The Patient Safety Leader of the Future

Patient safety made headlines at the recent Patient Safety Learning Conference when Professor Ted Baker (Chief Inspector of Hospital for the CQC) declared that there has been “little progress' for NHS patient safety over past 20 years”.

Such an assessment feels overly harsh, but in the context of the Mid Staffordshire incident and the more recent events in Liverpool, it is clear that sometimes hospitals do fail to protect the patients they are caring for.

When Aidan Fowler, NHS National Director of Patient Safety, called for “Directors of Patient Safety” to be appointed in every NHS organisation it was a positive move towards reducing the variation in patient safety across the country. And if the enthusiasm at the recent Patient Safety Learning Conference is anything to go by, then we may soon be able to reach that goal.

One of the interesting discussions at the conference was what do these future directors of patient safety look like? What are the skills and attributes that they will possess? Professor Ted Baker pinpointed three key areas, but what would these look like in practice?

The first identified attribute was that a leader of patient safety should be “humble”. A true leader must be able to reflect on when they are wrong.

Based on some misplaced Machiavellian leaderships beliefs, we've often trained leaders to feel like they have to be infallible. However the art of a true leader is actually someone who can reflect and take accountability for their mistakes.

In healthcare there is no room for cover-ups, the stakes are too high. We need a leader who can put their hands up when things are not safe, and be an advocate for the patients that they are working to protect.

Often when things have gone wrong, it's because organisations have failed to be transparent about the problems that they are facing. The leaders of patient safety must be able to be a torchbearer of safety and be humble enough to admit when the right standards are not being met.

The second element of a good leader for patient safety is “strong values”.

To be a real leader and an advocate for patients they must truly believe in the values of NHS organisations. They must be genuine and believe that the values are there to be upheld. Too often leaders pay mere lip service to values and fail to exhibit the right behaviours.

We see examples of bad behaviour in the workplace but too often they are left unchallenged. A patient safety leader must act with integrity and be prepared to challenge individuals when their behaviours fail to live up to the organisation’s values.

The final attribute of a good patient safety leader is one that works “collaboratively”.

Healthcare works at its best when it utilises the skill sets of all its staff. Only through a multi-disciplinary approach can we hope to keep our patients safe.

The best knowledge is gleaned from a wide range of staff, and patients are kept at their safest when teams work together. Therefore, a patient safety leader of the future would need to be collaborative and able to engage a wide range of expert clinicians.

Only then can we learn to share our mistakes and improve the care we deliver so that every patient gets the standard of treatment they deserve.

Not all people will be able to stay humble, value focused and collaborative whilst delivering patient safety to an organisation. We must be able to have the right conversations with patients to ensure that they are able to make informed decisions to keep themselves safe in our care.

Only through patient engagement can we get the full picture and make care safer in the NHS.

Patient safety is a discipline in its own right and we must not assume all healthcare staff possess the knowledge and skill sets to be leaders in the field.

Patient safety is complex, it is multifaceted, and it cannot be done by one person alone. We must work to train more staff in patient safety so that all healthcare professionals can see its value and the impact that poor patient safety has.

We must all work to be patient safety leaders of the future and work openly and collaboratively to learn from our mistakes.

Oh I Do Like to be Beside the Bedside...

My holidays are here and it's time to dust off the suitcase and drag out the shorts from the bottom drawer. Like many British households it's time to jump in the car, fire up the Sat Nav and race to the nearest seaside resort. What we are presented with is over fifty different options to get to our destination. Dodge the tolls, keep off the "B" roads and swerve past the annual village fête. The same is true for the guidance on falls prevention. There are multiple interventions to apply to patients to reduce falls with harm but difficult to know what direction to take. So what advice should we all be following?

The latest Cochrane review on "Interventions for preventing falls in older people" tells us that there is a vast sea of uncertainty around interventions for falls. The report found that there was uncertainty around the effect of additional physiotherapy, questions around the effect of bed sensor alarms and that multifactorial interventions may reduce rate of falls, but it was difficult to say whether this had an impact on the risk of falling. I'm more certain that it will be a sunny day in Britain in June than researchers are on the evidence for the prevention of falls.

So then what is there left to do? Well, falls represent a huge cost to NHS hospitals and the wider healthcare system, with annual total costs to the NHS alone from falls among older people estimated by the National Institute for Health and Care Excellence (NICE) at £2.3 billion. Falls can cause physical harm to patients resulting in prolonged hospital stays, complaints and sometimes litigation but can also cause psychological distress with patients fearing further falls. Clearly action needs to be taken and in Scotland they have just launched a new consultation paper looking at the "Falls and Fracture Prevention Strategy for Scotland". And whilst it is useful to reflect on national policies and plan strategies for the upcoming years we need to be careful how this translates into the day to to day working on an NHS ward. If the evidence is saying that there is a giant question mark over how best to tackle falls in older people, what are busy patient-facing clinicians supposed to do when they don't have hours to trawl through library books hunting for the holy grail. 

A recent article in the HSJ told a very moving and difficult to read story about the poor care an elderly relative received whilst being treated for a fall at home. This is really disappointing, and unfortunately is not an uncommon story in the NHS. So clearly there is something that needs to be done about the prevention and treatment of falls in our hospitals. These wider strategies need to be translated down to the granularity of the daily working lives of nurses, doctors, physios and the teams on the front lines caring for patients. We need to breakdown these overarching policy documents into something that can be realistically achieved on the ward and intertwined with improvement methodology that wards can manage. 

There are heaps of interventions that wards can implement and then locally study the impact of their interventions. The issue that policy has is that there is not a one size fits all cure for improving falls with harm. There is too much local variance for a national improvement ideas to work across the NHS. The optimal bundle of components is not established, but common components include risk assessments for patients, patient and staff education, bedside signs and wristband alerts, footwear advice, scheduled and supervised toileting, and a medication review. Guidance produced by the National Institute for Health and Care Excellence encourages the participation of older people in falls prevention programmes and falls present a perfect opportunity for wards to involve patients in improvement work. Both patients and staff respond positively to education being delivered on their wards and raising awareness can empower staff and patients to work as a team to address falls prevention on hospital wards.

Preventing falls in patients can only be achieved through strong engaged clinical leadership. Going forward we will need to empower the whole multidisciplinary team to make improvement to their own environments and senior mangers to help build a climate for improvement to thrive. Teams must feel able to take ownership of delivering improvement work but be provided with the support of the organisation. By working with patients, teams can begin to develop customised falls bundles to their patient demographics and make recommendations to improve falls in their areas.