Safety is the key for change

Hugh Ross, Chief Executive, Cardiff and Vale NHS Trust speaks to Jenny Kowalczuk, News and Features Editor, www.saferhealthcare.org.uk

Hugh Ross is at the helm of one of the largest NHS trusts in the UK, with responsibility for over 13 500 staff and a turnover of £625 million. Previously Chief Executive at United Bristol Healthcare Trust, Hugh took over his role as the scale of past problems with paediatric cardiac services was becoming clear and led the Trust through the subsequent General Medical Council investigation and the Bristol Royal Infirmary Public Inquiry.

Hugh’s experience in Bristol has made him a tireless advocate for patient safety, and led him to made a successful bid in 2007 for Cardiff and Vale to join The Health Foundation sponsored Safer Patients Initiative. He tells Jenny Kowalczuk why he believes improvement and change for a large organisation like Cardiff and Vale is possible, and why safety holds the key.

Given the Bristol Inquiry—is patient safety better now than it was, or do we still have a mountain to climb?

Yes and yes. Having worked through the outfall from events in Bristol I think it’s absolutely true to say that we are more aware of safety—both as patients and clinical staff. We have greater awareness of the need to protect patients from harm and we understand the need for more and better systems to be put in place to do this. And yes, we do have a way to go—the early results and successes from the first four pilots in the Safer Patients Initiative [SPI] show that there’s an awful lot more we can all do.

Events in Bristol suggested that a cultural change is needed to protect patient safety, but how do you change culture in an organisation as massive as Cardiff and Vale NHS Trust?

Well, it’s not going to happen by me sending memos out. The answer is a little bit at a time, slowly and carefully. Doctors are data rational people, if they have the evidence for change, can see it makes sense then they will change their behaviour. There will always be resistance to change, but I hope if we create successful pilot projects as part of SPI, then people will see that improvements can be made and change is possible. Then we’ll build a small cadre of committed ambassadors for change who will take this work out and share it throughout the trust.

The SPI is a fantastic vehicle to get people talking about change and how we can change the way we work. We must learn to because we must become more efficient, effective and improve the quality of care, so the work we’re doing with SPI is part of a much bigger conversation about improvement and change.

Why did you want to join the Safer Patients Initiative?

Two reasons. First, as Chief Executive I believe I’ve a personal and moral responsibility to make sure we do all we can to deliver healthcare that’s as safe as it can possibly be. I can remember clearly many conversations I had with parents in Bristol during the years when the Inquiry was underway. Patients have every right to expect good standards in their treatment and care, and we have an obligation to make sure we meet these just expectations.

Second, the SPI presented us with an opportunity to develop, improve and support wider organisational change, quality improvement and development. Safety touches every single person at every level—it’s something everyone can understand and everyone can sign up to.

This is unlike many of the top-down directives, initiatives, programmes and changes in service delivery that as healthcare staff we have come to adapt to, accommodate and sometimes push against—whether or not they improve patient experience. For this reason, I believe safety is a key to learning and understanding the process of change in healthcare.

Do you think Health Inspectorate Wales [HIW], the equivalent to England’s Healthcare Commission in Wales, is doing enough to engage the public?

It’s true we are a little behind the level of engagement of the Healthcare Commission, but we are moving to the same system. We have agreed national standards and will be moving down the same self-assessment route as England in 2007/8. We absolutely need to take patients with us on the safety journey.

Public confidence in the health service has been undermined by insufficient attention to infection control—a problem compounded by old buildings and increased pressure on beds. The media are quicker to highlight failures but aren’t so interested in noting our successes. There are delays in transfers of care that are unacceptable. And all in all, patients worry about coming into our hospitals. But we have a new Quality Improvement Plan in Wales, and with HIW’s new published standards, I think we’re on our way.

How important is the business case for safety for you?

Well, I wouldn’t put it right up front. For me safety is a moral imperative, not a financial one. However, if you get safety and quality right then you will enjoy greater staff satisfaction and retention, shorter patient stays, happier patients, reduced drug bills and you will spend less on many other resources as well. But it won’t necessarily save any cash in the short term because as soon as one patient leaves our care another one will take the bed.

In fact, depending on the cost indicators you are measuring, we might expect an increase in costs as shorter patient stays result in greater throughput, and greater throughput costs more. This will change if we move to a system in Wales that more clearly links activity to income.

What safety issue keeps you awake at night?

I think with my experience I can put things in context, and so I don’t lie awake and worry. I’d rather get on and do something about my concerns if and when I have them. I’m also old enough now to know worry doesn’t achieve anything! The things that cause me problems are external.

I know this Trust can—and is—becoming more efficient and effective in delivering excellent healthcare. I have no doubt about that. But things like delays in transfer of care, demand management, lack of public confidence in primary care—the things I can’t do anything about, but have massive impacts on our work and our systems-cause me greater concern than what’s happening inside my Trust.