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.