Organising for impact

Organising for impact via Sign up to Safety

Campaigning, change programmes and safety interventions require organisation and organisers to create highly energised, but focused actions with specific goals and deadlines.

Sign up to Safety will use the snowflake model. This model shares leadership across the system and does not rely on authority or power, instead it is a web (or snowflake) of interdependent organisers and leaders who support others in becoming leaders (Ref: M Ganz).

For Ganz, this is the difference between leadership as a position, and leadership as a practice, it’s about accepting responsibility for enabling others to achieve purpose under conditions of uncertainty.

The campaign will have a central hub of organisers which are connected to four regional hubs, all of which will develop the relationships, motivate participation, strategise, and motivate people to act.   In order to create the unified feel to the English Patient Safety Programme the campaign community will connect the safety leads from participant sites together with the safety leads of the patient safety collaboratives.

The regional hubs will work alongside the AHSNs and be coordinated by the campaign and build a shared understanding of what we are trying to achieve with a sense of urgency, hope and solidarity that challenges feelings of inertia and apathy. We will empower people to take the responsibility to act. The campaign hubs will create the campaign community, bringing people together, building on current networks and creating new ones, guided towards a vision and goal for reducing avoidable harm by half and saving 6000 lives.

Sign up to Safety will use an innovative approach to creating an extended campaign team linked to the regional hubs. The London Olympics presented the concept of volunteering in a new light and showed just how much can be achieved by a group of committed individuals working towards a shared goal. With lessons from the Games Makers, the campaign will work with the NHS Care Makers, and NHS Change Day Hubbies to create safety volunteers as part of its virtual campaign team.

 

Designing a patient safety campaign

We have a name – Sign up to Safety

We have a website – http://www.england.nhs.uk/signuptosafety/about/

So where do you start.  What are the design principles for a national patient safety campaign?  With a clear goal of reducing harm and saving lives, each of these will be relevant:

  • Create the right culture
  • Ensure we represent the patient voice
  • Simplicity and focus on doing a few things well
  • Creating local ownership and accountability
  • Learn from and build on the past
  • Ensure a strong focus on effective measurement for improvement
  • Listen to staff on the frontline and build clinical engagement; gaining buy in so that all staff feel the initiative contributes and adds value towards their work
  • Align the safety work at all levels of the system so that staff understand how everything fits together and how everything can add value to each separate piece

Create the right culture:  Everyone in the NHS should all support a positive, open and fair (often referred to as ‘just’) culture rather than one of fear. By shining a light on successes we should aim to instil NHS staff with a sense of pride and joy in their work. An important aspect will be positive messaging, supported by powerful personal narratives of individual achievements that are designed to inspire people to act.

Ensure we represent the patient voice:  Meaningful engagement with patients and carers in relation to safety is hard to do. Patient safety improves when patients are more involved in their care and have more control. Patient involvement means more than simply engaging people in a discussions or getting ad hoc feedback about services. Patients and their carers will have ideas on how things can be improved and need to be given the space to share their ideas. The English Patient Safety Programme should build structures and processes to engage regularly and fully with patients and carers, to understand their perspectives on and contributions to patient safety. Patients should be involved in designing safer care and the measuring and monitoring of patient safety at organisational level and at a national level. As the Berwick reports states this will ‘require the system to learn and practice partnering with patients and to help patients acquire the skills to do so’. Organisations that join the campaign are asked to seek out the patient and carer voice as an essential asset in monitoring the safety and quality of care and to commit to developing a safety briefing for patients. This will be explored over the period of the campaign as to what the most effective mechanisms could be for patient briefing. For example patient videos can have significant potential to empower patients in the safety and quality of their care. However, it is important to note that efforts to implement patient safety films in practice need to consider different patient groups’ needs and characteristics rather than trying to adopt ‘a one size fits all’ approach. It is suggested therefore that participants think about the best way to do this in their organisation for their patients. This may be a video or it could be another mechanism such as a leaflet or face to face briefing on admission.  An example of a video launched just last week can be found at: http://www.youtube.com/watch?v=kQq-hkHomc4&feature=youtu.be

Simplicity and focus on doing a few things well:  Successful interventions focus everyone’s efforts on a few things, doing them well and fixing them before moving on. Organisations should create their own safety improvement plans which focus on a few things that matter to those who will be implementing them and their patients and should build on local priorities and current quality and safety plans. Where possible the topic themes derived from the personalised safety improvement plans (as part of the sign up to safety campaign) should feed into the safety collaboratives. Those that don’t will require separate networking and support.  One of the forthcoming blogs will focus on the creation of a safety improvement plan.

Creating local ownership and accountability:  Every person working in NHS-funded care has a duty to identify and help to reduce risks to the safety of patients, and to acquire the skills necessary to do so in relation to their own job, team and adjacent teams. Leaders of health care provider organisations, managers, and clinical leaders have a duty to provide the environment, resources and time to enable staff to acquire these skills. Campaigns need to understand local context, people, systems and processes. Teams should be supported by individuals with safety expertise who are based within the local context and who are also able to access external evidence and expertise. The campaign will support activity already happening locally and provide practical resources for teams to use structure their approach, providing complimentary materials for both improvement and local campaigning to help drive ownership of safety to the frontline.

Learn from and build on the past:  Over the last decade or so there have been a number of patient safety initiatives at scale. However, the impact of these has not been as much as was hoped by those that created them. Therefore we need to learn what worked and what didn’t work. We need to utilise the resources and materials that are the legacy of these initiatives and share them with pride rather than creating new ones. We need to create the foundations for a continuous learning culture across the NHS.

Ensure a strong focus on effective measurement for improvement:  Patient safety cannot be improved without active interrogation of information that is generated primarily for learning and improvement, not punishment. Information should include: the perspective of patients and their families; measures of harm; measures of the reliability of critical safety processes; information on practices that encourage the monitoring of safety on a day to day basis; on the capacity to anticipate safety problems; and on the capacity to respond and learn from safety information. Data on staff attitudes, awareness and feedback are important resources to gain insights into staff concerns.

Building clinical engagement: Listening to staff on the frontline provides a rich source of safety intelligence, especially those that move around the system frequently such as doctors in training. Building clinical engagement is vital; gaining buy in so that all staff feel the initiative contributes and adds value towards their work.  Safety improvement plans, the work of the Safety Fellows, the recommendations of the SAFE team and the Patient Safety Collaborative programmes need to describe changes that are relevant and needed; especially to clinicians and patients. The change needs to be better than the current situation with clear benefits, effective and evidence based interventions which have been demonstrated to have worked in the NHS. The plans need to be cost efficient and increase reliability. The changes should be easy to use and easy to adopt, possible to test on a small scale, and adapt to local conditions.

Alignment:  Part of my role is to align the safety work at all levels of the system so that staff understand how everything fits together and how everything can add value to each separate piece.   This is essential so that it is clear at the frontline what they all are, how they all fit together and what NHS staff are expected to do. Additionally system leaders; NHS England, Care Quality Commission, Monitor, Trust Development Authority, the NHS Litigation Authority and Health Education England should work together to put in place support for the NHS to achieve the shared goal.  A new group, the Strategy and Advisory Group, Chaired by Sir David Dalton, will align all the national patient safety initiatives and enable partnership working to ensure that each initiative adds value to the other. This strategic group will aim to support alignment of all patient safety initiatives including the campaign. It will:

  • Support a consistent approach across the NHS in England and facilitate open discussions and partnership working in relation to patient safety between the system leaders
  • Hear from the Chairs and Senior Responsible Officers for the relevant safety groups and initiatives

This is not a governance group as the programme initiatives are not ‘reporting’ to the Strategy and Advisory Group, but members of that group will commit to providing information and supporting both the overarching shared goal and the alignment of their efforts with all others.

A unified english patient safety ‘programme’

The NHS in England is a unified system with the ability to make systematic change on a national scale. However, it is also made up of a number of autonomous bodies in relation to patient safety, including national ones, with various responsibilities for provision, commissioning, assurance, leadership, regulation and supervision.  Following on from the outstanding Berwick Report into patient safety a number of patient safety initiatives have sprouted to support the commitment to making our care the safest in the world. This includes:

  • A national Patient Safety Collaboratives Programme
  • A national Safety Fellowship
  • Safety Action for England (SAFE)
  • A national patient safety campaign, Sign up to Safety

These initiatives are at various stages of development and delivery, will all have a variety of timescales and involve a range of partner organisations that vary between them in number and scope. There is clearly a need to align activity, coordinate outputs and ensure the many components are pulling in the same direction and deliver more than the sum of their parts.  The key unifying factor for the English Patient Safety Programme is the goal of reducing avoidable harm and saving. This should be the common and shared goal of the entire NHS in England; providers, commissioners, regulators, oversight bodies and the millions of people who work in it every day. There are a few things that can be done to support this shared goal and create a unified programme:

  1. Everyone play their part to create the conditions that support the reduction in avoidable harm and save  lives
  2. Everyone across the system works together towards this shared cause and sets out how they will support the shared goal to create the heart of the movement
  3. We all aggrees to work in synergy with each other, interact, interconnect and produce a result that is larger than each part simply added together
  4. Each new initiative should use and builds on each other’s strengths in a way that produces a greater gain
  5. We should all agree to share success and failure to create a learning culture for patient safety
  6. Leadership and coordination at all levels of the NHS should pull together to support implementation

So what are the different initiatives?

The national Patient Safety Collaboratives Programme:  The Patient Safety Collaboratives Programme is a new national network of 15 Patient Safety Collaboratives intended to be in place for at least five years. The Secretary of State described this as the engine room of the patient safety improvement throughout England. Each of the 15 Patient Safety Collaboratives will be led by an Academic Health Science Network to improve healthcare through better understanding of why certain healthcare interventions work in certain settings to deliver safe and reliable care. From hospital care to care in custody, and from local GP practices to mental health trusts, the collaboratives will address safety issues in every healthcare setting in a way we have never attempted before.  Healthcare providers and their partners across each healthcare economy will be supported to come together, identify their priorities for improvement, and devise and implement solutions in a collaborative approach that delivers real change. The Patient Safety Collaboratives Programme will be inclusive, bringing people from all settings together, working with patients and carers, along with front line staff and management, and patient safety academics. Put simply, participation in the Patient Safety Collaborative programme is a clear way for organisations to Sign up to Safety and support the aims of the campaign.

 The National Safety Fellowship:  The Safety Fellows initiative aims to recruit over the next five years, 5,000 individuals with safety expertise to create enduring ‘local change agents and experts; safety ambassadors, safety agitators, safety evangelists – a grassroots safety insurgency across England which will seek out harm, confront it and help to fix it’.   This initiative is being designed by and established with The Health Foundation.

Safety Action For England (SAFE):  This is an initiative that will be piloted in the NHS so support NHS providers with a small team consisting of patient safety experts with a proven track record in tackling unsafe care; people frontline staff will respect, listen to and work with. This team will provide fast, flexible and intensive support when significant safety problems are recognised by an organisation and they need assistance to get things right. They will support the aims of the English Patient Safety Programme by helping equip organisations with improvement and safety capability and the support needed to fully participate in the campaign and the collaboratives.

A national patient safety campaign – Sign up to Safety:   Sign up to Safety is a three year national patient safety campaign that aims to become the golden thread, the unifying force, that runs through the safety improvement activity of every provider of healthcare in England and which aligns the various initiatives underway. The vision for the campaign, and indeed the wider programme of work, is that the whole NHS will rise to the challenge and join. It is about more than the numbers of NHS organisations joining; the campaign will motivate participants to act. The campaign will support the movement to achieve demonstrable change no matter where the starting point is; shifting organisations from good to great. The central campaign organisers will reinforce local messages and energise individuals and teams, going beyond institutions to seek to sign as many individual staff in the NHS as possible to add to add to the movement. This will support and build with initiatives such as NHS Change Day and the Care Makers. Everyone that chooses to join will commit to the same shared goal: to reduce avoidable harm by a half and saving 6,000 lives nationally over the next three years.

 

Joyful

A friend asked me to sum up my new job on one word.  I said Joyful.  So I thought I would share some of that joy by doing a series of blogs to share what we are learning and how things are progressing from a single idea to a national campaign for England, Sign up to Safety; [http://www.england.nhs.uk/signuptosafety/about/] and then I will share over the course of the campaign the highs and lows and anything in between.   First … lets explore the skills needed to run a campaign.

Point 1. A particular set of life skills

People often ask me why I left my clinical career.  I have never looked at it like that.  My training as a general nurse – at St Thomas’ Hospital, my first bedroom was in a room that overlooked Big Ben, it doesnt get much better than that in terms of a room with a view!  and then in paediatrics and paediatric intensive care at Guys Hospital – where if we are going to talk about views, you should be on a night shift working in Guys Tower – astonishingly beautiful.  However I digress as it clearly was not just about views! It was about people.  The people I nursed and the people I nursed alongside.  The training and the following 15 years experience of caring for sick children provided me with confidence, skills, knowledge, leadership abilities and life experience which enabled me to try new things and move into a new world of clinical risk and then patient safety. I use my clinical knowledge and skills every single day.  I use the things I learned about how to lead a team, how to work effectively as part of a multidisciplinary team, how to challenge decisions and how to make them every single day.  I learned how to be adaptive, flexible, nimble, and resilient all of which are essential qualities for someone leading a campaign.

Point 2. Belief in the cause

So if these are the foundations, what else is needed?  If you are going to run a campaign you have to believe in it.  You have to believe that what you are doing is going to make a difference and that the cause you are campaigning about matters.  Most importantly, it matters to you.  So I believe that we need a new campaign for patient safety.  I have the privalege of going out and about across the country and meet student nurses, junior doctors, physiotherapy teams, consultants, Chief Executives and many many more.  And amongst the 1.3 million staff that work in the NHS there are still many who are unaware of the scale and nature of the problem and crucially that there are some wonderful [and evidence based] ways in which the problems can be addressed.  The problem is not one of lack of tools or interventions to make care safer, the problem is one of implementation.  I know this is said often and I myself keep going on about this subject but it is as simple as that. However, it isnt simple.  Implementation, requires all sorts of conditions and actions in which it becomes a success.  This will the the subject of a number of blogs over the coming months.

Point 3. Knowing your area well

Which brings me on to content knowledge.  If you are going to put yourself out there and lead something, then my view is that you should know your stuff. Inside and out.  You will be questioned by everyone; from patients, public, staff, media alike.  You need to know things about your cause, and if you dont then you need to know instantly where the questioner can get the information from.  You have to be someone that has crediblity and respect for those that are making the effort to join and take part.  That is earned by knowing your stuff.  In the case of a patient safety campaign like Sign up to Safety the following is the ‘knowledge specification’:

  • understanding of patient safety, how things can go wrong, when they go wrong, why they go wrong, the science behind it, human factors, reslience engineering, improvement methods, the concept of high reliability, the solutions to reducing risk and harm and the evidence behind them
  • how to measure, analyse and interpret patient safety information
  • understanding of behavioural change, instrinsic and extrinsic motivation, the adoption curve, psychology of change and the difference between different type of change and methodologies for addressing them
  • implementation science, the understanding of what it takes to put theory in to practice, to embed new ways of working and sustain it
  • the art of campaigning, the use of movements and movement principles, social marketing, social media and communication in multiple different ways for multiple different audiences

Next time around I will describe what the campaign is and how it fits with the other national patient safety initiatives in England.