Challenges and successes

The Sign up to Safety campaign team have been working with participants across the country. The challenges we have noticed include:

  • Challenges with metrics; there is no standardised way of recording or measuring harm and there is an over reliance on incident data
  • Confusion about the role of the patient safety collaboratives
  • A desire by some to be simply told what to do while at the same time a wish to move away from regulation, performance metrics and CQUINs
  • Some organisations are still really early in their journey and are even now only about to start developing their plans
  • Some organisations were dependent on getting the money from the NHS Litigation Authority and had to change their plans when unsuccessful – this caused some anxiety locally
  • A few organisations launched the campaign but workload increased and staff were not released to deliver the programme so have struggled since
  • Organisations have valued the ability to link all work streams together under the ‘heading’ of Sign up to Safety but not all have understood our easy this is and have unnecessarily created additional plans which duplicate or cross over existing plans
  • ‘Sign up’ has been on a steady increase each month since launch with nearly 300 organisations taking part but some only just starting.  Some organisations continue to sign up, for example 78 since January 2015, their campaigns’ first year started in 2015.  Organisations that continue to join (which means that for over 78 organisations their first year starts in 2015) will require the same level of support as those that started earlier
  • Preparation takes time – Signing up (completing the pledges and engaging the organisations senior leader or CEO to agree and sign the joining form) can take time with some organisations needing sign off from their Board.  So the process starts some months before they send in their sign up pack. Then once signed up they take on average between 3 and 6 months to develop their safety improvement plan as we ask them to review their last 3-5 years of data and seek feedback from their staff and patients in choosing what to work on for the next 3-5 years.  Therefore signing up in July 2015 could have meant planning started in January 2015 and their 3 year plan will not start until January 2016.

Positive aspects include:

  • Locally led – Delight that the campaign is trusting participants to develop locally led and locally driven safety improvement plans and relief that once written they could evolve. Also being asked to develop a 3 to five year plan, instead of an annual plan which is the norm, it has given people the permission and opportunity to think more longer term
  • Niche role – The campaign is filling a gap by focusing on cultural and behaviour change, helping implementation of locally led, self-directed safety improvement and in creating the coherent narrative for the front line.
  • Timing – There is a timely opportunity of the current changes at a national level of patient safety policy, strategy and infrastructure for the NHS in England with the campaign being a key method for shifting the emphasis away from focusing on one harm at a time.
  • Alignment – There is a strong desire for alignment, to create a more coherent approach and the campaign helps frontline organisations and staff to understand the different initiatives (patient safety collaboratives, the Q initiative and the buddying programme with Virginia Mason).  
  • Adaptability – The campaign team are kept purposefully small and nimble in order to support changes over time from raising awareness and engagement activity to energising and motivating activity (to keep people going) and to advancing knowledge and learning activity (to share what is working and progress).
  • Continuing to build the community – We have a strong community wand the channels and reach of the campaign is already considerable
  • Extending reach across primary care – CCGs have been mainly at a flat line in terms of sign up and a tiny handful of GPs only just came on board from April 2015 onwards.  Over the next year we have a fantastic opportunity to further engage primary care, care homes, GPs and other areas providing out of hospital care.
  • Implementation gap – It is as important to learn about implementation as it is to learn about improvement – i.e. learn about how as much as what they are doing – the campaign could continue with its unique approach to exploring the implementation gap between theory and practice.
  • Spread –  the campaign has an opportunity to share emerging lessons across the NHS at scale
  • Profile and trust – The campaign has built a trusted brand that is connected in a different way to participants than any of the other national organisations.
  • Skills and expertise – the campaigning, movement and communications skills and experience required for this are quite unique and niche – the current patient safety function does not have individuals with these
  • Evaluating impact – the campaign is exploring different ways to measure the difference we and others are making that does not create an additional reporting burden