Safety first

It may seem ironic that an organisation set up to improve people’s health can sometimes have the opposite effect but efforts are underway to reduce avoidable harm to patients, reports Richard Mackillican

Patient Safety First was launched in 2008 to eradicate all avoidable harm and avoidable death in the health service - a not inconsiderable task when one considers that, according to Department of Health data from 2006/7, of approximately 12 million admissions to NHS acute trusts recorded that year, one in ten resulted in a patient experiencing an incident which put their health at risk.

Patient Safety First hopes to achieve its aims through changing practice in specific areas, based on existing evidence and by actively looking for examples of harm, examining the causes and learning from them to avoid future incidences.

To do this, Patient Safety First needs the co-operation of NHS organisations throughout the country and despite the extremely challenging nature of the task, the campaign seems to be making progress.

“So far we have managed to recruit the vast majority of acute trusts, along with a significant number of trusts across other sectors,” says Murray Anderson-Wallace, head of field strategy and communications for the campaign.

“All of these trusts have made specific commitments to a number of actions around patient safety improvement in their organisations. Alongside this, we have also seen a significant amount of activity around improving patient safety happening, particularly in acute sector organisations. Although it is worth mentioning that both the primary care trusts (PCTs)and mental health trusts have been doing a lot of work off their own back in this area, as our focus was mainly in acute.

“Some organisations have done very well indeed, making very significant and systematic changes to the way in which they provide services, focusing on the activities which we are promoting. Other organisations have incorporated it within different aspects of their work such as quality frameworks and have made different sorts of progress.”

Murray says that whilst those involved in promoting Patient Safety First have been very clear in explaining the cause and aims, along with suggesting some evidence based interventions, they haven’t prescribed a one size fits all approach.

“There are differences in what different organisations have achieved but I think that anyone who has made a specific commitment and has begun the journey has, in their own way, made a difference.”

Although Patient Safety First has been very successful in creating the beginnings of a cultural shift toward patient safety in the health service, campaigners say it is hard to give quantitative examples of the campaign taking effect.

“Recent media coverage has highlighted how difficult it is to develop reliable ways of measuring patient safety or even determining what a good measure of patient safety is.

“What we have seen is organisations being able to link improvements to a reduction in specific types of harm within their organisations. Last year, Dr Foster reported a seven per cent reduction across the board in the standardised hospital mortality rate.”

One area which has seen significant improvements is that of cardiac arrests occurring outside accident & emergency and critical care units.

“There is both hard data and anecdotal data which says that the number of cardiac arrests occurring in general wards has dropped significantly. This is because of the way that trusts have been able to put in place reliable systems of improvement in both observation and early warning systems.”

As an example of this improvement, Murray cites Salford Royal NHS Foundation Trust’s Hope Hospital which has seen a 35 per cent reduction in its cardiac arrest calls during the period when teams where working on that intervention.

“Another trust which has seen a similar reduction is Guy’s and St Thomas’ NHS Foundation Trust, reporting significant reductions in incidents of cardiac arrest in their medical directorate. Their figures are very impressive.”

Given that the whole point of the health service is to make patients better, some have wondered why a campaign to protect patient safety is only voluntary.

“This was a very deliberate decision,” says Murray. “The campaign is about building the will to effect change and improvement at many different levels within the organisation. At an executive level, having the board’s commitment is very important, but equally for change to be real and sustainable, it has to permeate different parts of the organisation.

“Because of this, we wanted to make the cause and the aim of Patient Safety First so compelling that people would want to be part of it and would make a conscious choice to be part of it.”

This reasoning holds true. People will only enable change to happen if they themselves are passionate about the cause. It should go without saying in the health service but in an organisation as large as the NHS, sometimes it is important for both those in charge and those on the ground to reassess the core values of what they are doing and why they are doing it.

1 http://www.patientsafetyfirst.nhs.uk/Content.aspx?path=/About-the-campaign/FAQs/#What%20is%20patient%20safety?

2 http://www.patientsafetyfirst.nhs.uk/Content.aspx?path=/About-the-campaign/FAQs/#What%20is%20patient%20safety?