Raising concerns – what makes guidance useful?

Image of door handleThe Royal College of Surgeons commissioned me to write Acting on Concerns: Your Professional Responsibility in 2013, to support an increasing number of members seeking advice. The Nursing and Midwifery Council recently issued their new guidance on raising concerns, following the Royal College of Nursing who published advice in the spring.

Views differ on how useful such guidance can be, and what should be in it. The Surgeons’ is easily the most comprehensive. It starts with advice on how to head off crises by making day-to-day clinical governance fit for purpose. It follows with detailed information about how to escalate concerns. It concludes with how to respond when you are the person with whom colleagues raise their concerns, including when this is done informally through professional networks.

RCS officers agreed it would help surgeons get a handle on how to deal with concerns if we explained the research evidence about how people behave when they encounter something worrying. We also thought that detailed advice on how to write up a concern was useful. All this makes the RCS guidance long (it has checklist style summaries for people in a hurry).

By way of contrast, the NMC document is much shorter. It reads well and is approved by the Plain English Campaign. But there is nothing in it, or in the RCN guidance, to help people understand what it’s like to suspect that something is wrong when everyone around you is ignoring it. Nor does it say much about the tendency of colleagues to ‘shoot the messenger’, what to do about this, or what a good letter of concern might look like. And is written guidance the best way of doing all this anyhow?

I’d be interested to hear from you if you’ve used such guidance and have a view on what should be in it. Come and talk to me on twitter or email me in confidence.