Health & safety

Since its inception the National Patient Safety Agency has worked to improve standards in patient safety in the NHS. Richard Mackillican spoke toSuzette Woodward to find out about its plans for 2010

Increasing patient safety is no longer just about ensuring that staff give the right medication to the right patient. In today’s NHS, it is also about communicating a message.

One of the principal exponents of the patient safety message is the National Patient Safety Agency which, in conjunction with partner agencies, will have a number of social marketing programmes in operation over the course of this year.

“We are calling it Ten for 2010”, says patient safetydirector Suzette Woodward.

“ These are ten programmes which build on work of other projects such as the Patient Safety First campaign which will allow us to shift our focus from just being an agency which provides lots of information and guidance to one which is far more hands-on in its approach to providing support around improving patient safety in the NHS.”

Suzette says the agency’s method of raising awareness is a blend of a programmatic and a social marketing approach.

“If you have a blended approach your campaign is both ‘top down’ and ‘bottom up’, meaning that you inhabit the nirvana in between where you have both a clear direction and the ability to make interventions which are known to work. This also means that at a local level, people can take these programmes and adapt them to fit the context of their own position.

“This allows the user to build upon a peer to peer, ‘bottom up’ approach to change, which can then be coupled with a ‘top down’ approach to add support.”

An example of this approach is a programme called Matching Michigan, a patient safety initiative which aims to reduce catheter associated bloodstream infections in intensive care units. The two year project will involve both adult and paediatric ICUs and was introduced at 17 pilot units across the north east of England last year. The project is now being rolled out nationally.

The project is based on a model which, over an 18 month period, saved around 1,500 patient lives in Michigan by introducing measures that reduced central venous catheter associated bloodstream infections. It aims to match the success of the Michigan project by taking the same actions to reduce infections and improve patient care in England.

“This project is a mixture of what we call the technical and the adaptive. The technical is the actual intervention itself, so saying to practitioners if you do ‘X, Y and Z’ (in isolation) you will save ‘X’ amount of lives in intensive care. The adaptive approach is where we say if you follow up the initial technical intervention with a more permanent shift in culture, such as learning from mistakes, then you will be able to sustain the change in patient safety performance more thoroughly.

“This is what we have done with Patient Safety First by implementing some interventions which we know will work and backing that up, for example by giving leaders guidance how to sustain this positive change through team work and communication, along with how to measure patient safety in the future.”

Matching Michigan is only one of a number of patient safety programmes in which the agency will be engaging this year.

The other programmes include one focused on reducing patient harm associated with general deterioration in patients, one focused on reducing patient harm associated with falls and another focused on reducing harm associated with pressure ulcers.

These are accompanied by programmes focused on medication safety including one which is working to reduce patient harm associated with taking insulin along with another focused on anticoagulants.

“We are also branching out so that we take account of other care settings aside from acute care. These programmes will work towards reducing harm in both primary care and mental health care settings. Another focus will be around maternity care.”

Which are the main areas in need of improvement?

“Firstly, there needs to more leadership support in terms of patient safety. There needs to be a far deeper understanding by leaders of the levels of harm taking place within their organisations. I think that leaders are beginning to grasp this idea more strongly than before, given the media interest in things like the Dr Foster report released last year.

“However, I believe that leaders need to become smarter about comparing mortality levels with the case notes data which they have available and then matching that with patient accounts, to see the correlation between the numbers and real life.

“Another key tool which they can use is leadership ‘walkarounds’, where they actually go out and about, experiencing the front line as it happens, allowing them again to put the issues around patient safety and harm into context.

“Another important issue is around data, what we do with it and how we learn from it. Data is a fantastic mobiliser for change and shouldn’t be feared in the way in which it is in terms of performance. It should be there to let you know where you are now, thus allowing you to set very clear goals about where you want to be in the future. This is something which we are very passionate about, so we can tell what we want to achieve, when it needs to be achieved by and who is going to help us achieve our goals.

“The third key area which needs improving in the NHS is a perceived lack of sharing, which is also referred to as ‘funnel working’ or isolationism. The problem is that we have large numbers of people doing some excellent work within the NHS, but simply not sharing it with someone else.

“We need to cultivate a culture where information and best practice can be shared more readily, because we often end up with people who have worked to ‘re-invent’ the wheel, only to find that similar work top solve a problem had already been done by a trust down the road, except no one knew about it.

“If we can address these three issues, then we will be off to a good start.”