Improving Patient Safety: new horizons, new perspectives

With the festive season approaching and 2019 drawing to a close, now is a nice time to look at how the professions can celebrate their successes through the prism of quality improvement, and consider some resolutions related to our mental wellbeing to take into the new year. 

The following insights were taken from the ‘Improving Patient Safety: new horizons, new perspectives’ conference in October.

Hosted by The Improvement Academy and the NIHR Yorkshire and Humber Patient Safety Translational Research Centre based at the Bradford Institute for Health Research, the ‘Improving Patient Safety’ conference drew together patient safety advocates with the aim of ‘sharing knowledge and creating a new vision, for patient safety research and practice’. As part of the two-day meeting, the organisers also invited staff from other professions – including veterinary medicine – to compare and contrast approaches and interventions for promoting safety.

Workshops covered a range of contemporary challenges but there were also talks designed to inspire, from the likes of Philip Lewer and Suzette Woodward.

Philip, Chairman of Calderdale and Huddersfield NHS Foundation Trust, asked his audience to consider the importance of taking time to get to know staff better – not only to drive engagement but also as a way to learn more about the clinics or hospitals they lead. After all, learning is at the heart of quality improvement. And brandishing a humble – and I should say very clean-looking – sock, he made his next point effectively: if two people independently find a lonely-looking foot warmer, their conundrums will only be solved if they actually communicate with one another.

Suzette, a Senior Advisor for the Department of Health and Social Care, meanwhile gave an impassioned speech about the potential benefits and pitfalls of patient safety initiatives, including the need to think carefully about the language we use when planning improvement strategies.

Introducing the concept of the ‘complex adaptive system’ – a good example would be a GP surgery – she explained that a combination of undesirable and wholly unforeseeable events can conspire to impact patient care despite the very best efforts of everyone involved. Crucially, this means that, in contrast to nuclear power plants, where contingencies can be designed for almost every scenario, there will always be medical safety incidents, even in the best-run practices. In the NHS, the fact that so-called ‘never events’ still occur is evidence of this phenomenon.

A related theme of her talk was the fascinating subject of ‘Safety II’. Safety II describes the investigation of how and why care so often goes well, even when the trip-wire of unpredictability is ever-present and potentially calamitous. Mirroring Philip’s eulogy, Suzette championed staff. People, she explained, are continually accounting for unforeseen events, adjusting to them, and ensuring high standards are maintained, despite sometimes chaotic circumstances. They are the origin of the unpublicised successes that occur quietly in care up and down the country, day after day.

In conclusion, she argued we need to be careful about the language we use when wanting to ‘improve’. Such terms can suggest we might iron out many of the mistakes that people make, but the terminology fails to recognise their remarkable ability to adapt and still achieve when the odds are conspiring against them. Finally, she mentioned, therefore, how important it is that we treat people with respect and civility. For a thought-provoking video on the topic of incivility, I would recommend ‘Make or Break: Incivility in the Workplace’, produced by Epsom and St Helier University Hospitals NHS Trust: https://www.youtube.com/watch?v=S1EDatTYMkE.

In a subsequent session on second victims, delegates discussed the effects of medical errors and near-misses on the clinicians involved. Errors can induce feelings that many of us may be familiar with: guilt, shame, anxiety, as well as a loss of confidence. A useful website designed for doctors and nurses may be highly relevant to veterinary professionals: https://secondvictim.co.uk/. This resource is for second victims and those responsible for or interested in their wellbeing.

On a related topic, Judith Johnson presented research on burnout. There is now robust evidence suggesting a link between burnout and:

• reduced empathy
• an increase in inappropriate referrals
• poor decision-making.

These cognitive effects apparently lead to twice the average number of patient safety incidents, and two times the risk of having dissatisfied clients amongst those affected. The financial costs are still largely opaque, however. Perhaps unsurprisingly, there is also evidence of the relationship between the number of patients seen in a day and the risk of burnout – a potentially thorny topic for our time-poor and resource-strapped industry. But on a more positive note, the same research reported a link between appropriate and timely emotional support and reduced burnout.

Later in the day, an inter-disciplinary workshop co-hosted by Jane Heyhoe, Ruth Simms-Ellis, Gillian Janes and Gemma Louch, focused on the subject of ‘wellbeing for safety’ and how different professions address work-related threats to wellbeing to enable front-line staff to maintain effective standards for service users. Representatives from healthcare, the police service, the fire service, offshore navigation and the veterinary professions, discussed their experiences, and we were all given an effective summary of the three areas to focus on when considering staff wellbeing in hazardous industries.

It is called the stress management model:

Finally, a poster session highlighted the broad nature of research currently underway into patient safety, both in the human and veterinary arenas. Elly Russell presented a summary of her research to date into communication behaviour in the veterinary professions. An initiative at the Leeds Teaching Hospitals NHS Trust also caught my eye: recognising the need to improve morale in junior doctors. A group there has, amongst other things, started an annual Junior Doctor Awards event. Sounds like a good idea, and another example of an exciting project on a day that really did feel like it was creating a new vision for patient safety.

Mark Turner is a small animal veterinary surgeon, with a particular interest in patient safety and quality improvement. He holds a Masters from the Royal Veterinary College in Patient Safety Culture. 

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