When I was a student I remember our clinical sub dean explaining to us that medicine was a very individualistic profession, and that success or failure was very much a reflection on us personally. Problems were seen as being caused by character flaws and ignorance, not as events that would happen every so often, and which would arise from a complex mix of personal factors, the system, and the patient and their diseases and our treatments of them. The subject of error was always a worry, but rarely seen positively, or as Kathryn Schulz describes inBeing Wrong: Adventures in the Margin of Error
an opportunity for learning.
The NHS keeps its doctors busy, and gives them relatively (and sometimes absolutely) little time for reflection on their work. Most doctors are busy getting on with their work, rather than thinking about exactly what their work should be, and about how it should be carried out safely, effectively and humanely. The pleas have gone out for "clinical Engagement" but most doctors feel they are already fully engaged with their work- and that if they are any good at their job it is mostly despite the NHS rather than because of it.
Professor Vincent is an internationally respected expert on patient safety and in this book he defines the problem (many patients are harmed by the healthcare system) and then describes well the various ways of looking at this problem, analysing it, and trying to improve the situation. He does this gradually, and pays attention to the tragedy of avoidable medical harm and then to the analysis of the structures, processes and outcomes of care that give rise to these avoidable harms. He pays attention to events at the level of individual doctors, nurses and patients and at the level of the systematic factors that lead to healthcare systems harbouring these risks of harm. He emphasises that errors should be understood at many levels- the patient, the individual clinician, the system and its culture. He castigates the rush to blame and shame individuals seen in response to some events, as opposed to nuanced investigations that look at errors at many levels. That said sometimes individuals are personally culpable, but more often the system has set up the individual for a fall.
This book is a superb summary of and introduction to safety issues in healthcare. The author's expertise is demonstrated throughout, and his examples are drawn from UK, American, European healthcare systems, with appropriate comparison across to other industries where they are useful. He is superb at describing the strengths and weakness of the various measurements that can be made, and at showing whether and when comparisons with other industries and occupations are accurate or not.
This book has significant knowledge within it that I think all practising doctors and nurses, and most healthcare managers should know and understand. Medical students should read it as preparation, but will not realise how much wisdom it contains till they have been practising for a few years. The knowledge in this book will add to your speciality knowledge, and allow you to use that more effectively and safely to benefit patients.
The book is thorough enough to be useful, without being too long. It is well written and well referenced. It is well structured and easy to follow and understand. Professor Vincent has done clinicians, managers and their patients a great service by bringing this knowledge together into an accessible and usable format.
Indeed if the ideas in this book were implemented, and if we concentrated on ensuring the safe flow of patients around the system, e.g as describedSystems Thinking in the Public Sector: The Failure of the Reform Regime.... and a Manifesto for a Better Way
by John Seddon rather than on the atomised unit costs of Refusing Treatment: The NHS and market-based reform
market transactions then it would make a better white paper for the NHS than the current one.
Lots of good ideas in this book for doctors, nurses, and the managers. I recommend it strongly to my colleagues in the UK NHS, and in other healthcare systems worldwide.