This safety improvement checklist is based on what we have learnt from the frontline teams we have supported and funded to improve safety over the past decade.
It is designed to help people working in provider organisations who are thinking about how to tackle a safety problem. They might, for example, want to reduce the incidence of falls in a ward, to or to improve the reporting of adverse events or near misses across an organisation.
We hope it will act as a useful reference point when safety interventions are being considered.
1. Safety data are used for the primary purpose of improvement
Data plays an integral role in identifying areas for improvement, and in tracking the impact of an intervention. A fundamental principle of such information is to avoid using it to performance manage teams or individuals, as this will undermine improvement efforts.
2. Past, emergent and future risks are continuously measured and monitored
The NHS is awash with data, but most of it focuses on just one aspect of safety – past harm – which includes incident reports or complaints information. To gain a fuller picture of patient safety, information should also be collected on other aspects of safety, such as the reliability of processes and the presence of hazards and risks.
3. Care processes are defined and standardised first where possible
Although it is tempting to introduce an improvement intervention once a problem has been detected, it is necessary to carefully understand the care pathway first. An approach to doing this was developed as part of the Health Foundation’s Safer Clinical Systems programme, where it helped to quantify known risks as well as to surface ones that were previously invisible.
4. Quality improvement methods are then selected and used appropriately
Interventions should be selected carefully, as not all solutions will suit all situations. Environments that should be routine and predictable, such as in diagnostic services, can benefit most from process standardisation, while situations where patients are at risk of rapid deterioration, often need more adaptive techniques.
5. Patients, carers and families are supported to play an active role to improve safety
Patients, carers and families have traditionally been seen as the passive recipients of care, not as an asset to help improve safety. But we know that patients, carers and families can identify safety concerns that health professionals themselves miss when the right feedback mechanisms are in place, and when they are encouraged to take part.
6. Members of staff are supported to develop and use their skills in improvement
Building the knowledge and skills of health professionals to improve care is a prerequisite to delivering reliably safe care. There are some practical steps that senior leaders can take to do this at scale, and organisations like East London NHS Foundation Trust illustrate the impact that such an approach can have on the workforce as well as on patient outcomes.
7. Members of staff at all levels share the approach taken to improve safety
When improvement interventions are being considered, staff should be involved at an early stage. There is evidence that this has not been done consistently, resulting in safety improvement initiatives being abandoned shortly after their introduction. At a strategic level, this can be in the form of an explicit organisation-wide commitment to safe care.
8. Information about safety concerns is actively sought and welcomed
The Safer Clinical Systems programme epitomised a proactive approach to safety, unearthing risks in services before they led to harm to patients. For instance, one team identified 99 risks in one pathway of care. Such an approach requires a shift in mind-set, away from comfort-seeking behaviours to actively seek out such information.
Checklists on their own are not a solution. As Don Berwick states in his foreword to our report:
’Certainly there are techniques that can help… But, fundamentally, the quest for the installable fix is doomed. The most important cultural characteristic of the safest enterprises is not that they have the right technical features in place (although they should), but rather that they are full of people at all levels who can sense, change, adapt and change again in response to the ever-changing terrain of threat and challenge – and are supported by their leaders to do so.’