Re-positioning won’t improve patient safety but cultural change supported by training, staff empowerment and quality infrastructure will
As speculation mounts that the Care Quality Commission (CQC) are to take on the patient safety role from NHS England many hope this move will provide a catalyst for improvement. However to my mind, when improvement is the goal, movement is not always the answer. Patient safety improvement is multi-faceted – dependent on more than one single governing factor. It will therefore take more than an organisational reshuffle, to improve services. However the new “Sign up to Safety” campaign is an encouraging sign that the significant cultural change needed may well be under way.
Cultural change is systematic and will not happen overnight, but it has to start somewhere – to be built from the bottom up if you like. And there is every indication that the new five step “Sign Up to Safety” campaign could be about to do for the NHS, what the culture of safety model has done for the aviation industry. Just like passengers on a plane, patients’ want to feel safe and secure that no new danger will come to them in hospital.And while life ultimately permits no absolute safety, patients’ need to both trust and be able to see that their safety is as important to their clinicians as it is to them, and to be able to see that there are processes in place to protect them wherever possible.
As with all the key measures of quality, understanding patient safety is vital if we are to improve it and health & social care quality over all. The most reliable way to achieve this is to monitor, measure and analyse each contributing factor. From here it is possible to see where and if each is meeting, exceeding – or in a lot of cases, not meeting expectations. Using this evidence into practice model makes it much easier to map a path to improve services and essentially do better.
Speaking of evidence, we only have to look at the recent contaminated baby food case and even the damning negligence revealed in the Saville Investigations, to see that patient safety is a growing public concern. And rightly so, as the results of the recent 2013 Inpatient and Staff survey showed that there is significant room for improvement. Some of the key issues revealed were that staff are overworked, under-supported, and not communicating with patients or each other as they should.
For patients to feel safe they need to not only be informed about their treatment, but included in the process. Doctors may know the best course of treatment for a patient, but patients themselves have an emotional knowledge and sense of self that a clinician could never understand – without speaking to them. Understanding the value of treating and listening to patients is vital to providing a quality patient experience, equally, transparency is key.
The NHS’s staff are its most valuable resource, so staff wellbeing and support are vital if patients are to receive optimum care, and to trust that no harm will come to them while in hospital. It stands to reason though that overworked, unwell, unsupported staff are not best placed to provide this. Add to that a perverse culture of the naming and shaming, and side-lining of “whistle blowers”, and we have sometimes found ourselves in a state where staff are too scared to speak up when they spot a mistake, or more worryingly to, admit to making one themselves.
Scapegoating or bullying a staff member for making a mistake, or raising the alarm, will not stop another event from happening in the future. But training staff and putting mechanisms in place that support safety procedures will. Astaff empowerment campaign, targeting everyone from the doctors to the junior nurses and cleaners, so that they are not afraid to speak up when a safety issue arises, will. And advocating strong staff-patient communication that ensures that patients are kept as informed about their treatment as they can be, will – providing the campaign is tackled collectively.
In each pledge to put patients first, continually learn, be honest, collaborate and support, Sign up to Safety not only acknowledges the need to tackle this adverse culture, but offers clear guidelines on improvement from the bottom to the top of the service. For the campaign to fulfil its purpose, and be adopted throughout the service, it will need to be supported by training with guidelines set for individual organisations and staff to adhere at all levels. Safety is as much for a cleaner or a cook as it is a clinician’s responsibility.
Patient safety is not a stand-alone issue, it affects and feeds into, amongst other issues; quality planning, commissioning and patient experience. Currently each of these strands is governed by a different organisation – creating significant boundaries that naturally restrict healthcare improvement. It would make more sense – and be much more productive, for them to work together, feeding in to key areas of governance and strategy,ensuring that all areas are covered, and that improvements can be made – instead of held back.
Add to that a quality infrastructure, that supports efficient, effective care delivery and the use of data collection to continually assess and understand patient experience – with a view to improvement, and you find yourself not only in a “safe hospital” or a culture of safety, but a culture of improvement. It is at this point that offering quality care to all patients goes from an aspirational goal to an achievable reality. We have known all this since the 1960s – now we must implement it!
Whether it is implementing a new policy measure or moving patient safety to a new agency there is simply no single factor that will create a culture of safety for healthcare. It will only come when we remove the boundaries view the issue as a collective concern, with a collective solution. I look forward to seeing “Sign up to Safety” in action, as the service tackles this issue head on.