Sharon Beamish is chief executive of George Eliot Hospital is the deputy director of nursing at George Eliot Hospital
Patient Safety is about working together day in, day out, 365 days a year. It requires hard work and commitment to the cause, with each individual playing a vital role in preventing errors being made.
At the George Eliot Hospital we have an inspiring story to tell. In 2005 we had both the highest HSMR (143) and Clostridium difficile rates in England. To make matters worse we had a funding deficit of £7.3 million.
So far we have succeeded in making our patients safer by meeting set targets and continuing to reduce the number of adverse events.
What is perhaps most surprising is that 93 per cent of the staff that were employed by the George Eliot in 2007 are exactly the same (not including new doctors who have joined the team since) as those employed today. So what changes did we make?
We changed practice, at every level. We began by adopting an attitude and strategy that required our patients to receive safe, high quality, timely, efficient and effective services based on best practice and national benchmarks.
Everyone who works in the NHS at every level wants the best for every patient – patient safety is always the highest priority but in October 2007 we decided to make this clear.
We signed up to the Patient Safety First initiative in 2008 as we saw it as the perfect opportunity to strengthen our patient safety message. We chose to sign up to each of the five interventions, with the most important of these being the Leadership Intervention which requires individuals at board level to demonstrably promote patient safety so that others could follow suit.
We saw the signing up to the campaign as a fantastic opportunity to support the cultural shift we had already put into place with the aim of decreasing the number of hospital acquired infections. Patient Safety First gave us the tools to deal with issues that had gone wrong in the past and make a fresh start.
Changes in action
When you’re going off on these types of journeys to make large changes in the way you work, you think it’s going to be an additional set of work from what you’re already doing but actually once we started implementing the interventions we realised that they were inherent in everything we did. The difference is we are now aware of what we are doing, are measuring our actions and ensuring that others – at every level – are doing the same.
In October 2007 we signed up to the Leading Improvement in Patient Safety programme. This encouraged us to:
- Facilitate board ownership and leadership
- Organise a cultural change with the trust
- Reduce hospital acquired infections
- Better manage the deteriorating patient
- Have better intelligence of patient safety issues
Shortly after implementing the LIPS programme, we created an objective to reduce the level of HSMR to 90 by March 2009. In order to do so, we would reduce infections, improve cleanliness, reduce harm, reduce Medical Outliers, improve Coding and use the Global Trigger Tool.
LIPS and Patient Safety First have therefore complemented each other well, meaning that we have had strong support to help us improve.
We pride ourselves on an honesty policy to help us learn for improvement and in April 2008 we took the risky step of taking part in a press conference where we put all of our infection, risk and cleanliness data out into the public domain.
We were unsure of the response this would receive from the media but were surprised that the local press really embraced it as they praised us for our honesty in admitting, “this is the situation right now and this is what we’re going to do about it.” We accepted that we had bad results in the past and that it needed to change.
We continue to keep our figures out in the public domain because regardless of how things are going, when you’re working with the public they have a right to know the current situation.
We have a quarter of a million contacts with the public every year so they have already gathered their own views on the service we provide; we just wanted to show we were actively making a change to make patient care safer. For many people this could be the difference between life and death so we thought it was something they deserved to know.
Another key element for changing practice was increasing staff awareness. In 2008 we held an Improving Patient Safety Conference where staff could ask questions about what we were doing and express their views on how we should take the next step.
We could never underestimate the power of measuring for improvement, which is a key component of Patient Safety First. We dismissed the idea of league tables that could put one trust up against another and instead used ‘Run charts’ that showed how we had changed practice for the better. These show visually whether we have improved and demonstrated statistically significant change that allowed analysis.
Signing up to Patient Safety First in 2008 has given us improved guidelines as to how we can move our patient safety journey forward. We decided to implement each of the five interventions:
- Leadership for Safety – getting trust management boards to clearly demonstrate that patient safety is their highest priority and lead by example.
- Care of deteriorating patients in acute care– to reduce in-hospital cardiac arrest and mortality rates through earlier recognition and treatment of the deteriorating patient.
- Reducing harm in critical care – improving the care of patients receiving critical care through the reliable application of care bundles.
- Reducing harm in perioperative care – preventing surgical site infection and implementing the World Health Organisation’s Safe Surgery Checklist.
- Reduction of harm from high-risk medication – preventing harm from high risk meds such as anticoagulants, narcotics, insulin and sedatives.
The real leverage at George Eliot has come with the leadership intervention at ward level. Managers of wards are the real drivers of this campaign as they monitor the team and encourage each individual to take responsibility for ensuring that patient safety always comes first.
By signing up to Patient Safety First, and other government-backed campaigns, we have come across our difficulties. The most trying of these have been encouraging engagement amongst staff. People were very sceptical about what we can deliver. However, the measurement tools given to us by Patient Safety First encouraged others to take part and change practice as they saw evidence of success.
Therefore, measuring for improvement is not only important to show patients how we are making changes for the better, but to encourage staff who may be cynical about the campaign, to see that they can actively make a difference.
Other problems included compliance, relentless commitment and the need to change the language that we were speaking to suit all staff at every level.
However, these problems were overcome thanks to ward level and clinical leadership, challenge and support. We also have regular meetings with representatives for different members of staff where we have received a positive response to the changes. This is beginning to be reflected in the annual staff survey that is issued to encourage comment and feedback.
The nurses’ role
Nurses are the absolute backbone of Patient Safety First. They are responsible for driving forward the changes as they are managing the wards and delivering the care. They are the ones on the front line, with patients 24 hours a day, seven days a week, so it is they who are responsible for the continuity and consistency of the campaign.
Nurses are undoubtedly the glue holding the campaign together but at the same time strong nursing cannot make the campaign a success without strong leadership – both are imperative to make patient safety the priority.
We have still got a long way to go, we cannot deny this. But now we have a zero tolerance approach to infection control and poor practice where we used to have target numbers for reduction. The difference between a target number and a zero tolerance approach is the difference between being accepting of one infection or being accepting of none!
Patient Safety First has taught us to expect more from the way staff work, at board level and on the wards. We have excellent expectations for the future – our patient safety journey is ongoing and we are saving money as we go; poorly organised systems cost trusts money, for example the contraction of C diff can cost thousands of pounds.
With better management and improved awareness and responsibility, we will continue to make sure the wards at George Eliot are as safe as they possibly can be.
See www.patientsafetyfirst.nhs.uk for more info
Patient Safety First