Research, risk and patient safety: making decisions under uncertainty
Dr Jenny Rivers, Director of Research & Development, Barts Health NHS Trust
4 minutes
Dr Kamran Abbasi, Dr Jenny Rivers, Professor Sir Chris Whitty, and Professor Sir Andrew Morris
In a recent joint lecture with The BMJ, Professor Sir Chris Whitty FMedSci explored risk, uncertainty and medical decision-making. He argued that the rapid transformation of medical science demands significant changes in how the medical profession works and how we prepare health professionals to hold risk.
Below, Dr Jenny Rivers, Director of Research & Development, Barts Health NHS Trust and FLIER Cohort 3, shares her reflections on the lecture:
One of the ideas that stayed with me from Professor Sir Chris Whitty’s lecture on risk, uncertainty and medical decision-making was the concept of ‘holding risk’.
Holding risk
Medicine requires us to make decisions with incomplete information. We cannot always wait for certainty: there are risks in acting, but there can be equally significant risks in not acting.
Chris’s lecture prompted me to think about what it means to hold that risk, not only as an individual clinician, but as a leader within a complex health and care system. How do we make good decisions when there is no risk-free option? How do we explain uncertainty honestly? And how do we create the trust needed to act?
I was particularly struck by Chris’s reflections on how increasing knowledge does not necessarily make these decisions simpler. More evidence, new diagnostics and technologies such as AI can give us greater insight, but they can also introduce new complexity. We need to equip people not simply with technical knowledge, but with the ability to make good judgements in the face of uncertainty.
Research as a way of managing uncertainty safely
This led me to think about the role of research.
We often describe research as a way of reducing uncertainty; generating better evidence so that clinicians, patients and health systems can make better decisions. But research also gives us a rigorous way of managing uncertainty safely.
Good research does not look away from risk, it makes it explicit. We define the question, scrutinise the evidence, put governance and safeguards around what we do, monitor what happens to patients, and learn and adapt as the evidence changes.
Chris Whitty speaking at a lecture on risk.
Research doesn’t remove risk. It gives us a disciplined way to understand it, manage it and learn from it.
For me, that connects research directly to patient safety, quality and assurance. It is also why I feel so strongly about embedding research into everyday clinical care.
At Barts Health, our ambition is for research to be a core component of clinical care, considered alongside diagnosis and treatment, rather than something that sits separately from them. A research-active healthcare system is not simply one that runs more studies. It is one that continually asks questions of itself, tests assumptions, generates evidence and uses what it learns to improve care.
From research leadership to systems leadership
My experience of the Academy of Medical Sciences’ FLIER programme has made me think differently about this too.
I came into FLIER thinking a great deal about how to become a better leader of research. What the programme has increasingly encouraged me to think about is something broader: how research can create value across the whole health and care system.
Find out more about our FLIER programme
Holding risk at that level cannot mean carrying it alone. Complex systems require us to bring together different perspectives, to create space for challenge, to be willing to say “I don’t know”, and to remain curious about what, and who, we might be missing. Then, ultimately, we still have to take responsibility for acting and be prepared to change course as we learn.
For me, this is an important part of systems leadership. The value of research is not only in the number of studies we deliver or participants we recruit. It is in what research enables across the system: better outcomes, safer and higher-quality care, innovation, workforce development, greater equity and a culture of continual learning. This wider concept of system value is also central to our research strategy at Barts Health.
A truly research-active health and care system will never be a system without uncertainty. But it can be a system that knows how to manage uncertainty, learn from it and continually turn that learning into safer and better care.
I’m very grateful to Professor Sir Chris Whitty for such a thoughtful and thought-provoking lecture, and particularly for giving me a new lens through which to think about some of the questions I encounter in my own work. I’m also grateful to the Academy of Medical Sciences and The BMJ for the opportunity not only to contribute to the evening, but to stop and reflect on how the ideas Chris explored connect with my own leadership journey through FLIER and with our ambitions for research in the NHS and beyond.
I left, appropriately, with more questions than answers, which is probably the sign of a very good lecture.