Inspired by the Reith lectures

One doesn’t immediately expect that the distinguished thoughts of a Reith lecturer would have immediate relevance to our work to address domestic abuse – but this year’s lecturer, Atul Gawande, who spoke so eloquently about different issues affecting the future of healthcare, mentioned three points that felt highly relevant. You can listen to the lectures which are brilliant at http://www.bbc.co.uk/programmes/b00729d9

His second lecture talks about systems – how medicine is moving from the ‘magic bullet’ of penicillin to complex systems involving many practitioners, technology and inter-related problems. You will see the link with making a proper safety plan for a victim and children – it involves the resources of several agencies, clear communication and attention to detail as every case is different and the risk of getting it wrong is high. He suggests (I hope I do his lecture justice) that not only do the really complex aspects of a surgical procedure need to be done well, but also all the mundane but vital (literally) elements such as hand washing by nursing staff. To ensure consistency of practice he recommends….using a checklist. Does this sound familiar? And just like the CAADA-DASH risk checklist which was not/is not uniformly popular, nor was his checklist for medical staff. While many practitioners did not welcome the new medical checklist, nearly all of them said that they would want the procedure to be followed in exactly this way if they were undergoing an operation. Why didn’t we think to ask that about the risk checklist?! Of course any sensible person would want to have all those elements covered by an IDVA or police officer before a safety plan was made. The types of abuse suffered, the additional vulnerabilities and needs of a victim or particular risks associated with a perpetrator need to be identified if they are present. You can read more about his thoughts on this at http://www.nytimes.com/2007/12/30/opinion/30gawande.html?_r=2&oref=slogin&

Secondly, in a later talk, he comes back to the idea of how we implement systems. He talks about developing standards, writing guidance, and last of all when there is still a lack of consistent quality, he notes that there are sanctions for individuals who do not ‘follow the guidelines’. Again, this sounds all too familiar. In fact, we have done our fair share of guideline writing… Rather he argues, we should reward good practice and encourage those who are doing it right. A message for those responsible for driving culture change following the HMIC inspection?

Finally, and most importantly, he argues eloquently that the medical profession needs to listen to the patient. Radical. The same is true as we develop our response to domestic abuse – ensuring that lived experience is at the heart of what we do. For the group of victims, family members, survivors and thrivers who are helping us to shape our thinking at CAADA, I can only say, ‘Thank you – your input is vital – literally’.

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