Brave Clarice-healthcare serial killers, patterns, motives, and solutions

Healthcare serial killing involves the intentional killing of multiple patients by a healthcare professional. It is a formidable challenge to identify in the medical context, and a daunting legal task to prove beyond reasonable doubt. What can be done or remains to be done to intercept these serial killing events and help serve justice, while at the same time not risk dismantling public trust in the healthcare system? In light of several recent modern charges of murder against healthcare practitioners across the world, this review aims to report the themes, patterns, and motives of medical serial killers as well as highlight areas of work on both medical and legal fronts to help identify these events, and to most importantly protect the vulnerable patient community.

Clinical engagement: a new concept or common sense all round?

Clinical engagement has supplemented clinical governance in healthcare to strengthen the contribution of medical professionals to the assessment of clinical outcomes for patients. Assessments of clinical engagement have, until now, been qualitative; this case study introduces the concept of quantitative assessment of clinical engagement by measuring the number of patients managed according to specialist society guidelines. Such an assessment engages all staff (medical, nursing, allied health and pharmacy) involved in patients receiving treatment according to such guidelines and provides an assessment of individual and organisational compliance with those guidelines. Clinical engagement is then quantified as the percentage of patients that have been documented to receive specialist society- or college-approved guideline-compliant treatment, relative to the total number who could receive such treatment, in any healthcare organisation. What is known about the topic? Clinical engagement has emerged in recent years as a virtue to be encouraged in healthcare organisations because of its association with improved patient outcomes and employee satisfaction. Assessments have relied on repeated staff surveys in order to gauge engagement. What does this paper add? This paper proposes a novel means of measuring clinical engagement in an organisational setting. The vision put forward is that adherence to clinical guidelines in an organisation measures clinician engagement across professional disciplines. What are the implications for practitioners? The implications are that organisations will contribute to measuring the adherence of specialty groups of clinicians to guidelines that the clinicians select and use the data for individual and organisational accreditation.