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.