Martha’s rule and patients’ rights to a second opinion

Cooksley, Tim; Astbury, Susan; Holland, Mark

doi:10.1136/bmj.p2221

Cited by 5 publications

(3 citation statements)

References 16 publications

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“…Our research highlights the significance of the wider care context including the pressure that staff were facing at the time of the fieldwork and its impact on the workforce. 41 Sites were struggling with turnover of staff and the impact of industrial action. Staff from all three sites reported challenging workforce conditions and exhaustion after COVID which is likely to have had a negative influence on implementation of the system.…”

Section: Discussionmentioning

confidence: 99%

Understanding the enablers and barriers to implementing a patient-led escalation system: a qualitative study

Sutton,

Ibrahim,

Plath

et al. 2024

BMJ Qual Saf

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BackgroundThe management of acute deterioration following surgery remains highly variable. Patients and families can play an important role in identifying early signs of deterioration but effective contribution to escalation of care can be practically difficult to achieve. This paper reports the enablers and barriers to the implementation of patient-led escalation systems found during a process evaluation of a quality improvement programme Rescue for Emergency Surgery Patients Observed to uNdergo acute Deterioration (RESPOND).MethodsThe research used ethnographic methods, including over 100 hours of observations on surgical units in three English hospitals in order to understand the everyday context of care. Observations focused on the coordination of activities such as handovers and how rescue featured as part of this. We also conducted 27 interviews with a range of clinical and managerial staff and patients. We employed a thematic analysis approach, combined with a theoretically focused implementation coding framework, based on Normalisation Process Theory.ResultsWe found that organisational infrastructural support in the form of a leadership support and clinical care outreach teams with capacity were enablers in implementing the patient-led escalation system. Barriers to implementation included making changes to professional practice without discussing the value and legitimacy of operationalising patient concerns, and ensuring equity of use. We found that organisational work is needed to overcome patient fears about disrupting social and cultural norms.ConclusionsThis paper reveals the need for infrastructural support to facilitate the implementation of a patient-led escalation system, and leadership support to normalise the everyday process of involving patients and families in escalation. This type of system may not achieve its goals without properly understanding and addressing the concerns of both nurses and patients.

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Section: Discussionmentioning

confidence: 99%

Understanding the enablers and barriers to implementing a patient-led escalation system: a qualitative study

Sutton,

Ibrahim,

Plath

et al. 2024

BMJ Qual Saf

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show abstract

“…Or, even if PARR systems have a negligible impact on patient safety, they may nevertheless be an acceptable use of healthcare resources if they facilitate patients having a greater voice in their care. 21 However we understand the benefits of PARR services, we must ensure they effectively and efficiently deliver these benefits.…”

Section: Effectiveness and Efficiencymentioning

confidence: 99%

Getting rights right: implementing ‘Martha’s Rule’

Graham,

Hanson,

Hart

et al. 2024

J Med Ethics

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The UK government has recently committed to adopting a new policy—dubbed ‘Martha’s Rule’—which has been characterised as providing patients the right to rapidly access a second clinical opinion in urgent or contested cases. Support for the rule emerged following the death of Martha Mills in 2021, after doctors failed to admit her to intensive care despite concerns raised by her parents. We argue that framing this issue in terms of patient rights is not productive, and should be avoided. Insofar as the ultimate goal of Martha’s Rule is the provision of a clinical service that protects patient safety, an approach that focuses on the obligations of the health system—rather than the individual rights of patients—will better serve this goal. We outline an alternative approach that situates rapid clinical review as part of a suite of services aimed at enhancing and protecting patient care. This approach would make greater progress towards addressing the difficult systemic issues that Martha’s Rule does not, while also better engaging with the constraints of clinical practice.

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“…Systems for patients or carers to instigate a second opinion already exist in places (doi:10.1136/bmj.p2331), and the evidence is encouraging, albeit preliminary (doi:10.1136/bmj.p2221). 45 The health professions are broadly supportive. Informal behaviours should now become standard practice.…”

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confidence: 99%

Martha’s rule: an undeniable right to a second medical opinion

Abbasi

2023

BMJ

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Martha’s rule and patients’ rights to a second opinion

Cited by 5 publications

References 16 publications

Understanding the enablers and barriers to implementing a patient-led escalation system: a qualitative study

Understanding the enablers and barriers to implementing a patient-led escalation system: a qualitative study

Getting rights right: implementing ‘Martha’s Rule’

Martha’s rule: an undeniable right to a second medical opinion

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Martha’s rule and patients’ rights to a second opinion

Cited by 5 publications

References 16 publications

Understanding the enablers and barriers to implementing a patient-led escalation system: a qualitative study

Understanding the enablers and barriers to implementing a patient-led escalation system: a qualitative study

Getting rights right: implementing ‘Martha’s Rule’

­Martha’s rule: an undeniable right to a second medical opinion

Contact Info

Product

Resources

About

Martha’s rule: an undeniable right to a second medical opinion