How to create a culture of safety in the NHS

As in the Maidstone C difficile outbreak, one question to ask is where were the directors of medicine and nursing? What were they doing while these events developed and unfolded?

The difference now is we have a new regulator on the patch. The Care Quality Commission is likely to use the events at Mid Staffordshire to demand much more from all hospital clinicians. Not just senior doctors and nurses, but everyone involved in patient care.

‘We need to create a culture where doctors are obliged to challenge each other’

CQC chair Barbara Young

Community clinicians need not be complacent as the CQC is also responsible for social care, and it may expect doctors and nurses in the community to be partly responsible for monitoring care in care homes.

CQC chair Barbara Young has said: “We need to create a culture where doctors are obliged to challenge each other. It is not happening everywhere at the moment… Nurses play an essential role.”

This will be a shift of culture for many hospitals. Poorly performing trusts and clinicians hide behind a veil of excuses and bullying. Senior clinicians and managers (even in the best trusts) consider it to be too difficult to take on the challenge of dealing with antagonistic consultants and poor care.

This is now unacceptable.

Culture change

Senior leaders need to consider the impact on their organisation and the actions they need to take to facilitate such a shift in culture in their organisation. Clinicians everywhere need to consider what their responsibilities are. This is not a witch hunt; it is putting the patient’s care and safety at the top of the agenda. As Lord Darzi says: “Quality is the organising principle.”

So what do trusts need to do?

Most importantly, senior leaders need to continue to explicitly demonstrate that patient safety and quality of care are important to them. Walk the wards, talk to staff more, welcome critical but constructive comments.

Second, trusts need to encourage multidisciplinary team working in all specialties. Those teams need to develop agreed pathways of care, so that everyone knows what will happen and what to expect next. So if it does not happen questions are asked, immediately.

Next, measure what matters, not just targets. There are simple ways of measuring patient satisfaction. Companies such as the RAC have used hand-held devices for some years to gather this information. Then give the data back to those multidisciplinary teams and ask them all to improve.

Senior managers and clinicians need to tackle the difficult stuff - the poorly performing areas within their trust, where the staff say they would not want to receive care.

Finally, we all need to change our attitudes. It is no longer acceptable to ignore poor performance. We have to do what is right, otherwise we are all responsible for that failure, that blunder, that scandal.

As a clever Greek - Hippocrates - said thousands of years ago: “First do no harm.”