'Patient safety demands adequate resources, effectively applied'

Patient safety is central to the Nursing and Midwifery Council’s work. It is required by statute to safeguard the health and wellbeing of people using the services of nurses and midwives, which gives the council an interest in ensuring safe care is delivered to every person who comes into contact with the 662,000 nurses and midwives it registers.

The NMC sees the very worst outcomes of failures in healthcare delivery. Sadly, too many cases involve neglect and incompetent practice, often affecting the most vulnerable patients: older people in nursing homes, people with mental ill health and those already at risk of harm. Action can be taken, and is taken, to remove failing nurses and midwives from the professions.

Too often, patient safety is compromised not through deliberate and malicious acts, but because of poor management and a lack of critical thinking

While systems and environments have impact on the ability of good nurses and midwives to deliver consistent high quality care, individuals are usually culpable. This does not simply mean acting against the nurse or midwife who delivered the poor quality care on the front line: directors of nursing directly accountable for the failures in the environments they manage must also be held to account.

High quality nursing environments lead to better outcomes for patients. Dr Linda Aiken and her colleagues at the Center for Health Outcomes and Policy Research in the US made a study of 168 Pennsylvania hospitals which demonstrated a clear impact of nursing practice environments on patient outcomes, showing patients were 14 per cent less likely to die in hospitals with better care environments than in those with poor ones. Environments, systems, teams and individuals: these elements are intricately woven together and all have an impact on patient safety.

Recognising these multiple factors and their impact on each other means that, as a professional regulator, the NMC cannot act alone. As a result, the NMC has recently signed a memorandum of understanding with the Care Quality Commission, describing how the two organisations will work together to safeguard the wellbeing of the public receiving health and adult social care services in England. The NMC will be seeking similar agreements with other systems regulators across the UK. The hope is that acting together will more clearly identify situations where failures in professional standards contribute to the failure of healthcare delivery.

The ability to act will always be limited by time and resources. Effective patient safety has to be the day to day responsibility of directors of nursing and their teams, not simply regulators.

Simply reminding directors of nursing of their responsibilities and accountability to their regulator is not enough. Patient safety is not just a matter of professional pride, but of adequate resources effectively applied. Directors of nursing cannot ensure patients are cared for safely without the support of their chief executive and finance director, and their wider leadership team.

In the face of ever more squeezed budgets and the pressures of reorganisation, chief executives and finance directors ignore patient safety at their peril. It has to be taken seriously as a corporate responsibility. Directors of nursing have professional responsibilities to their regulators that extend beyond the scope of the jobs they are in now. When the inquests and inquiries are distant memories, failure for chief executives or finance directors can mean a golden handshake and an easy move into consultancy. For a nursing or medical director, it means the end of a career.

So how do we ensure patient safety stays a top priority? Overcoming complacency is essential. Too often, patient safety is compromised not through deliberate and malicious acts, but because of poor management and a lack of critical thinking about environments of care.

As Harvard professor of health policy Lucian Leape says: “Among the powerful barriers to making progress in patient safety is an attitude of complacency induced by the rarity of serious events and the general human bias toward assuming that things will work as they are supposed to.”

It is said that the hardest part of the journey in improving quality is not from poor to good, but from good to excellent. However hard that part of the journey is to achieve, it is essential.

For the directors of nursing we regulate, for the environments they manage, and for the leadership teams of which they are a part, being “good enough” is simply not good enough.