My mum and I spent a small fortune one year in buying online what we considered were the most beautiful plants for her garden.  They arrived tiny and frail but full of promise, we had even proudly drawn up a garden design for where they would go in the particular border we wanted to improve.

We dug and fertilised the ground they were going to be planted in and went for it.  The result was mixed to say the least, some died, some grew in a way we had not planned, one or two dominated over the others nearby so that they could not flourish and most did not quite match the ‘description’ in terms of height, width or even colour.

The people working in safety today and on initiatives to address individual aspects of safety are simply trying to do that; improve their particular area and planting the seeds of change, new ideas, innovations or improvements.  Their intent is for their initiatives to flourish and grow and as a result healthcare will get a little safer each day as they succeed.  However they too will experience the gap between what they expected and what actually happened.

There are significant advantages in working in patient safety for so long.  You can see history attempt to repeat itself, ‘new’ ideas you know are in fact ‘old’ ideas and you witness the same energy and enthusiasm by people who really really want to make a difference (this time).  With the benefit of time and a little bit of wisdom you start to realise that unless the foundations, the ‘ground’, the conditions are addressed all of our ideas and initiatives will ultimately fail.  The energy and enthusiasm gets sapped and people move on and others move in.

Throughout the people who are just trying to get through their day are doing just that, getting through their day with the occasional ‘interruption’ of a new idea or intervention that claims to make their day safer.  In the meantime their day is full of pressure, stress, lack of people, lack of time, difficult dilemmas and decisions, limited resources, workarounds of unworkable policies and initiatives, incivility and even bullying.

It is no wonder that there are a few people who are starting to ask whether we could do something different. However, even these may be in danger of being considered the latest ‘new idea’ or fad; Safety II, Learning from Excellence, Just Culture.  But the fundamental difference is these ‘ideas’ are about rebooting our approach to safety – creating the right conditions that help people work together, help people learn about what they do to keep people safer now rather than about how they fail, what they can replicate not just what they could do differently, address the factors that cause people to struggle, help them with the difficult decisions and move away from the blame and shame culture.  All this needs kindness and compassion.  These are the things we should be putting all our energy and enthusiasm into.

This needs some bold people to say enough is enough.  Can we sort out the day to day stuff, can we sort out the way we behave towards each other, the way in which we grow and nurture team working and a psychologically safe environment.  Can we stop the relentless focus on the negative and the failures and show gratitude for the achievements.  People thrive in an environment where they feel valued and cared for.  they thrive in an environment that is fun, fills them with laughter and joy.  They thrive when they can enjoy the people they work alongside.  This is what will help them work safely.  It’s as simple as that.


  1. Dear Suzette                       I enjoyed reading this and I would like to reproduce it in the newsletter I edit for the Association of Clinical Pathologists.I’ll be happy to give you more information about our association or newsletter should be interested. Best wishes Dr Eric Watts

  2. Thank you so much Maria – I completely agree how utterly complex it is across boundaries – we are so far from addressing this issue. I do hope that you and your friend are recovering – we need people like you in the system. I often wonder if when I talk about simplicity that people don’t quite understand that simplicity is not the easy way out – it is perhaps the most difficult. It just feels the right thing to do. Take care xx

  3. Suzette It’s not often I respond or reply to posts but an element of what you write resonated with me. Like you having worked in and around patient safety for 20 years+ one sees initiatives, ideas and fashions come and go, and then repeat. I also agree there has been an over focus on reactive approaches to safety improvement at the detriment to more proactive and uplifting activities. Hopefully the new strategy will help address that alongside the awaited PSIRF. I agree the basic principles of good team working, caring, watching each other’s back, not being fearful of ‘shouting out’, not showing a blind eye to shortcuts remain as relevant to safety today as they did in the early 1990’s when ‘patient safety’ began to emerge as a discipline, and before. Through 2019 I was a patient during a prolonged period of ill health and also a carer and advocate for a friend having major life saving surgery. My personal experience of NHS care was mostly excellent and at several locations nationally. My friend – also. But there were notable safety gaps, that were avoidable and introduced significant risk. The biggest risk was when clinical management for my friend crossed the boundaries of 3 different NHS Trusts – that was a nightmare that I ended up having to manage in the interests of safety. What was lacking – a communication plan between the three providers, named contact points in each location and basic coordination. Nothing clever. Nothing costly. Safety enhancement in my experience is often achieved by actions that cost little, but deliver an uplifting safety punch. Sadly it is my experience both in the above, and also in my work as an NHS reviewer of sad outcome incidents, that the pace of NHS work means that simple interventions can feel impossible to achieve, and/or get forgotten/lost sight of. So your post about simplicity struck a chord.

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