This is part two of a three part series of articles by Steve Turner. For Part One please click here
In light of the recent announcement by the Secretary of State for Health in England of a review of whistleblowing, and new initiatives announced to improve patient safety.I’ve been working on a list of steps which will help deliver safer care. The aim is to bring together various influences and focus on the key messages. The main influences are the King’s Fund work on developing collective leadership; the announcement by the Secretary of State for Health on a review of whistleblowing in the NHS; the NHS England ‘Sign up to Safety’ campaign and the increased focus on human factors in healthcare.
There is really nothing new in what I have to say. It’s all based on the work of others. What I’ve tried to do is draw together the key themes, initiatives, reports and recommendations. Actions on all these are all needed in equal measure to deliver safer, cost-effective, healthcare.
3. Implement a human factors based approach
Jeremy Hunt, Secretary of State for Health (England) has made the following statement.
“I want our NHS to be the first system in the world that starts introducing airline levels of safety” (Nursing Times, May 2014).
This statement was has been influenced by the Clinical Human Factors Group and the work of Martin Bromiley, whose wife died during a routine operation in March 2005. This was an avoidable death which resulted from a combination of individual and systems mistakes. These failings can be best understood by adopting the aviation industry approach around ‘human factors’.
To find out more about human factors I recommend watching the video Just a Routine Operation(mentioned earlier). In summary, Human Factors is based on common sense with insights from the aviation industry on things which we can be blind to in critical situations; the need to take our feelings in to account, and the ways in which over the top hierarchies can get in the way.
In my view, one of the biggest barriers to safety in healthcare is where there are complex and rigid hierarchies. It’s still common in the NHS for staff to have more than one boss; often reporting structures act as a barrier to good communication, and deference to authority sometimes trumps safety. This quote from the whistleblower David Drew is typical:
‘I was castigated by the Trust lawyer for having dared to speak to the ‘most important person in the organisation [the CEO]’ in this way’ (David Drew (2014) ‘Little Stories of life and death @NHSWhistleblowr’ Matador, Leicestershire.)
Contrast this to the words of NHS Employers:
So my key ideas for action here are:
- Flatten over-the-top hierarchies
- Use checklists to improve safety
- Recognise that we don’t always arrive at work ‘fighting fit and ready to go’. Support each other and take feelings into account
‘Steve has a background in healthcare delivery and information technology as Head of I.T. in an NHS Trust, and worked as a senior healthcare consultant for a US company. Steve is a registered general and mental health nurse prescriber, having worked in an assertive outreach team. He has an honours degree in social policy and post graduate diploma in clinical education. Steve now leads Care Right Now CIC. This is a company specialising in healthcare systems development across organisations in complex settings. Steve is a NICE Medicines and Prescribing Centre Associate; CQC Specialist Advisor; Associate Lecturer at Plymouth University and runs a Chapter of the Institute for Healthcare Improvement.