9 Overcoming barriers to exception reporting in two district general hospitals in the East Midlands; a quality improvement project

The 2016 junior doctor contract (JDC) implemented a system of exception reporting (ER); this allowed trainees to report missed educational opportunities, and breaches of safe working as outlined in the 2016 JDC. Foundation doctors starting from 2018 will not have experienced a system prior to the implementation of the 2016 JDC and ER. Foundation doctors filled out a survey measuring potential barriers to ER and their confidence in ER. Teaching was delivered, explaining the process of ER with a focus on the identified barriers, followed by a repeat survey to assess for change. 81 trainees attended the teaching across two hospitals. 78 trainees filled out the pre-teaching survey, with 69 completing the post-teaching survey. 47.4% had submitted an ER by the mid-point of their 2nd/4th placement. 97.1% of trainees felt the teaching addressed some of the barriers to ER; such as ‘explaining the process of ER’ (50.7%), ‘simplifying the process of ER’ (49.3%), and ‘recovery of log in details’ (37.7%). 69.2% of trainees felt the major barrier to ER was ‘too much hassle’. 26.9% reported that senior pressure was still a barrier to ER. An improvement in confidence levels was observed with initial confidence levels (1- unconfident, 10- confident) amongst respondents at a mean value of 5.49, following the teaching this improved to a mean of 7.03. 87% of doctors felt they were more likely to exception report following this presentation. Trainees should be encouraged to exception report to identify areas of unsafe working, so that changes can be made to address this, and provide appropriate reimbursement for additional time spent at work. To facilitate this refresher sessions should be delivered to trainees, and the process of ER reviewed to ensure that it remains streamlined. Of note, there is still a perceived culture of senior discouragement with regards to ER. Further work will focus on understanding and addressing the barriers to ER amongst supervisors.