Carl Horsley wrote on twitter just the other day…

It’s not about Safety II or even safety, really. It’s bigger than that. It’s about how we work. And it touches on leadership, teams, quality, safety, staff and patient experience.


Over the last five years a small group of us have had the privilege of working on the Sign up to Safety campaign.

Previous campaigns had focused on disseminating interventions related to individual area of harm. In fact we were initially charged with reducing harm by 50% and saving 6000 lives. Interestingly these figures have been bought to life again in the latest national patient safety strategy.

We were adamant that a focus on reducing harm was not the way to go. Our collective experiences in patient safety had taught us that things needed to be done differently.

Our curiosity led us to study psychology, behavioural insights, complexity theory, safety theory, just culture, human factors, safety II and more. We have shared this learning over the last five years on our website, in presentations and in this blog.

Our first realisation was that relationships and how people talk to and listen to each other was at the heart of creating a safety system and culture.

This led us to encourage conversations within and across teams. We called them ‘kitchen tables’ to bring to mind the times people sit round a table and share their day.

We encouraged conversations with respect, humility, curiosity, kindness, and civility.

However over the last two years it has felt like there was something missing, something just over the horizon but we couldn’t yet see it.

This view has just recently become clearer and clearer as we and others have grown in the understanding about really what safety is.

That it is clearly about learning about success as much as failure but so much more.

Our second realisation was that there is an undeniable link between staff health and wellbeing and safety.

For us staff health and wellbeing is not just that they are physically or psychologically cared for or that their basic physical needs are met such as food, hydration and sleep. Staff health and wellbeing is dependent upon the way they are led, the way they are trusted and supported especially when things don’t go as planned.

Staff health and wellbeing is also dependent upon the way people behave towards each other, the way they are kind to each other. It also means building a positive workplace; increasing morale and enjoyment at work.

What is thrilling is that there is not only an evidence base behind all of this thinking but that there is a growing group of people who are coming to the same conclusion.

Patient Safety will be enhanced if we care for the people that care – help staff with their everyday.

Help people work well, be the best they can be, learn, perform, and work together across the different professions and boundaries.

In fact it’s not just about patient safety, as Carl says … it’s bigger than that. Which comes to our third realisation .. thank you Carl.

It is about how we work.

It’s everything.

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