Pursuing Zero – a winning approach to safety

A team from Great Ormond Street Hospital Foundation Trust was named Berwick Patient Safety Team of the Year at the BMJ Awards earlier this month. They were recognised for work which saw the Trust develop a culture where every member of staff focuses on the importance of providing safe, high quality care for children. Since its launch in 2007, the project has seen some promising results on its journey towards zero harm. 

Striving for zero harm

Great Ormond Street Hospital (GOSH) set up the ‘Zero harm, no waits, no waste’ programme seven years ago, with the ultimate aim of eliminating all harm to children in their care. The transformational programme centres on changing organisational culture, developing learning in quality improvement and patient safety, working with parents and families, and developing safer processes to protect children from harm.

Even though the programme existed before the Berwick report, it is arranged around four of its key recommendations:

• patients and carers are at the heart of the change
• work ensures there are appropriate numbers of staff in place to care for patients
• learning is promoted throughout the hospital, with staff training in clinical leadership, patient safety, and quality improvement
• data are collected, shared, and acted upon. 

‘Our strategy has been to develop a system of continual improvement and learning in partnership with staff, children and parents. This means a continual process of critically appraising our work to always strive for the best possible outcome’, says Peter Lachman, Deputy Medical Director, who leads on the transformation programme at GOSH.

Working towards their aim of ‘zero harm’, the team have developed new ways of identifying risks to children and of measuring harm, partnering with the NHS Institute for Innovation and Improvement to develop a new paediatric trigger tool.

This more indepth understanding of harm led to the setting up of numerous improvement programmes. Staff are working to achieve a range of outcomes: to reduce unnecessary delays, maintain high levels of medication safety, make prescribing more reliable, eliminate hospital acquired infections, and recognise and respond to the unexpected deterioration of children.

A culture of improvement and safety

The programme aims to embed a culture of improvement and safety throughout the organisation and key to this has been developing strong leadership for change. 

The work is led by 10 senior members of staff who have dedicated time in their job plans to implement change and learning in their divisions. They are supported by a transformation team, which includes four dedicated data analysts and six improvement managers, as well as a number of special project leads. The use of data and the bespoke data for improvement system they created have been major factors in the success achieved.

The Trust also uses executive walkrounds and ensures that discussions about safety and harm are prominent on board meeting agendas. ‘The support from senior leadership has been vital’, says Peter. ‘It really makes a difference having leaders who want to go on the journey with you.’

Patients at the heart of change

Throughout the programme the team has also made a point of involving patients and carers. ‘Parents have been central to many of the projects, and have held us to account for what we are doing’, says Peter. 

One particular project, which was funded by the Health Foundation’s Shine programme, introduced a daily feedback questionnaire completed by parents and patients. This asks about medication errors, equipment problems, failures in communication, or problems with the way care is organised. Nurses go through the questionnaire with the parent or patient so that problems are fixed as quickly as possible.

Reduction of harm

The programme costs around £1m a year, a tiny proportion of the Trust’s £360m annual expenditure. The Trust has not yet achieved zero harm but the trajectory is promising: by the Trust’s calculations harm to patients has reduced to 10% from 15% at the beginning of the programme, as measured by the paediatric trigger tool. The Trust recognises that there are many measures of harm and has worked to develop a composite harm dashboard to reflect this.

‘We’ve achieved a lot’, says Peter. ‘The culture of the organisation is definitely different, more open to learning and change. There is still a lot to do, there are pockets we haven’t managed to reach within the hospital. But we’re so much better than we were, and the programme has created a momentum for change which continues to drive us forward.’

About the award

Sponsored by the Health Foundation, the Berwick patient safety award honours teams that are trying to realise Don Berwick’s vision to make the NHS a safer place, removing blame culture, engaging patients and carers in health care and promoting quality improvement.

Read about the other shortlisted projects in this category.