Written by Sarah Williams RGN MBA BSC ILM

When I took on the role at LivingCare as the Director of Patient Safety and Clinical Effectiveness my role was made that little bit easier by the dedicated hard-working teams that I had around me. Safety Culture has always been something that has been regarded as high priority for all teams within LivingCare and this has been represented within our core values:

However, there are still improvements that can be made to any team, and I was pleased to see that last week the NHS launched its practical guide to Improving patient safety culture. This is a topic that here at LivingCare we take very seriously, and we have already invested lots of time in getting this right and having a culture that promotes patient safety at its core.

Dr Matt Hill (National Clinical Advisor, NHS England) in his foreword stated ‘Safety culture can appear nebulous, and it can be unclear how to improve it or indeed how the shift occurs. This has led to a broad number of approaches which are associated with improvements in safety culture but are not always successful when they are used in similar or different contexts. In considering the safety culture of where we work, we often separate out ‘what’ work we do from ‘how’ we work. This can lead to a disconnect and lead to ‘how’ we work not transferring into the ‘what’ we do.

By considering the ‘what’ and the ‘how’ as two intertwined threads where each is necessary to provide a strong team, we can see that unless we give them equal attention the overall strength of it will weaken.’

In 2008 a ‘pragmatic and measurable approach’ to high quality healthcare was introduced to the healthcare sector with the publication of High-Quality care for all (Darzi 2008) The report described quality using the three domains of effectiveness, safety, and patient experience, this definition was then later transcribed into Law when the Health and Social Care Act (2012) was introduced.

Over the last 10 years there have been published public reports regarding patient safety incidents in the UK including the Keogh review (Keogh 2013), the Francis report (Francis 2013), and more recently the Ockenden (2022) report all of which show failings and lack of learnings internally within NHS hospital Trusts. There have also been reviews that were ordered detailing failings across independent healthcare sector providers such as the Paterson inquiry (James 2020). So why is it that despite all the incidents reported and the plethora of information that staff and leaders could learn from the healthcare sector keep repeating similar mistakes? 

In 2019 the National Health Service (NHS) in the UK introduced the Patient Safety Strategy (NHS England, July 2019) and the concept of a Patient Safety Specialist role to ensure that there was collective intent across organisations to improve Patient Safety by learning from events, driving safe effective care and have robust governance.  The introduction of practical guide to Improving patient safety culture toolkit is now adding to this and giving Healthcare staff a ‘menu of ingredients and a toolbox to help the reader create a personalised strategy’ (Professor Suzette Woodward.)

The focus areas within the document are:

1. Teamwork and communication
2. Just and restorative culture
3. Psychological safety
4. Promoting diversity and inclusive behaviours
5. Civility

Teamwork within LivingCare is something that I am very proud of, and I am proud that we have an active Freedom to speak up group lead by our Guardian (Numesh Mulliah) and we encourage all team members to speak up and our leadership team to listen up.

We start every morning with a safety huddle to ensure that all staff no matter what their role are aware of what is the plan for the day. We use the SBAR communication tool for communication of safety-critical information. We utilise the WHO checklist for all higher risk procedures and ensure that the whole team are happy to proceed before any procedure is started.

As Director of Patient Safety and Clinical Effectiveness it is my role to ensure that we have a positive safety culture. I am proud that for the last three years our complaints and incident rate within all our teams has been <1%.

In our recent patient safety survey (Jan 2023) the leaders within our organisation articulated well the processes that occurred ‘behind the scenes’ that enabled the teams to work in a safe environment and to ensure the patients are seen in a safe environment. They stated that they would recommend friends and family to come to our organisation for their treatment. ‘I would be very happy for my family to be seen here; in fact, they have been multiple times. I am proud of what we do here.’ (Donna McDonald – Head of Patient Experience)

Post running our survey, we came up with our own internal definition of what patient safety meant to us:

‘Patient safety to us is to provide an environment that is free from intentional physical and psychological harm. We are an organisation that listens to our staff and patients to ensure we provide a safe, caring, and effective environment that delivers high quality healthcare for all’.

(Senior Leadership Team - LivingCare 2023)

I personally am constantly reading and learning about safety culture and how I can improve myself and how our teams can also improve. Recent reading includes the work of Matthew Syed – Black box thinking and Niall Downey – Oops! Why things go wrong.

We promote civility in the workplace and understand how incivility can lead to our teams not performing at their best. ‘Civil work environments matter because they reduce errors, reduce stress and foster excellence’ Dr Chris Turner – Civility Saves lives.

We will continue to support each other at LivingCare, to enable us to have an excellent place to work for all our teams and ultimately provide safe and effective care to all our patients.

Sarah Williams

Director of Patient Safety and

Clinical Effectiveness

References:

Darzi, A. (2008) High Quality Care for all. Department of Health.

Downey,N. (2023) Oops! When things go wrong. Liffey Press.

Francis, R (2013). Report into the Mid Staffordshire NHS Foundation Trust Public Inquiry. The Stationary Office. London    

Hill.M. (2023) Page 1. NHS England » Improving patient safety culture – a practical guide

Keogh, B. (2013). Should the NHS work at weekends as it does in the week? Yes. BMJ, 346. 

NHS (2021) https://www.england.nhs.uk/patient-safety/the-nhs-patient-safety-strategy/

NHS (2023) NHS England » Improving patient safety culture – a practical guide

Ockenden, F. (2022). Findings, conclusions, and essential actions From the Independent review of maternity services at The Shrewsbury and Telford Hospital NHS Trust. House of Commons. London

Syed, M. (2015). Black box thinking: why most people never learn from Their mistakes--But some Do. Penguin.

Tuner, C. (Accessed 2023). https://www.civilitysaveslives.com/

Woodward.S. (2023) Page 1. NHS England » Improving patient safety culture – a practical guide