You may have read in the media that the HA is reviewing its disciplinary policy and procedures, particularly related to medical incidents. I want to explain why we are doing this and the process we are using.

The first reason is that we want to support staff to embrace our open disclosure policy so we can learn from our mistakes. In particular, our patient safety focus is on how to change the systems to improve patient safety. If a mistake can happen in one hospital, then it can happen in other hospitals. The best way to stop a mistake from happening again somewhere else in the HA is for colleagues to report the incident and for the hospital to analyse why it happened and what system changes might prevent it from happening again (the "root cause analysis").

Our HR policies must support our objectives and not punish colleagues who take the initiative and report errors or incidents.

If someone performs a wilfully negligent act that seriously harms patients, then they must take responsibility and strong disciplinary action must follow. However, in my experience these situations are very rare, and front-line colleagues mostly make "honest" or "careless" mistakes under the pressure of a busy workload and complex systems.

Second, aside from medical incidents we also have the need sometimes to counsel or discipline staff for a variety of reasons ranging from poor work performance or behaviour to poor work attendance.

Relevant parts of our policy manual are vague in defining what types of staff actions should receive disciplinary action. It has three categories of "offences": "minor offences", "unsatisfactory performance", and "gross misconduct". How to define these is not clear, and they are more about behaviour and character (e.g. "absent from duty without permission") than about whether our medical services are delivered safely for patients. Without clearer definitions, it is not possible to give guidance on what is an appropriate staff discipline response. It also means staff do not easily know the potential consequences of their actions.

Third, mitigating circumstances need to be considered in assessing disciplinary action. Many of our clinical incidents have system contributing factors, rather than being caused solely by individual human error. Examples are poor labelling of drugs, lack of training, excessive workload and confusing patient handover systems, which may all contribute to an incident.

For each major medical incident, the new disciplinary system must assess the balance between system shortcomings and individual human error.

There are also many other factors which need to be examined in looking at a medical incident which may involve some human error. Was the patient seriously harmed because of human error? Is the incident an expected (even though unfortunate) complication rather than an error? Did the healthcare professional behave in a way consistent with the standards of others in the same profession and rank?

Finally, our existing system lacks consistency. While we cannot apply a "formula response" to such complex situations, there should be some sense of fairness and consistency across the HA. The very few serious cases (e.g. causing patient death or serious injury, and involving human error) may have to be assessed by a central HA panel, but most should be handled by Clusters and hospitals, applying a fair and consistent procedure.

The process we are using is a number of staff have participated in some feedback workshops and now we are developing a draft policy which will be open for full consultation through our existing staff consultation mechanisms. We will also post the new draft on the HA intranet so that all staff have a chance to comment on the proposal. We will start this process of consultation before the end of the year.

I hope the new system will create greater consistency, fairness, and security for front-line colleagues who are putting our open disclosure and learning culture into action.