Systematic Review GRADE checks for bias don't codify failures in trial quality, such as gross errors. This leaves decisions to include dubious data to subjective opinion. Observational STROBE or RCT CONSORT tools don't accommodate for undisclosed funding, ie where the PI had declared conflicted interest elsewhere than in the article considered.
Australia has no Office of Research Integrity, and Bretag's Handbook of Academic Integrity explains the weaknesses of governance framework in this country. I have a case series of 3 violations of our Motherhood statements eg Helsinki, E72, Belmont Report etc. Each institution's HREC won't correspond, nor will the publishing editors. How can these investigations be recounted, while protecting privacy of individuals whose guilt cannot be assured - for want of a forum to raise allegations?
https://www.researchgate.net/publication/235388597_Collusion_and_negligence_in_hospitals
One big problem is collusion of the staff
See minute 4
https://www.youtube.com/watch?v=jDIZS4IQlQk
Article Collusion and negligence in hospitals
Thankyou, Judy. I've been assisted by UOW's Brian Martin with the thematic message for a manuscript, along the lines of an advisory to potential whistleblowers. First consider your institution's record of investigations, then consider the escalation risk in national complaint, and consider the likelihood of a truncated career.
As an ex-serviceman, I'm cognisant of the esprit de corps exemplified by Simon in your link, however workplace unity is less cultural - and more reflective of a pragmatic understanding of the futility of complaint. The Marines' moral code isn't just because lives are at stake, but it's because command & control and its review process must be reliable when managing firepower. The presence of the press in military operations spotlights failure, and demands accountability.
A brief stay in my home of a West Point cadet exemplified what you are talking about. I work as a private homebirth midwife using those same principles of accountability. Because of my motivation and principles, i no longer need to carry a kit to stitch women after birth because I have figured out and published a way to deliver all women over an intact perineum. Even women with a previous third or fourth degree damage. Because of my motivation, I figured out and published a very easy protocol that prevents all hemorrhaging at all vaginal births- high and low risk. It is telling that these protocols are not adopted by hospitals. Instead, the lowest recorded hemorrhage rates in hospital at vaginal birth is 5% , with 1% of women needing blood transfusions. All that bleeding is preventable- no animals hemorrhage at birth. All animals evolved not to hemorrhage at birth, including humans. and 80% of women get stitches in hospital, all preventable. I have never encountered any accountability in hospitals. There is a new book about the methods how to improve systems- about how flying became so safe. I will get you the name of it. The same principles could be applied to hospitals, but there is no interest to improve outcomes in hospital settings.
I wonder if there is not a better use of your power. I know of many like you, who tried and failed to improve the lack of accountability in hospital settings. If you have the goal of improving accountability in hospitals, I would recommend that you consider to veer away from academic pursuits. I believe that movies are a good potential way to change hospital practice. I wrote one- that i can send you (for some reason it would not attach) I posted it on AMAZON.COM under Motherhood the movie. Have not found anyone interested in making it, but I continue to send it around hoping to find someone interested.
There is a big push for Consumer representation on hospital boards and committees here. Safer Care Victoria is collecting patient experience (altho' it's not yet reported upon) and Health Issues Centre has forums and training to enable consumers to step up to participate.
Yes, the lack of rigour in academic circles makes them aware of their vulnerability - indeed, the Journal of Accountability in Research has twice rejected a manuscript documenting the total absence of accountability in the Australian context. For different reasons each time! Seemingly transparency is to be reported upon in the abstract, not the empirical.
I've been accepted into a hospital Council (honorary), and can now hopefully use my insights for good.
The Victorian Auditor General has slammed hospital reporting of incidents, so the hard work of reform has overcome the first hurdle of creating awareness.
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