With around 14,000 staff, NHS Tayside provides a comprehensive range of primary, community-based and acute hospital services for the populations of Dundee City, Angus and Perth and Kinross in Scotland. Patient safety is literally at the top of the agenda at NHS Tayside. Rather than finance or performance management, safety is the first issue discussed at the executive team’s weekly meeting.
Pat O’Connor, Head of Safety, Governance and Risk at NHS Tayside, believes that this has speeded up the decision-making process. “We have team briefings on patient safety activity involving the executive team plus key frontline staff,” she says. “So we don’t have the linear decision-making process that most people identify with the NHS. This means decisions filter down much quicker and the organisation can be much more responsive in addressing a particular problem.”
The executive team’s role
Pat says that this high-level support for the patient safety programme has been integral to its success. “Certainly at times you do need a senior leader to lead from the front, particularly in the early days,” she explains. "But then at different times you need someone at the back encouraging people.
“We’ve been fortunate to have that support from the outset, but you will always get some resistance in large organisations such as ours,” she continues. “The Institute for Healthcare Improvement’s advice is to focus on the ‘early adopters’ who have the will to change and generate momentum that way. Perhaps before I would have concentrated first on the people who were less interested, but I know now that’s not necessarily the best way to implement change.”
Much of the leadership development work at Tayside is focused around coaching and building skills for individuals who are improving safety on the front line. Clinicians are encouraged to find solutions to problems themselves, rather than taking issues up the management chain. As well as ensuring that management time can be focused on other priorities, this approach helps staff better understand the system in which they are working. They also feel greater ownership of the solution as a result.
There are numerous events throughout the year when clinicians can profile their achievements and an informal open monthly meeting called ’Celebrating Success’. At these sessions, the monitoring data is reviewed and all staff have the opportunity to air their opinions on implemented changes. Each team raises two challenges they’ve faced that month and the group collectively helps resolve them.
Lessons in clinical leadership
Jean Balfour is a leadership development consultant who has been working closely with the patient safety team at NHS Tayside. She says that the concept of shared leadership is about ensuring that improvement skills are spread throughout an organisation, rather than remaining at the top.
“If leadership is left to the few, particularly in a senior role, then it stops change, innovation and improvement being able to permeate through the organisation,” Jean explains. “Whereas if leadership is shared with clinicians throughout the organisation, it enables people to lead change and improve things at all levels. In the case of NHS Tayside, we’ve seen that by developing and enabling leaders throughout the organisation at all levels, we can actually help to speed up the improvement process.”
Jean was asked to help the team work together more effectively and engage others in their safety improvement work. “A lot of my role was helping them work out how they were going to work with people who weren’t so engaged. How they were going to influence them, get them on board, teach them and help them to change their own practice,” she says.
Although Jean gave the team some formal coaching, much of her work focused on the facilitation of discussions. For example, one clinician used Jean as a regular sounding board, particularly for advice on how to influence other doctors. They used Myers Briggs Type Indicators ® to understand how to deal with different personality types in the team. This in turn helped them to devise more effective influencing strategies.
On a practical level, Jean advises that a flexible approach is needed. “You can’t just pull people away from the wards, theatres and clinics at pre-defined times,” she says. “At Tayside, things started to work really well when clinicians came to me and said, ‘I’ve got half an hour free at this time,’ because you knew that if they suggested a convenient time, you would be more likely to get their full focus.”
In Jean’s view, the progress that NHS Tayside has made in patient safety has not just come about from improvements to systems and processes but also from a clear recognition that leaders need to be developed and empowered at all levels. This has enabled clinicians to test out their own solutions to problems, communicate the results and influence others to adopt them.
“By using problem solving action learning sessions, we got people to come together and explore issues such as how to spread hand washing compliance across the whole of the hospital,” Jean explains. “They then set about unravelling the problem together. As a leadership consultant, it’s rare for me to be so rooted in a clinical setting but it’s been so rewarding for me to see this work result in improved outcomes for patients.”
Holding the gains
Changing the culture of an organisation is a long-term objective. Once change has been implemented and improvements recorded, the challenge is to sustain those advances, while also identifying other areas for improvement. “We call this holding the gains,” Pat explains. “For us, this means embedding safety considerations in everyday practice.
“Senior leadership used to be expected to have all the answers. Now people are saying ‘This is my problem and I need to find a solution to it.’ Solving the problem then gives them confidence to share their experience with others,” Pat concludes.
04 June 2007