Sarah Woolley explains how Heart of England Foundation Trust has put the Patient Safety First campaign into action.
Heart of England’s patient safety strategy pre-dates sign-up to Patient Safety First (August 2009), so the campaign was a natural step to support the improvement programme. Crucial members of the team, including the chief executive, attended a leadership in patient safety course that crystallised our thinking about patient safety.
Patient Safety First enabled us to focus on what the organisation needed to do.
One key change was the introduction of a new team created specifically with patient safety in mind. A director of medical safety was introduced and two critical care nurses were made patient safety advisers, responsible for working with the corporate safety team and frontline staff to develop and implement safety solutions. They investigate how incidents occur and identify trends and themes.
This information is used to develop a programme of activities and help staff make care safer for patients, and sends a clear message about our commitment to creating a just culture. It builds trust with frontline staff so that they felt confident to report errors and adverse events.
In conjunction with Patient Safety First we did a baseline assessment about our entire safety systems, processes and outcomes to determine where to focus and improve. The campaign has given us the confidence that we’re pointing in the right direction. Now we’re getting out there doing patient safety walkrounds and connecting with frontline staff.
Reducing harm from deterioration
The trust has recently invested in and extended the critical outreach service to provide 24/7 cover to support our staff and implementation of MEWS procedures. We audit progress so that we can ensure that people are taking observations in the correct way. Levels of escalation have improved greatly but not as much as hoped so we are working to build on this.
To increase communication between team members we have implemented the SBAR communication system across the trust. Initially it took a while to encourage people to actually use it, so we asked staff about their perceived barriers and put in place additional coaching and training resources on how to use it.
Using the Global Trigger Tool helps us understand the main causes of harm in the hospital and has been useful in reinforcing other parts of the risk management system. The WHO Surgical Safety Checklist is another introduction we are implementing which has been well received by staff.
While many changes are still work in progress, we are positive about the future and the power of these tools to support us in improving our safety culture and reducing adverse event rates.
Our experience has taught us that you can’t just give people new interventions and expect them to do it. You need to apply human factors and error theory and recognise that staff need support with using these new tools and concepts.
Coaching and training help staff understand how they improve safety; by doing this, we know that they have a greater impact and change is more sustained.
Communication between staff is essential and we are keen to spread the Patient Safety First message further in the trust. The main aim for this year is to raise awareness of patient safety and ensure it is always highest priority. A full multimedia communications plan is ready, including podcasts where frontline staff can tell their stories. This will in turn encourage staff to make a difference as they’ll feel more involved.
Heart of England is on the first steps of the patient safety journey which has so far received a positive response from staff. We’ve had great feedback from those who’ve been using the SBAR systems and staff who participated in the walkabouts. Signing up to the campaign in-line with the LIPS Programme has certainly made it easier to implement changes as well as being a terrific help in putting a framework together for our ideas.
With Patient Safety First we are creating a just culture where we understand why an incident happens and make changes to ensure similar things don’t happen in the future.
For more information on Patient Safety First, visit www.patientsafetyfirst.nhs.uk
Sarah Woolley is director of safety and governance at Heart of England Foundation Trust.