The rise and rise of the MPSI — Niche Consult

Preparing for Multi Population Serious Incidents

On February 4th 2020 the report of the independent inquiry into the practice of breast surgeon Ian Paterson was released.

There are special considerations both in the immediate management of MPSIs and also in relation to the investigation of the circumstances surrounding the event and sharing the resultant learning. In our review of provider Incident Management Polices which are publicly available we found very few which might begin to address the handling of multi-population serious Incidents as a specific category. Additional guidance for organisations to enable them to respond in a decisive and controlled way, would be useful. Considerations when a potential MPSI has been alerted might include:

• Establishing a task force to understand the potential extent of ‘harms ‘ — this means not allowing the task force to accept premature reassurances without proper evidence of impact;
• Identifying a specific cohort of patients where the harm may have been catastrophic or resulted in death. This might involve the rapid development of a patient cohort modelling programme;
• Taking an early decision on how patients and families should be notified and consideration of extending and publicising access channels;
• Not allowing the ‘system’ or task force to be overly reassured without robust evidence and being prepared not to dismiss indications of wider harm?
• Developing a screening programme to determine those in immediate need verses the ‘worried well’;
• Understanding the extent of those who may be affected by proxy;
• Understanding the impact upon other services, planning for an increased volume of potentially higher risk patients;
• Early and active engagement with GPs, regulators and Public Health England;
• An early assessment of the resource required to tackle the problem. Is it that additional staff are needed or temporary staff to backfill key management posts? it could be money required to install a completely new secondary screening service to address the sudden influx of high-risk referrals;
• Development of a media and communications plan , including precise and accurate communications to individual patients affected; and
• Ensuring precise, accurate communications to individual patients affected

All of the above items in turn might take at least a week each to develop under normal circumstances, but, in the event of a MPSI you might only have five days in totality, to rapidly mobilise a plan, and in most circumstances this is less. Many organisations find out at this point that their existing policy and procedural documents are woefully inadequate to support the eventuality of a MPSI.

MPSIs are perhaps more common than we think. Many organisations in the last ten years have had issues with screening and recall programmes, or IT failures which have resulted in the wrong letters being sent. Then there are the infinitely more high-profile MPSIs; Paterson, Mid-Staffordshire, Bristol Heart, and Harold Shipman. Of course, no one can really prepare for events of this magnitude (particularly where individuals are acting with intent), but, it is likely that most of these organisations in retrospect would change things about their approaches in the aftermath of the scenario. Particularly, that they didn’t make things worse by inadvertently looking like they were trying to cover-up events because of their sheer disorganisation in the face of such operational chaos. Or indeed, those organisations who did try to defend the indefensible, managing successfully in their response to turn an inflamed situation into an eventual firestorm.

Once organisations have been able to deal with the immediate crisis, to provide care to those harmed or to fully understand the extent of the issue, the next step is a full investigation.

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