Learning from hospital mortality.

Understanding and learning from hospital deaths is an important component of good clinical practice but current approaches and measures are complex, controversial and difficult to understand. Patients who die are not a homogeneous group but fall into three distinct categories; most learning will be achieved by recognising this and investigating categories of deaths in different ways, relying heavily on qualitative approaches. Numerical measures of overall hospital mortality, such as hospital standardised mortality ratio (HSMR) or measures of 'preventable' deaths, are most unlikely to be helpful at a hospital level and may even give false reassurance, as accuracy of measurement is strongly influenced by factors apart from quality of care.

Documenting the process of patient decision making: a review of the development of the law on consent.

The doctor's role involves helping patients to understand their condition, including the anticipated benefits and risks of proposed treatments or omissions to treat. In order to treat, doctors require consent from patients but the duty to advise is equally strong if conservative management is appropriate. The recent judgement in the case of Montgomery has set a precedent for patient autonomy. However, doctors are still required to judge what risks they should disclose in their reasonable assessment of that patient and their specific situation. The General Medical Council reflects a consensus that the empowered autonomous patient is more likely to be satisfied with their clinical outcome than the passive victim of medical paternalism. Doctors, regardless of specialty, must counsel their patients adequately, paying particular attention to identifying material risks that are likely to be significant to their case.

The Royal College of Physician's Quality Improvement Hub - how can it help physicians to improve patient care?

Doctors have a central role in managing patients across a multitude of clinical environments, which places them in the ideal position to identify systemic issues. Traditional medical training focuses on the knowledge and technical skills required; rarely are doctors trained in leadership, management or how to analyse and understand systems so as to design safer, better care. Quality improvement methodology is an approach that is known to enable improvement of the systems in which healthcare professionals work in order to provide safe, timely, evidence-based, equitable, efficient and patient-centred care. To address the current disparity, the Royal College of Physicians (RCP) has launched a Quality Improvement Hub, which will aim to support physicians to face the challenges of improving medical care, enabling them to navigate the tools with more confidence and share and implement the learning more swiftly.