Before the case discussions

The Group

Equipment

The process

  1. Explain aims:
    • to improve the quality of patient care by learning from good and bad aspects of previous care,
    • to avoid attributing individual blame, 
    • to develop guidelines for good practice.
  2. Explain process:
    • to talk through a specific case in (eg) half an hour, 
    • to have available a summary of the case and the patient's...
  3. Case notes: 
    1. to identify what those present see as good or bad incidents in the care given, and why, 
    2. to offer suggestions as to how things could have been done better,
    3. to develop practice protocols where appropriate.

Establish ground rules for the group, eg confidentiality, speaking for self (using '1' not 'we'), allowing people to speak uninterrupted.

The facilitator

The case discussions

Discussing the case

Feedback

Review

Facilitators

Rules for facilitators

Pros and cons of external facilitators

Pros  Cons
Leaves everyone in the team free to contribute. If facilitator is someone from another practice, could be threatening - try MAAG facilitator.
Not involved in any internal 'games' can keep boundaries better.  Likely to be more expensive.
Safer if there are nay feelings of distrust in the PHCT. Internal facilitators might be more flexible eg use different people on different occasions
Someone to off load distress onto.
Takes responsibility for keeping it going.
External facilitators can get support for themselves more easily.

Problems

The group (PHCT)

Environment

Discussions

Settled starts