Now entering its second year, The Health Foundation’s £4.3 million Safer Patient Initiative (SPI) is currently running in four UK acute trusts in partnership with the Institute for Healthcare Improvement (IHI) in the US. The initiative is showing early, but significant, results in improving patient safety.
The four trusts are conducting an organisation-wide programme to radically improve patient safety within their hospitals. They aim to reduce adverse events by 50% by October 2006 and to become centres of excellence in the UK.
Chief Executives and other key participants in the Safer Patient Initiative presented two sessions at the National Patient Safety Agency’s 2006 Patient Safety Conference. They spoke about some of the challenges and some of the early results they are achieving to ensure that improving patient safety is their primary hospital priority.
A summary of the two sessions is presented here:
The Role of Leadership in sustaining an organisational focus on patient safety
Safety is a strategic issue, and one that must not be delegated. This was the key message from Dr Carol Haraden, Vice President of the Institute for Healthcare Improvement (IHI). Dr Haraden is working with staff at the UK Safer Patients Initiative (SPI) hospital trusts to integrate patient safety into hospital management, culture and across all clinical practices.
Leaders must understand their unique role, Dr Haraden commented. They set the tone and values of an organisation and it is their responsibility to improve patient safety. Leaders need a deep understanding of their system’s vulnerabilities and to plan how to react to unwanted errors. Their key role is to instigate the practices and remove the barriers to prioritising patient safety.
“An organisation hasn’t changed, until the staff articulate how they are contributing to patient safety, each day,” she commented.
Dr Haraden called for patient safety to be the priority issue for trust boards. Patient safety contributes to the overall goal of an organisation, she argued, and it can reduce mortality, patient harm, wasted expenditure as well as improve staff morale and retention and trust within the local community.
“We will have arrived,” she said, “When the senior leaders and the board knows as much about quality and safety, as about finance.”
But achieving patient safety requires huge discipline, focus, commitment and hard work. The culture of hospitals needs to move from blame to openness to achieve this organisational goal. And leaders need to inspire staff towards this change, and identify champions who will drive it through.
In Luton & Dunstable NHS Trust, Chief Executive Stephen Ramsden reported the trust had reduced its mortality rate whilst participating in SPI. This had taken courage for clinicians and managers to talk openly about methods to achieve this, and had required the sustained input of many staff.
Measurement is essential. The SPI is putting into practice evidence-based knowledge through new methodologies. Staff are using the PDSA (Plan, Do, Study Act) change model. This is based on testing new procedures on a small scale and, once proven, using ‘spread’ to introduce these across the organisation.
Gren Kershaw, Chief Executive of Conwy & Denbighshire NHS Trust commented, “This is a different way of implementing change – not by dictat, circular or management notes. It feels different. It’s a way of inspiring people to change for the right reasons, for reasons they understand. ‘Spread’ has been a really powerful tool.” Early reports are indicating that improvements have already been made through participating in SPI. For instance, infections rates in intensive care units has been reduced through use of ventilator care bundles. This has led to reducing length of patient stay and associated costs.
To demonstrate their commitment to patient safety, the chief executive’s of the SPI trusts conduct weekly hospital WalkRounds. Based around a series of open questions, these are designed to identify areas for improvement. The chief executives are committed to respond within 72 hours to any issues raised. This can lead to some unexpected results. For instance, Gerry Marr, chief executive of NHS Tayside, was told by a senior charge nurse that “the one thing that could improve patient safety is for you to give me my job back.” This led to a review and re-prioritisation of this role within the trust. The Chief Nursing Officer for Scotland is now considering this review across all trusts.
Leadership through teams: how teams can lead improvement in patient safety
In a second session at the NPSA conference, speakers from NHS Tayside in Scotland, one of the trusts participating in the Health Foundation’s Safer Patients Initiative (SPI) discussed how teams can best work together to improve patient safety. They also described new initiatives to embed patient safety methodologies into future generations of medical and nursing staff.
“It takes an effective team to keep patients safe,” commented Jean Balfour, the Leadership Development Consultant working with NHS Tayside. As mutually accountable groups, with shared objectives, teams can be highly effective, but effective teams need developing, which takes time and continual commitment.
Like the other SPI sites, NHS Tayside is working to achieve system-level changes, not simply project-level changes, to improve patient safety. This requires effort at every level within the organisation. Pat O’Connor, Head of Risk Management and Safety said, “Patient safety is one of the transformational goals for our organisation. We are working to weave patient improvement activity into the fabric of everyday operations for the entire organisation.”
NHS Tayside has adopted a shared approach, recognising change comes from acting together. They believe the key to the success is having the will to do what it takes to create change, the strength of ideas, and importantly the execution of these ideas. Within this, staff need to have clear, time-bound targets.
The trust is developing their teams through dedicated sessions, looking at group processes, communication, collective problem solving, and by using the Myers Briggs Type Indicator to understand different work styles. Through regular feedback sessions and recognition of successes, staff are supported to test and measure the steps towards improvement. The trust has run weekend retreats for all staff, to build on knowledge and develop morale to achieving this transformational goal.
The trust is also working hard to integrate patient representatives into their teams, so that views of patients can be heard, and where appropriate, included into practice.
To ensure the learning of the SPI is not lost, the Social Dimensions of Health Institute of St Andrews and Dundee University is working with the SPI in Tayside to document how staff are translating evidence based theory into clinical practice.
Too often good practice is not recorded and is lost. By documenting the learning from SPI, the universities will ensure this knowledge is transmitted to others. To achieve this, clinical staff are being supported in building confidence in their research capacities. Ultimately this will lead to publishing a series of papers looking at different aspects of patient safety.
Although just into its second year, NHS Tayside staff working on SPI have already starting succession planning. Medical and nursing schools are now introducing the PDSA methodology to first year students as part of their curriculum. And this month students have started clinical placements based around the SPI and its change methodologies, so these practices become integral to their work as doctors and nurses of the future.