“The task is, not so much to see what no one has yet seen; but to think what nobody has yet thought, about that which everybody sees”
Erwin Schrodinger (1952)
Sign up to Safety is a national campaign focused on helping people work safely. We are part of a number of patient safety initiatives across the NHS in England. We started with a very broad mission of helping the NHS reduce avoidable harm and save lives as a result. Over the last three years we have evolved into something quite different.
Who are we? We are a small group of people who have differing experiences and expertise in subjects like nursing, patient safety, campaigning, social movements, digital media and communication.
We started with 12 organisations (members) and have grown to pretty much the whole of the NHS in England – at the time of the blog we have nearly 480 member organisations. Our emerging approach is based on the latest thinking on patient safety together with our learning from the last three years working within the NHS helping people think about what they can do to work safely in a somewhat complex and often chaotic environment.
We started fairly traditionally, by asking people to analyse their patient safety data and talk to their staff and patients, to create a vision for what they wanted for their organisation and then to create and implement a 3-5 year safety improvement plan.
What we saw and what we heard changed our thinking and approach. We saw how leaders were grappling with the dilemma of directing how things should go versus enabling staff to organise themselves. This requires a careful balance. Too little organising and there is chaos, too much and people feel you are back to telling people what to do.
Over the last three years we have listened and heard how staff wanted to be valued, respected and trusted to do the right thing. We have met people who are increasingly confused and conflicted by being told what to do and they are fatigued by the current approach to change.
We have seen new interventions, ‘catchy’ names for local initiatives which are different from the ‘catchy’ name of the same thing down the road and old methods dressed up as new methods. We have seen them being imposed on busy staff who shuffle from one intervention to the other without knowing quite why they are being asked to do it.
So we chose not to add to the current ‘top down’ list of interventions and trusted organisations to develop their own plans and to work on things that matter to them. We wanted to give people the freedom to best exercise their own expertise and knowledge. Our philosophy is that the campaign belongs to everyone who has joined so instead of ‘one’ campaign we are 480 campaigns.
However this was not our main concern. Interventions will always come and go. Essentially a lot of them are all the same just dressed up differently. No, our main concern was what people were telling us about how they felt. How they struggled to develop relationships, they struggled to speak up and they struggled to be heard.
Healthcare is always about relationships and those relationships are completely dependent upon people being able to talk to each other. So we wanted to restore the balance, provide real support and help people with the vital skills in communication and cooperation they lacked. We also wanted to do it with kindness.
We help by providing ideas, insights, and positive encouragement via our website and newsletter. We conduct extensive research on all aspects of patient safety and share other people’s ideas, opinions, and knowledge. We then go round the country talking and listening to lots of different people who work in healthcare, helping them through coaching and connections to think about what they could do differently. We have found that people react really positively to our thinking; we hope the same will be true for you.
What can we all do differently?
- Help people create the right environment so that people can feel safe to talk to one another
- Provide people with the opportunity of talking to one another and practice the skills needed for a good conversation
- Help people think about their purpose, goals with a long term mind-set
- Role model positivity, kindness curiosity and humility
- Mobilise people to act and help them flourish and shine
- Promote a form of ‘distributed leadership’ and a way of working which avoids the fragility and narrowness of relying on a central team or a single person who holds all authority
- Encourage people to trust their teams, to start to decentralise structures and decision making, to recognise that different people contribute different strengths
- Help people recognise what their staff are doing and thank them for what they do
- Use stories to create an emotional link to the shared purpose and values
- Adeptly use tone and language to make information more understandable, making emotional connections, telling stories of hope
We leave the other ‘tools of change’ to those responsible for quality improvement, performance management, inspection, contracts, targets and incentive schemes. The last thing we need to do is duplicate what these organisations and people are already doing but instead we chose to add value and find the gaps that are not being addressed.
What is our shared purpose or common cause?
Helping people work safely is clearly the topic but we have narrowed this down to safety culture and then narrowed it down even further to how people talk to each other.
We believe that in order to grow a safety culture people need to be able to talk to each other freely and without judgement. To some extent this is a profoundly simple solution; engaging in conversations where people are willing and able to share their stories and people are willing and able to listen carefully to one another.
That is our call for action; talk to each other.