Analysis

Have you ever been ‘Datixed’? How to end weaponised incident reporting

Bullying and back-covering is leading to inappropriate ‘safety’ reports in the NHS

When bullying, back-covering and defensiveness pervade the workplace culture, colleagues can turn on each other using NHS digital incident reporting systems

  • Incident reporting is essential for safety in nursing, but systems such as Datix are sometimes misused to draw attention to trivial concerns
  • Advice on using your online incident reporting system, plus tips for managers on creating an open, fear-free learning culture
  • CPD opportunities: find out about related RCNiLearning modules

Could your eyebrows frighten people at work, or have you ever eaten chocolates meant for a colleague? If so, be warned – you could find yourself being ‘Datixed’.

Reports of staff using incident reporting systems such as Datix to

When bullying, back-covering and defensiveness pervade the workplace culture, colleagues can turn on each other using NHS digital incident reporting systems

  • Incident reporting is essential for safety in nursing, but systems such as Datix are sometimes misused to draw attention to trivial concerns
  • Advice on using your online incident reporting system, plus tips for managers on creating an open, fear-free learning culture
  • CPD opportunities: find out about related RCNiLearning modules
Picture: iStock

Could your eyebrows frighten people at work, or have you ever eaten chocolates meant for a colleague? If so, be warned – you could find yourself being ‘Datixed’.

Reports of staff using incident reporting systems such as Datix to blame, punish or threaten colleagues have circulated on social media for several years. But the pandemic and the extra pressure it has placed on healthcare professionals may have led to an increase in inappropriate, and even bizarre, use of such mechanisms.

Defences go up under pressure

1986

RLDatix, the firm behind incident reporting and risk management software Datix, is established
Source: RLDatix

Fiona Maxton, lead nurse for research and development at North West Anglia NHS Foundation Trust and an honorary visiting fellow at Anglia Ruskin University, says nurses and doctors have become more defensive about their practice over the past 18 months, which could explain why ‘I’m going to Datix you’ may have been heard more frequently.

‘I think it’s because staff are worn-out and exhausted,’ she says. ‘So when something is raised, even if it’s not against them directly, they feel it is and their defences go up.’

Datix abuse and misuse

Earlier this year, Dr Maxton, who is also a National Institute for Health Research ‘70@70’ research programme senior nurse research leader, co-wrote an editorial on the ‘travesty of Datix abuse’. The authors cite numerous instances where a system designed to monitor and enhance safety had been used – or misused – to report issues including:

  • ‘Not fully closing a door.’
  • ‘Wasp in bay #2.’
  • ‘Not supporting night nurses concerned about a possible ghost.’

It was a junior doctor whose eyebrows caused offence and who was reported on Datix as a result. ‘Apparently my eyebrows shown above my mask looked “aggressive”,’ the doctor said on Twitter.

‘Literally, someone did not like her face,’ Dr Maxton and co-authors wrote in their editorial.

From paper-based incident reporting to the web-based revolution

The company now known as RLDatix has developed and provided patient safety systems for 35 years. It produces web-based incident reporting and risk management software now used in 19 countries.

Former chief executive Jonathan Hazan says the aim and purpose of Datix has remained the same since the company was founded – ‘to record incidents and near-misses, to find out what went wrong, why something went wrong and put in place actions to stop those sorts of things happening in the future’.

‘Datix has become associated with fear, retribution and blame’

Jonathan Hazan, former chief executive of RLDatix

Mr Hazan, who stepped down from the role in 2015 but remained on the board until 2018, joined Datix after university in 1995 as a programmer. During his tenure, use of Datix in the UK expanded to cover 80% of the NHS.

Before online reporting systems existed, the recording of adverse events was paper-based and laborious.

80%

of NHS organisations use Datix
Source: RLDatix

‘People would report incidents on these large, complicated forms,’ he says. ‘The real revolution came when web-based incident report forms were introduced and people could report incidents as they happened directly into the system, and ward managers, nurses and patient safety people would get immediate notification.

‘You had very up-to-date information and it was possible to feed back electronically to the person reporting the incident.’

With ease of reporting comes a lowering of threshold criteria

But along the way something appears to have gone wrong and perceptions of what qualifies as an adverse incident have, in some cases, become skewed.

Mr Hazan, who now chairs the board of trustees of the charity Patient Safety Learning (PSL), last year published a blog on its website. Datix, he wrote, ‘has become associated with fear, retribution and blame’. He suggested two reasons why.

‘If incident reporting has no positive outcomes, it’s seen only as a burden and a tool for punishment,’ Mr Hazan wrote.

‘It’s also a symptom of a culture of fear, bullying and a lack of resources, where stressed managers want to discourage the reporting of incidents as they don’t have the time or resources to do anything about them.’

CPD module: Understanding bullying in healthcare organisations

It’s not difficult to find instances of Datix seeming to be being weaponised. But verifying and quantifying them is more difficult.

‘There’s an element of people reporting just to cover themselves. It’s that “just-in-case” culture’

Fiona Maxton, lead nurse for research and development at North West Anglia NHS Foundation Trust

Dr Maxton says in her trust about 100 incidents are reported every day and some of them ‘may well be erroneous’.

‘What seems to be happening is that there’s an element of people reporting just to cover themselves,’ she says. ‘It’s that “just-in-case” culture.’

What happens when managers fail to act on legitimate safety concerns

‘Culture’ is often the real culprit. It is not that incident reporting mechanisms are faulty; systems such as Datix, when used correctly, can help minimise risk and improve safety standards.

Rather, the problem appears to be people misunderstanding what they should be reporting and organisations neglecting to educate staff on appropriate use. Plus, if managers fail to act on incidents that pose a genuine threat to safety, the process risks becoming corrupted.

‘It’s complex’ says Mr Hazan. ‘There’s an awful lot going on.’

He suggests that staff who use Datix punitively or as a threat are not always doing so maliciously. ‘It’s not necessarily because that person is a bad person. They could be under a huge amount of pressure themselves.

He adds: ‘This is not a problem with Datix as a system. It’s about the culture in which it and all other incident reporting systems are used.’

CPD module: The effect of organisational culture on patient safety

Dr Maxton agrees.

‘It’s not the system that’s at fault,’ she says. ‘When used correctly, the system is ideal. It’s the person who enters the data and the follow-up of what happens then.’

Mr Hazan argues that where there are cultural problems in organisations in relation to the use of Datix, these can usually be traced back to the top.

‘Perhaps there’s uncertainty at the level of the board and perhaps the directors are under pressure themselves to get a result and are acting in a bullying way which filters down through the rest of the organisation.’

Prevent vexatious reporting on Datix and optimise its constructive use

All of which raises questions about how incident reporting systems can be used to maximum effect and inappropriate reporting prevented.

1,000 lives and £100m

could be saved every year by improving safety in the NHS
Source: 2019 NHS Patient Safety Strategy

A guiding principle, says Mr Hazan, is safety. Managers should ensure everyone understands that Datix reporting is about maintaining the safety of patients and staff.

‘Make it clear on the form that if you put in a malicious complaint about someone, that’s going to be ignored and “I’m going to Datix you” incidents will not be acted on.’

That said, nurses should always be encouraged to report issues that threaten safety, he says. ‘There are a number of reasons why people don’t want to report incidents. And a lot of that is to do with the configuration of the system, which is done at trust level.

‘I would encourage trusts to take a good, long look at how they have designed their incident report forms and make them as simple as possible for people to use. Cut out all the extraneous fields, get rid of the dropdowns and basically just have a big text box asking people what happened.’

Picture: iStock

How to use online incident reporting systems effectively

  • Before you report anything, establish what are the kinds of incidents on which your organisation expects you to provide feedback. ‘The most important thing is to remember why Datix is there,’ says research nurse Fiona Maxton. ‘All of these systems are a tool to report incidents so we can create learning to prevent a recurrence’
  • Follow local guidelines on how to write an accurate report. For example, the Black Country Partnership NHS Foundation Trust guidance on reporting an incident offers advice on good reporting practice. Most of the Datix dropdown boxes covering when and where an incident took place are self-explanatory, but where there is space for free text, the guidance says you should stick to the facts, avoid opinion and assumption, and avoid any identifiers such as names or initials. Refer instead to ‘Patient 1’ or ‘Staff Nurse 1’
  • Managers should ensure staff are properly educated on effective use of online incident reporting systems, says former Datix chief executive Jonathan Hazan. ‘As part of a junior doctor’s or nurse’s induction, you should make it clear what Datix is used for and what it’s not used for. And make it clear they won’t get into trouble either for reporting an incident or for being included in an incident report’
  • Managers should make sure reported incidents are acted on, Mr Hazan says. ‘A lot of people become disillusioned by incident reporting because they report something they think is really serious and either they don’t get a response or they’re told, “There’s nothing we can do about it”.’ If that happens, staff will fail to take incident reporting seriously, he adds
  • Ask yourself whether it might be more appropriate to have a conversation than report something, Dr Maxton suggests. ‘Sometimes it’s about behaviour – staff behaviour towards each other is Datixed. But I don’t think there’s a place for filling in an incident report on people’s behaviour. You get far more from talking to people.’ She cites the case of a doctor who was reported through Datix for eating chocolates intended for nurses
  • Highlight that the purpose is learning not blame Leaders should encourage staff to understand that Datix is not about apportioning blame. In an editorial on Datix abuse, Dr Maxton and colleagues write: ‘Datix feedback is often perceived as a guilty or not guilty verdict rather than a safety learning moment that may prevent a dangerous reoccurrence’
CPD module: Promoting patient safety through effective communication and teamwork

The vital role of online incident reporting in healthcare

Despite the apparent prevalence of the ‘I’m going to Datix you’ culture, Dr Maxton believes online incident-reporting will continue to play an important part in ensuring safety – providing the systems are used appropriately.

‘So how do we use them correctly? We need to have a much better understanding of their purpose, of what an “event” is and what it isn’t,’ she says.

Stories of individuals being ‘Datixed’ for frivolous reasons can obscure important discussions about safety in healthcare.

The 2019 NHS Patient Safety Strategy claimed that improving safety could save almost 1,000 lives and £100 million in care costs each year.

But it said that attempts to establish an effective patient safety culture often fail because staff ‘fear blame and close ranks, losing sight of the need to improve’.

Drawing on the work of Erik Hollnagel of Denmark’s Institute for Regional Health Research, the strategy called for less emphasis in the NHS on ‘Safety I’, where the focus is on things going wrong, and more on a ‘Safety II’ approach, which considers the ‘nuances and subtleties of what it means to get stuff done’ despite pressures and limited resources.

Anticipating when things could go wrong

The strategy adds: ‘Keeping patients safe is about having a constantly enquiring mind; noticing what happens every moment of every day; noticing when things go right; noticing when they could go wrong; and noticing when they do go wrong.’

Through appreciative inquiry and conversations with people who get things done despite the pressures, staff can then report anticipated problems without waiting for an incident to happen, the strategy states.

‘This can free up the whole process of learning as it will not be restricted by any reticence to report actual errors and harm,’ the authors add.

And so, the ‘Datixing’ of colleagues with the wrong eyebrows might perhaps be consigned to history.


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