June 2024 - Duty of candour - College of Optometrists

All healthcare professionals have a responsibility to uphold high professional standards and ethics through honesty, integrity and lifelong development. The General Optical Council's ‘Outcomes for Registration and Approved Qualifications’ stresses the requirement to act openly and honestly, and in accordance with their Duty of Candour guidelines.

Candour has been defined by the Professional Standards Authority as “being open and transparent when something has gone wrong”. Patients and families have a right to receive explanations for what happened as soon as possible, and a meaningful apology. As Emily McCormick highlights, it is “beneficial to both them [the registrants] as a practitioner and to patient care – ultimately, it helps to resolve concerns at a local level.”^[¹^]

How to instil a duty of candour in learners

Encourage confidence in learners to recognise when things have gone wrong.
Foster a sense of openness and honesty. Sharing experiences in a safe space will enable learners to feel more comfortable when having to face their own adversity.
Lifelong learning - lack of clinical knowledge can result in mistakes so it is essential for all optometrists and dispensing opticians, at whatever stage of their career, to commit time to professional development.
Gain experience with example scenarios. The College of Optometrists offers a series of ethical scenarios to explore. Looking at, and discussing these will to help develop emotional intelligence and the skill of acting honestly when mistakes are made. As, Yvonne Birks, from the University of York, highlights, “training, where it exists, focuses on raising awareness of the moral and legal imperative but occasionally also on how to have a challenging conversation.”^[3] Attention should therefore focus on how to approach difficult conversations.
As registered nurse, Donato Tallo emphasises, the duty of candour is a concept that “aims to enhance and improve nursing and healthcare practice and for this reason alone it should be viewed not with suspicion, negativity or fear but with positivity, maturity and seriousness.” ^[²^]Learners must aim to remove the fear of being candid. As humans, there is potential for error so learners must be prepared for these scenarios and not fear them. Vince Clarke, paramedic and senior lecturer at the University of Hertfordshire explores some of the factors that might discourage candour and provides some top tips on how to overcome these in his video: Overcoming the challenges of being candid.

What to do when things go wrong

Duty of candour requires transparency. Being candid is not always easy but is the right thing to do, especially when things go wrong.

In many cases it is the lack of timely apology that pushes people to take legal action. To fulfil the duty of candour, you must apologise for the harm caused, regardless of fault, as well as being open and transparent about what has happened. Regulation 20: Duty of candour - Care Quality Commission (cqc.org.uk)

Following good practice should consider the following steps:

Tell the patient (and family/carer where appropriate) when something has gone wrong
Apologise to the patient (and family/carer where appropriate), and share all known facts that are believed to be true
Take action to offer a suitable remedy where possible and explain this course of action to the patient (and family/carer where applicable)
Follow relevant arrangements for incident reporting, notification and escalation
Offer support to the patient (type of support will vary depending on the situation.)

Educators should encourage learners to consult with colleagues, peers, employers and professional associations so that they feel supported and can act appropriately when things go wrong.

Learning to fail successfully

Handling failure productively is an essential component that underpins meeting duty of candour expectations. The way failure is managed is vitally important for all involved.

“Failure is success in progress,” the Nobel prize winning physicist Albert Einstein once said. Whilst mistakes and failure are an unfortunate element of clinical practice for all involved, they can serve as steps to success.

Use mistakes and failures as educational experiences. Creating a culture of shared learning is vital and learners should be encouraged to reflect on any mistakes made as they provide opportunities to improve future skills. A multi-disciplinary team of health workers in the East Midlands have created a project whereby they review patient safety incidents in a no-blame environment to encourage a culture of candour and learning from mistakes, while linking to specific actions for improvement. ^[4]Exposing optometry and ophthalmic dispensing learners to environments such as these will help to foster a culture of shared learning from bad practice as well as good.
Resilience training to ensure learners have the determination and strength of skills to bounce back from failure and reflect upon it. December's topic feature looks at how to instil resilience in learners.
Be kind, not only to others but to yourself. Optometrist, Lipsey-Liu is an advocate for kindness –“we are so much harder on ourselves than on anyone else. If you catch yourself saying something to yourself that you wouldn't say to any other person, then stop.”
Listen to the patient. The way the situation is dealt with is often as important as the incident itself. As Optical Consumer Complaints Service head, Jennie Jones emphasises, “in a situation where there has been a mistake, or the consumer believes there has been an error, communication is absolutely at the heart of managing that conflict.”

SPOKE: Sector Partnership for Optical Knowledge and Education