Independent Capability Investigation — Case Study — Niche Consult

Overview

In this case study by Kathryn Hyde-Bales and Sue Salas, we describe the learning points which arose from an independent capability investigation we completed into the conduct of a senior clinician. Our investigation did not uphold any of the concerns raised against the clinician, with the exception of one, which was partially upheld. Whilst concerns about the clinician prompted the investigation, we found there were cultural, systemic, and operational processes in the department which had created the situation.

An acute Trust asked us to conduct an independent capability investigation, using its Capability policy, into concerns around conduct in relation to a senior clinician.

The issue

We agreed the terms of reference for the investigation with the Trust at the outset. The investigation focused broadly on:

• The lack of pre-operative documentation regarding consultation with a patient to explore the risks and benefits associated with a procedure
• Clinical management of the patient
• The clinicians’ perceived behaviour in response to colleagues’ concerns about the management of the patient and their welfare.

The scope of the investigation was later expanded to include a second patient in relation to pre-operative documentation.

Our Approach

We appointed an experienced specialist in the relevant clinical field to act as clinical expert for the Niche investigation team.

The investigation was conducted over four months. We met with the Trust clinician and their legal advisor at the outset of the investigation. Throughout the investigation we held regular project meetings with Trust nominated contacts. We submitted regular project updates. In addition, our project manager was available throughout the investigation to respond to questions.

The outcome

Our investigation did not uphold any of the concerns raised against the clinician, with the exception of one, which was partially upheld.

We submitted a project report with 15 recommendations to the Trust. Our recommendations focused on short- and long-term changes and suggested actions the Trust needed to take. We grouped our recommendations under the following headings:

• Departmental cultural issues
• Outpatient clinics
• Record keeping
• Multi-disciplinary meetings
• Audit and policies

Concerns about a practising clinician prompted this investigation. However, in reality we found there were cultural, systemic and operational processes within the department which had created a situation in which a clinician was practicing and working almost in silo, without appropriate support, regular line management and robust governance processes being in place. This is why our recommendations placed emphasis on broader departmental change as opposed to focusing simply on the practice of the one clinician. The Trust accepted our findings and committed to developing an action plan in response to the recommendations.

Originally published at https://www.nicheconsult.co.uk.