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J R Soc Med. 2006 February; 99(2): 54.
PMCID: PMC1360482

Walking the walk

John Main, Consultant Nephrologist

I am afraid Phil Hadridge needs to remove the inverted commas from `ridiculous' in his recent contribution (December 2005 JRSM1). Should doctors have to be given a detailed briefing about their immediate environment every time they meet somewhere? It is exceedingly unlikely that, by checking the fire escapes in a room, a doctor would significantly reduce the risk of a catastrophe, and it certainly would not make patients any safer. So as a direct action it is ridiculous.

Would such an action set a good example? Well, of course, I would like to be seen as rational and flexible: however, checking the fire exits everywhere would give the opposite impression. If you want to change behaviour, first convince people that what you want is sensible and correct.

As for the `well it won't hurt' argument? Why not offer up a quick prayer, or take a vitamin tablet at the start of each meeting—easy, cheap and useless. The reasons that we are bad at patient safety are that too many problems are hard to fix, and living with unfixable problems makes it easy to ignore the fixable ones. Some of the latter are now being addressed—for example, the introduction of alcohol handwash dispensers everywhere, and a new culture which makes it easy to roll up sleeves and discard ties, jackets and white coats, has greatly increased the frequency of handwashing. If management are serious about patient safety, they should make this their priority rather than finance and DH targets. If adequate bed area cleansing were regarded as more important than meeting the 4-hour A&E target, and bed occupancy rates fixed at safe levels, I have little doubt that nosocomial infection rates would fall. There is also little doubt that patient waiting times would increase and mangers would be sacked (or relocated). The NHS seems to be concentrating on quantity of treatment whilst accepting some reduction in quality. And given resource limitations, and the fact that the vast majority of the huge number of treatments carried out daily are successful, the balance may not be far out. However, if we want to improve patient safety, management mumbo jumbo is not the answer—adequate time and space to treat patients is.


1. Hadridge P. Leading safely: `ridiculous' lessons from oil and other industries. J R Soc Med 2005;98: 539-41 [PMC free article] [PubMed]

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