Improving your organisation's approach to safety: five questions to ask

(Re-)read the Berwick report recently? While it perhaps didn't get much profile beyond improvement enthusiasts when it came out, I find people are increasingly referring to it. Perhaps this is because, in a post MidStaffs debate that can otherwise be fairly negative, it offers a positive vision and manifesto for improvement.

We hear frustration anecdotally from leaders in organisations: ‘Look, we know there is a problem with culture, and we know we need our staff to understand how safety and quality improvement actually works, but we don’t know where to start to address it’. The Berwick report is a useful and authoritative resource that, in effect, provides organisations with a template for their safety strategy.  

At the BMJ/IHI International Forum in Paris last month, I supported Jason Leitch, David Dalton and Elaine Inglesby-Burke from the Berwick Review group to deliver a one day masterclass on implementing the recommendations of the Berwick report. Seeing the room filled to capacity with nearly 200 people from all over the world made me reflect on what I perceive to be a growing interest in, and momentum behind, the report.

In their presentations, Jason, David and Elaine broke the report down into five key areas of activity for organisations:

• How will you listen to the views of patients and staff?
• How will you demonstrate leadership behaviours?
• How will you build your capacity and capability for improving safety?
• How will you improve the measurement and transparency around safety?
• How will you improve your organisation’s learning around safety?

Participants then used the driver diagram technique to identify means of addressing each area. The resulting driver diagram is below.

I was initially sceptical about whether this technique would work for something as complex as developing an organisational safety strategy. But the session was really productive and showed that, in fact, it is precisely when your task is more complex and will involve many people that you most need to find ways to simplify the challenge and make it accessible.

The focus is on being able to develop a proactive strategy for improving safety as a group within your organisation. A strategy which responds to the multiple forces – internal and external – in a coherent way, rather than one which makes scores of uncoordinated recommendations for further work. 

With the Sign up for Safety campaign providing a new push for organisations to articulate their goals and strategy for safety, is this a good opportunity to question how far your organisation has a mish mash of activities and initiatives or a coherent, purposeful strategy? 

Penny is Assistant Director at the Health Foundation, www.twitter.com/PennyPereira1