Patient safety is important, but it doesn’t happen on its own. There are some deliberate things we need to do to get there, including #SpeakUpForSafety. I believe that patient safety culture in the NHS is at a turning point, moving towards a proactive and ultimately generative safety culture.
The 2019 NHS Patient Safety Strategy highlighted the futility of two myths that have a detrimental impact on safety culture:
- the perfection myth: that if we try hard enough, we will not make any errors; and
- the punishment myth: that if we punish people when they make errors, they will not make them again.
Both myths lead to fear but also lead to the ‘individual approach’ to patient safety, where we focus on the role or some aspect of the person in what goes wrong instead of recognising that healthcare staff operate in complex systems. Staff want to do a good job and should be able to rely on the wider system to help them to be successful.
The next update to the NHS Patient Safety Strategy (to be published soon) will continue a focus on delivering the ‘systems approach’ to patient safety; building knowledge, capability and capacity in ‘systems-thinking’ through the NHS Patient Safety Syllabus and associated training, and the creation of the Patient Safety Specialists network.
We also recently launched the new Patient Safety Incident Response Framework (PSIRF), representing a significant shift in the way the NHS responds to patient safety incidents, increasing focus on understanding how incidents happen – including the factors which contribute to them. This new framework embodies the systems approach and moves us from a retrospective focus on ‘past harm’ to a more balanced approach that considers proactive risk mitigation alongside examining what has already happened. PSIRF sets out the NHS’s approach to developing and maintaining effective systems and processes for responding to patient safety incidents for the purpose of learning and improving safety. The new PSIRF approach also focuses on greater engagement with those affected by an incident, including patients, families and staff, ensuring they are treated with compassion and able to be part of any investigation.
Positive patient safety and a healthy ‘speaking up’ culture are two sides of the same coin. A culture in which staff are valued, well-supported and engaged in their work, and feel able to speak up without fear of negative consequences, leads to safe, high-quality care. The NHS People Promise describes what good staff experience should look like, including ‘we are safe and healthy’. Looking after and growing our workforce – through successful recruitment and retention of staff – and supporting positive approaches to patient safety, are aligned with the potential to establish a virtuous cycle. Hence it is important that patient safety and staff health and wellbeing strategies are dovetailed.
Beyond that, we are exploring how a focus on staff safety can support patient safety. This means both psychological safety and physical safety, including considering staff engagement, fatigue, burn-out, presenteeism, and the impact these can have on risks to patients and staff alike.
The safety of patients, service users and colleagues is our priority and everyone needs to play their part in creating a ‘speaking up’ culture where everyone feels valued, listened to and safe.