Published: 30/09/2004, Volume II4, No. 5925 Page 18 19

Clinicians and managers both agree that patient safety is a priority - but they have very different views on whether people or systems are to blame

Patient safety and the risks associated with hospital care have received a fair degree of scrutiny by the media and politicians lately.

Recent months have seen the publication of mortality rates for cardiac surgery - a prime target for headlines of the 'blundering surgeon' variety - as well as the issuing of patient safety alerts about widely used drugs such as Methotrexate.

Meanwhile, coverage of 'superbugs' has ensured that the issue of hospital-acquired infection stays on the front pages and on the radars of politicians and chief executives alike.

Looking behind the headlines, what do the people responsible for leading our health services think about patient safety? A new opinion polling programme from the Health Foundation has provided an opportunity to find out. Over 500 executives, senior managers and clinician leaders across the UK took part in an online poll on the subject during August, the results of which are released this week.

There is no doubt that patient safety is high on panellists' priorities.

Most respondents reported that improving patient safety is a top priority for their organisation.

Asked to give marks out of 10, half the sample awarded patient safety seven or eight, placing it as either the second or the third most important issue for their organisation.

The poll also suggests that healthcare leaders are far from complacent.More than nine out of 10 (96 per cent) of the healthcare leaders surveyed think that improvements in patient safety are needed, with just 3 per cent agreeing with the statement: 'The current level of incidents is as low as we can reasonably expect.' (See question one).

Having established that patient safety is a key area for healthcare organisations, we asked our panel to rank a number of suggestions for improving it. The three most popular steps were 'an organisational culture which encourages reporting and avoids blame', 'more emphasis on infection control', and 'better communication between staff and patients' (see question two).

The lowest ranked suggestions were 'having a government regulatory agency sanction hospitals for too many patient safety incidents' and 'stronger penalties for staff who make mistakes' - underlining the belief that cultural change rather than coercion is the secret to good patient safety.

But while healthcare leaders share the view that patient safety is important, they have different ideas about what should be done.

Clinicians were more likely than managers to prioritise steps to improve the system as a whole, such as making greater use of IT in dispensing and administering medication, rather than steps aimed at changing individual behaviour, such as better training of health professionals.

These differences reflect the division between clinical and non-clinical panellists about the root causes of patient safety problems.Managers divided roughly equally between those who regard system error as the greater cause of breakdowns in patient safety (44 per cent) and those who consider human error to be the bigger threat (43 per cent). In contrast, clinicians were twice as likely to see system error (63 per cent) rather than human error (33 per cent) as the greater problem.

Have managers been slower to make the mental shift needed to take a 'whole-systems' approach to better safety? Do clinicians, sometimes castigated for a failure to embrace teamwork, actually have a better understanding of the complex nature of multidisciplinary healthcare than their non-clinical colleagues?

The poll does not allow us to draw firm conclusions, but these differences in managerial and clinical views go to the heart of some of the unresolved questions about how best to improve safety and reduce risk.

The Health Foundation's safer patients initiative, a£4m programme launched in June, will be exploring some of the practical dilemmas involved in making hospitals safer for patients, such as how non-clinical staff can be encouraged to embrace their role in safeguarding patient care, and what disciplinary measures are needed to ensure accountability and uphold standards without creating a climate of fear among staff.

One of the biggest areas where cultural change is needed is the extent to which staff involve patients as partners in their treatment and care - the possessors of 'different but equal expertise' as the Bristol enquiry described them.When asked about the most effective ways of improving patient safety, two out of three healthcare leaders (64 per cent) placed a high priority on better communication between staff and patients.

Half of respondents reported that some or most patients in their organisation were actively involved in steps to reduce risk and improve safety, while a third of respondents (30 per cent) said that patients were not involved, and a further one in five said they did not know (see question three).

However, the survey suggests that, while healthcare leaders seem convinced of the benefits of better staff-patient communication, they are unsure how to make it happen.

Healthcare leaders face significant challenges in making the kind of improvements in safety and reductions in risk that they know are needed.

Our first healthcare leaders survey suggests that executives, clinicians and managers alike are aware of these challenges, and are more than equal to the task of generating the kind of intelligent and creative organisational responses that are needed.

The real challenge now is how we learn from their experiences, to build a better understanding of what makes healthcare safer for patients.

Natasha Gowman is head of public affairs at the Health Foundation.

Further information

For more information, including a full report of the survey and details of The Health Foundation's Safer Patients initiative, visit www. health. org. uk.