Carl Macrae is a social psychologist specialising in how organisations achieve high levels of safety, quality and resilience. His work has focused on health care and aviation.

Formerly a special advisor and a business architect at the NHS National Patient Safety Agency, he led the design of new approaches to analysing and learning from patient safety incidents.

Carl holds a PhD in risk management conducted in collaboration with a large airline, and is based at the Centre for Patient Safety and Service Quality at Imperial College London.

In 2014, Carl published Close Calls, a book whichdraws on his previous work in the aviation sector and explores the often invisible infrastructures that support safety improvement in airlines, particularly around the analysis and investigation of safety incidents. It offers a range of insights relevant to the organisation and regulation of patient safety in health care.

Carl’s project

Major reforms are about to change the way the NHS is run and regulated. 'But', says Carl, 'there has been little research looking at how regulation can help or hinder the work of patient safety improvement.

‘My project will analyse how patient safety regulation works: how it influences the improvement activities of organisations and health care staff, how it can be better designed to support local organisations in their work to continuously improve patient safety’.  

He aims to focus on intensive care which provides complex challenges around safety improvement and is subject to a wide range of health care regulations and other safety initiatives.

Regulation and patient safety

His research will systematically identify and characterise the types of regulation that target patient safety in the NHS in England.

'Regulation is pervasive but sometimes not easily visible in health care,' says Carl. 'Regulation takes many forms, from legal enforcement and formal standards, to professional norms and values and the priorities that are signalled by local leaders. My research will examine how all these aspects interact and how they impact on patient safety improvement activities.'

Using direct observations and interviews, he will study the impact of regulation on local patient safety improvement activities at three hospitals with intensive care units, looking from the ‘blunt end’ of organisations – where standards are set, resources allocated and policies produced – to the ‘sharp end’ of work on the units.

‘This is an area that has not been systematically examined before,’ he says. ‘It will produce a valuable ‘map’ of patient safety regulation, a detailed analysis of how organisations and staff respond to this regulation, and theoretical models and practical recommendations for how regulation can better shape and support local patient safety improvement activities.’

Carl says he is highly committed to developing as a leader, to taking full advantage of opportunities for learning and reflective practice.

Lasting improvements

He hopes his research will help bring about lasting improvements in the quality, safety, and value of patient care by informing the selection and design of optimal regulatory strategies.

‘It will produce findings that will have a direct bearing on the function and techniques used by health care regulators’.

He continues: ‘Improvement science has suffered from insufficient engagement with regulatory studies. By helping to close this gap, my work will expand understanding of the institutional causes and antecedents of effective improvement practices, and reveal relationships between the regulation of safety and the local-level practices of improvement’.

Related resources

Close calls