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.

  1. Really understanding accountability

The word ‘accountability’ is bandied about a lot, but I’m not sure everyone has a deep understanding of what it means. We often hear that boards are ultimately accountable, and codes of practice for professional bodies aim to set out what accountability means. But accountability is not just for the board or for clinicians. We are all accountable. A lack of deeper understanding of this, at all levels, has been evident in much of my work over the years.

Accountability is a hard thing to ‘train’ on. We’ve all heard the mantra of accountability being ‘to the organisation’; ‘professional bodies’, ‘under the law’, ‘to the patients’, ‘to yourself’ etc. Over my years in healthcare I’ve often come across situations where people behave as if accountability is transferrable. So, if ‘I’m told to do something by my boss, they are accountable for anything that goes wrong’ or senior leaders claiming that lack of knowledge of bad practice absolves them of responsibility!People may not say this explicitly, but their actions betray a misunderstanding of accountability.

Recently my company, Care Right Now (CIC), has been developing learning modules which allow staff groups, from all disciplines and at all levels, to take a hard look at what accountability means to them. Rather than lecturing them on laws and policies, we use case studies to help the attendees learn more deeply and reflect. We normally use scenarios from another area of practice, in order to be less threatening. These may be from another service but the issues are always common. As a result, key points e.g. about the duty to raise safety concerns and to listen and act, come across more clearly. We also ask the participants to reflect together during the session and do some homework. This has been very well received. Participants often produce something of lasting value (checklists, aide memoirs etc…)

I could write much more on this. Instead here are some key ideas for action:

  1. Use material from great role models. I recommend @DrUmeshPrabhu
  2. Find on-line scenarios on YouTube etc. I use  ‘Just a Routine Operation’ from  Martin Bromiley

(a version which crosses the NHS net is I recommend only watching the start, and switching off when the analysis starts, it’s better to allow the audience to think for themselves).

  1. Encourage Peer Supervision /Support Groups, or any form of Community of Practice. (As long as they are well led and include an element of action learning and action research). The role of ‘critical friend’ is really valuable.


CARE_RIGHT_NOW_ÔÇô_COLOUR_LOGO_(EMOTIVE_STRAP)[1]‘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.

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