A scientist at the University of Exeter has applied his studies to create a virtual reality stress training system. Dr Sam Vine’s initiative immerses trainees in a 360-degree, interactive virtual world modelled on real stress situations faced by workers in aviation, nuclear power and the military. Could this kind of training help front-line NHS staff to prevent mistakes?
I think it could help. But if NHS reform is going to address instances of clinical negligence in a truly meaningful way, a broader review – and indeed, a broader overview – is required. This would start by acknowledging that any healthcare system has a set of systemic stresses built into its design, which can lead to cases of negligence.
As a solicitor, I have seen cases where clinical negligence has arisen out of a complex set of circumstantial stresses in the health service, both situational and systemic. I was involved in a case in which a patient with persistent psychiatric conditions presented, not for the first time, to her local Mental Health Services team. The situation was extremely distressing for the patient as well as the staff who tried to assist and persuade her to attend hospital. Instead, she left the premises and was later injured, having jumped from a height in an apparent suicide attempt. The case was settled without the need for court proceedings, with an acknowledgement that she should have been admitted under section.
Prior virtual reality stress training might well have helped staff in that case. Every day, NHS workers face rapidly-evolving situations requiring split-second decision-making. It is no wonder so many television dramas are set in hospitals; A&E wards and mental health units, as they are by their very nature, sites of drama, tension and urgency.
Many situational stresses in the health service require immediate action – these situations have to be dealt with rather than avoided. But what of systemic stresses? The NHS is a highly complex bureaucracy in which front-line staff can find themselves in systemically stressful situations, caused by the decisions of NHS doctors, bureaucrats and administrators far removed from the front line. Added to this, the priorities and funding arrangements of the NHS are undoubtedly political issues, and MPs and ministers rightly have views and influences on the way the service operates. This can result in front-line staff being placed in difficult situations created by circumstances far beyond their control.
A review of the systemic stresses would need to start by recognising that front-line staff are often the last people in a long chain of decision-makers who may have contributed to cases of clinical negligence. The review should encourage a broader cultural shift in the debate, away from simple searches for individual blame and fault, and towards a broader analysis of the way our complex health system creates situations where, despite good intentions, negligence occurs and therefore needs redress.
This new way of thinking could help address many of the problems I come across in my work. Virtual reality training could surely be part of a broader change to the situations in which we place our valuable front-line NHS workers but is not the only solution.
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