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Jeanne Hardacre, Senior Associate, HSMC
Since patient safety was propelled to the top of the NHS agenda with the Berwick and Keogh reviews last year, healthcare organisations have had good reason to re-evaluate how confident they are about the safety of care and treatment experienced by patients.
Yet the simplicity of the mantra Patient Safety First belies the complexity of the myriad clinical choices, professional judgments, critical decisions, team dynamics, financial implications and in some cases, personal risk at play in each and every patient interaction within our health and social care system.
What strategies are available to leaders wishing to embed patient safety into all that they and their colleagues do?
Boiling down this multi-faceted question to its essence, there is a key technical challenge and a central cultural challenge in leading safer NHS organisations. As with so many aspects of leadership, these are interdependent and intertwined; one without the other has the potential to fly of a bird with clipped wings and the potential to dissect less than that of a blunted blade.
The technical aspect is where many leadership teams have focused much of their attention. This includes enhancing their data literacy about safety-related issues, learning to measure and monitor safety, both retrospectively and - increasingly - by proactively identifying areas of potential harm within patient pathways, and candidly articulating these in what has become known as a Safety Case (as opposed to a Business Case).
Along with understanding and applying methods from improvement science to identify and address problems, this technical aspect of leading patient safety takes incisive scrutiny, the detailed understanding of clinical processes and the ability to measure improvement into previously uncharted territory.
Yet, armed with data and diagnostics, a solutions-focused approach to ‘solve’ a patient safety issue from a technical perspective can easily end up hitting the target and missing the point. Without meaningful work on the cultural dimensions of patient safety, a technical fix may improve the visible symptoms but will overlook the complex underlying causes.
In a professionalised and often silo-based system, it can seem to many that ‘if I do my best’ then that’s a job well done. But keeping patients safe from harm is a collective endeavour, linked less to individual professional standards (which are generally high) and associated much more with what joins healthcare teams together; the climate, the culture and a clearly articulated shared sense of purpose.
That trips off the tongue so easily!
How much shared purpose around patient safety is there between an Executive Team undertaking a quarterly review of incidents and a junior doctor observing worrying patterns of patients falling? Or a nurse noticing unfamiliar dosages when doing the drugs round? It is likely they all see the issue from their own – by definition limited – perspective. Yet whatever our role, the anxiety, the worry and the sleepless nights which can accompany patient safety concerns are part of our common human connection with why our work in the NHS matters.
The breakthroughs come when we can see patient safety not just from our own perspective, but from that of others – of our colleagues, our team members, our managers and, crucially, of patients themselves. This requires the opposite of a solutions-focused approach. It needs inquiry. A deep, curious thirst to understand how we all – in our work together – enhance or hinder the safety of the people we care for.
By enabling a culture which encourages this thirst for inquiry, leaders can make a huge impact on making treatment and care safer.
A culture where we do not assume we know the problem’s cause before we inquire into it, where any concern regarding patient safety is a valid one, where we accept that we may need to change our practice, where we talk about why this matters and we openly discuss how difficult this can be. And where openness and approachability replace reticence, defensiveness and fear.
For a chief executive, a lead consultant, a care home manager or a housekeeping supervisor, leading the cultural dimensions of patient safety will underpin the success of those critical technical and process improvements. Where organisations and teams achieve this balance in their patient safety work, the blade will dissect with unprecedented precision and the bird will fly to places as yet undiscovered.