Analysis
NHS England learns lessons from Scottish colleagues on improving patient safety A standardised programme in Scotland to improve protection of health service patients has also had a positive impact on staff. Jennifer Trueland reports ACCORDING TO internationally renowned health expert Donald Berwick, when it comes to learning about patient safety, the NHS in England should cast its eyes northwards. The president emeritus and senior fellow with the US-based Institute for Healthcare Improvement, who was called in by prime minister David Cameron to review patient safety in light of the Francis report, has made no secret of his admiration for the Scottish health service and its attempts to create a culture of safety. ‘The Scottish Patient Safety Programme marks Scotland as a leader, second to no nation on earth, in its commitment to reducing harm to patients, dramatically and continually,’ he writes on the institute’s website. In the wake of the Berwick review, NHS England has announced plans to set up a network of Patient Safety Collaboratives (PSCs). Fifteen PSCs, covering every part of England, would support staff and others to improve the safety of their systems of care. There would also be an NHS Improvement fellows programme, with the aim of awarding 5,000 individuals in five years. Quality improvements The plans have strong similarities to the Scottish Patient Safety Programme, which also has a ‘fellows’ strand and promotes a culture of continuous quality improvement. Senior nurses, and managers with a background in nursing, have played a strong part in developing and implementing the Scottish programme. For example, current lead Jo Matthews is a former senior nurse who worked 12 March 2014 | Volume 20 | Number 10
as a strategic commissioner with the then Brighton and Hove Primary Care Trust. So what lessons can the Scottish experience offer to colleagues south of the border? ‘The Scottish Patient Safety Programme has a tangible impact on patients, but also on clinicians, staff and managers,’ says Ms Matthews. ‘It has made big improvements and really changed the culture of the health service.’ The evidence behind improvement methodologies used by the Scottish programme is sound, she says, and the required outcomes – in terms of making systems reliable and consistent – are achievable.
But good leadership across the healthcare team is required. ‘It is about building capacity to make change happen,’ she says. ‘You have to build goodwill, be clear what you’re asking people to do, and get engagement at all levels.’ Other lessons include using data to improve services, and sharing learning. Motivating staff Barbara-Anne Niven, senior charge nurse in surgical rehabilitation at Forth Valley Royal Hospital in Larbert, near Stirling, says safety is now firmly embedded in her organisation. ‘The programme came to us in 2009 when it was rolled out in specific areas in acute hospitals,’ she says. ‘As a senior charge nurse you have to help motivate the team. You know there will be some people who will be ahead, and some that you’ll have to pull along. Now we can demonstrate that we are providing good and safe care; it is part of the culture.’
Creating an organisational culture that protects children As a Scottish Patient Safety Programme fellow, Jennifer Rodgers has been instrumental in changing paediatric care across the whole of Scotland’s biggest health board area. When she was senior charge nurse on a general paediatric ward in the Royal Alexandra Hospital in Paisley, she introduced the concept of community ‘huddles’, which bring multidisciplinary teams together twice a day for information updates. The scheme was so successful it has been expanded across NHS Greater Glasgow and Clyde. ‘The idea is to keep the organisation safe,’ she explains. ‘So if there are risks – such as two children with the same name, or a child is receiving an unfamiliar infusion – then that will be raised so everyone knows about it. We also have patients we call “watchers”, children that we’re worried about. The information is
passed on to everyone and it’s also written on a white board.’ As part of her fellowship, Ms Rodgers was able to visit Cincinnati Children’s Hospital in the US to see patient safety initiatives in action. Her interest in international experience and tools also led to another Scottish first – the adaptation of an American idea, called Lauren’s List, which is written by patients and sets out what they want from nurses and other healthcare staff. Happy nurses The Scottish version, called ‘What matters to me’, has proved popular with patients and useful for staff. ‘It can be things like “Please knock before coming in”, or “I want the nurses to be happy”. Even at that age children know that happy nurses make a difference.’ Since she began her patient safety work, Ms Rodgers moved to a new post promoting
NURSING MANAGEMENT
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best hospitals in the world,’ he says. ‘Since 2007, the Scottish Patient Safety Programme has seen a reduction in hospital standardised mortality rates of 12.4%; this is around 10,500 less deaths than expected. ‘We are delighted that the Department of Health in England is establishing a national patient safety programme based on the Scottish model.’
One of the first steps involved implementing so-called ‘surgical pauses’ – short meetings to set the tone at the start of each day where every member of the team is encouraged to raise any safety concerns. ‘Everyone has a voice. If the nursing auxiliary notices that the surgeon has marked the wrong leg for surgery, then he or she can raise it. It’s all about safety and minimising risk,’ Ms Niven says. She admits it was challenging to persuade everyone that these meetings were a valuable use of time. ‘It is a five- to ten-minute meeting when you’re not delivering direct patient care,’ she says. ‘But you have to get staff engagement so they recognise it’s actually about providing better, safer patient care.’ The programme has enjoyed high-level support from the Scottish Government and senior managers. Health secretary Alex Neil told Nursing Management that Scotland is leading the way. ‘It was the first country in the world to implement a patient safety programme across the whole healthcare system, and it has some of the safest and
Small initiatives help to paint the bigger picture
quality and safety within the health board, and is now working at Glasgow’s Royal Hospital for Sick Children at Yorkhill. Promoting and fostering a safety culture is clearly her passion – and she recommends the fellowship route. ‘It was a life-changing course,’ she says. ‘I was introduced to people I would never have met otherwise, both internationally and in Scotland. I was able to glean this super knowledge in a really supportive atmosphere.’ Clinical leaders are vital for developing a culture of safety, she says, but they should do so mindfully: ‘It’s important to be kind – people come into work believing they are doing a good job, so don’t come up to them and say “You’re rubbish”. ‘You have to be gentle, but firm. After all, you’re constantly trying to build capacity and capability.’
The Scottish Patient Safety Programme was launched in its current form in 2010, building on the work of the Scottish Patient Safety Alliance, founded three years earlier. The programme began with a focus on acute adult care, but has since expanded to include paediatrics, maternity and neonatal care, mental health and primary care. There are also work streams, such as a focus on sepsis, which straddle all clinical areas. Its objective is to steadily improve the safety of health care across the country, using evidence-based tools and techniques to improve the reliability and safety of everyday systems and processes. In hospitals, the programme includes initiatives such as structured handovers, surgical pauses and care ‘bundles’ covering areas including pressure ulcer prevention and early warning scores. Further information can be found at www.scottishpatientsafetyprogramme. scot.nhs.uk/programme
NURSING MANAGEMENT
Recruitment issues Simply having a programme in place is not a cure-all for patient safety issues, however. RCN Scotland warns that more needs to be done to ensure that the right number of suitably skilled nurses are in place before a safe health service can become a reality. ‘The Scottish Patient Safety Programme is only as good as the people available to deliver it, and health boards are struggling to recruit enough front line staff to provide high quality and safe patient care,’ says RCN Scotland associate director Norman Provan. The college is pressing the Scottish Government to make sure that every health board has an assurance system in operation, where data on issues affecting patient safety, such as staffing, demand and pressures, are collated in real time. ‘This will increase nursing and clinical scrutiny of decisions, and allow action to be taken to improve patient care and follow up on any concerns raised,’ Mr Provan adds. Colleagues from England are already taking the Scottish lessons on board; Ms Niven recently spent time with a senior charge nurse from the East of England, who visited Forth Valley to find out more about the Scottish Patient Safety Programme. ‘They were doing a lot of the same things, but not as standard,’ she says. ‘Not formally branded under that patient safety umbrella.’ ‘Having the national programme has really helped. It has streamlined what we were doing… it has given patient safety momentum, and that’s important.’ Jennifer Trueland is a freelance writer March 2014 | Volume 20 | Number 10 13
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NHS England learns lessons from Scottish colleagues on improving patient safety A standardised programme in Scotland to improve protection of health service patients has also had a positive impact on staff. Jennifer Trueland reports ACCORDING TO internationally renowned health expert Donald Berwick, when it comes to learning about patient safety, the NHS in England should cast its eyes northwards. The president emeritus and senior fellow with the US-based Institute for Healthcare Improvement, who was called in by prime minister David Cameron to review patient safety in light of the Francis report, has made no secret of his admiration for the Scottish health service and its attempts to create a culture of safety. ‘The Scottish Patient Safety Programme marks Scotland as a leader, second to no nation on earth, in its commitment to reducing harm to patients, dramatically and continually,’ he writes on the institute’s website. In the wake of the Berwick review, NHS England has announced plans to set up a network of Patient Safety Collaboratives (PSCs). Fifteen PSCs, covering every part of England, would support staff and others to improve the safety of their systems of care. There would also be an NHS Improvement fellows programme, with the aim of awarding 5,000 individuals in five years. Quality improvements The plans have strong similarities to the Scottish Patient Safety Programme, which also has a ‘fellows’ strand and promotes a culture of continuous quality improvement. Senior nurses, and managers with a background in nursing, have played a strong part in developing and implementing the Scottish programme. For example, current lead Jo Matthews is a former senior nurse who worked 12 March 2014 | Volume 20 | Number 10
as a strategic commissioner with the then Brighton and Hove Primary Care Trust. So what lessons can the Scottish experience offer to colleagues south of the border? ‘The Scottish Patient Safety Programme has a tangible impact on patients, but also on clinicians, staff and managers,’ says Ms Matthews. ‘It has made big improvements and really changed the culture of the health service.’ The evidence behind improvement methodologies used by the Scottish programme is sound, she says, and the required outcomes – in terms of making systems reliable and consistent – are achievable.
But good leadership across the healthcare team is required. ‘It is about building capacity to make change happen,’ she says. ‘You have to build goodwill, be clear what you’re asking people to do, and get engagement at all levels.’ Other lessons include using data to improve services, and sharing learning. Motivating staff Barbara-Anne Niven, senior charge nurse in surgical rehabilitation at Forth Valley Royal Hospital in Larbert, near Stirling, says safety is now firmly embedded in her organisation. ‘The programme came to us in 2009 when it was rolled out in specific areas in acute hospitals,’ she says. ‘As a senior charge nurse you have to help motivate the team. You know there will be some people who will be ahead, and some that you’ll have to pull along. Now we can demonstrate that we are providing good and safe care; it is part of the culture.’
Creating an organisational culture that protects children As a Scottish Patient Safety Programme fellow, Jennifer Rodgers has been instrumental in changing paediatric care across the whole of Scotland’s biggest health board area. When she was senior charge nurse on a general paediatric ward in the Royal Alexandra Hospital in Paisley, she introduced the concept of community ‘huddles’, which bring multidisciplinary teams together twice a day for information updates. The scheme was so successful it has been expanded across NHS Greater Glasgow and Clyde. ‘The idea is to keep the organisation safe,’ she explains. ‘So if there are risks – such as two children with the same name, or a child is receiving an unfamiliar infusion – then that will be raised so everyone knows about it. We also have patients we call “watchers”, children that we’re worried about. The information is
passed on to everyone and it’s also written on a white board.’ As part of her fellowship, Ms Rodgers was able to visit Cincinnati Children’s Hospital in the US to see patient safety initiatives in action. Her interest in international experience and tools also led to another Scottish first – the adaptation of an American idea, called Lauren’s List, which is written by patients and sets out what they want from nurses and other healthcare staff. Happy nurses The Scottish version, called ‘What matters to me’, has proved popular with patients and useful for staff. ‘It can be things like “Please knock before coming in”, or “I want the nurses to be happy”. Even at that age children know that happy nurses make a difference.’ Since she began her patient safety work, Ms Rodgers moved to a new post promoting
NURSING MANAGEMENT
Downloaded from RCNi.com by ${individualUser.displayName} on Nov 22, 2015. For personal use only. No other uses without permission. Copyright © 2015 RCNi Ltd. All rights reserved.
best hospitals in the world,’ he says. ‘Since 2007, the Scottish Patient Safety Programme has seen a reduction in hospital standardised mortality rates of 12.4%; this is around 10,500 less deaths than expected. ‘We are delighted that the Department of Health in England is establishing a national patient safety programme based on the Scottish model.’
One of the first steps involved implementing so-called ‘surgical pauses’ – short meetings to set the tone at the start of each day where every member of the team is encouraged to raise any safety concerns. ‘Everyone has a voice. If the nursing auxiliary notices that the surgeon has marked the wrong leg for surgery, then he or she can raise it. It’s all about safety and minimising risk,’ Ms Niven says. She admits it was challenging to persuade everyone that these meetings were a valuable use of time. ‘It is a five- to ten-minute meeting when you’re not delivering direct patient care,’ she says. ‘But you have to get staff engagement so they recognise it’s actually about providing better, safer patient care.’ The programme has enjoyed high-level support from the Scottish Government and senior managers. Health secretary Alex Neil told Nursing Management that Scotland is leading the way. ‘It was the first country in the world to implement a patient safety programme across the whole healthcare system, and it has some of the safest and
Small initiatives help to paint the bigger picture
quality and safety within the health board, and is now working at Glasgow’s Royal Hospital for Sick Children at Yorkhill. Promoting and fostering a safety culture is clearly her passion – and she recommends the fellowship route. ‘It was a life-changing course,’ she says. ‘I was introduced to people I would never have met otherwise, both internationally and in Scotland. I was able to glean this super knowledge in a really supportive atmosphere.’ Clinical leaders are vital for developing a culture of safety, she says, but they should do so mindfully: ‘It’s important to be kind – people come into work believing they are doing a good job, so don’t come up to them and say “You’re rubbish”. ‘You have to be gentle, but firm. After all, you’re constantly trying to build capacity and capability.’
The Scottish Patient Safety Programme was launched in its current form in 2010, building on the work of the Scottish Patient Safety Alliance, founded three years earlier. The programme began with a focus on acute adult care, but has since expanded to include paediatrics, maternity and neonatal care, mental health and primary care. There are also work streams, such as a focus on sepsis, which straddle all clinical areas. Its objective is to steadily improve the safety of health care across the country, using evidence-based tools and techniques to improve the reliability and safety of everyday systems and processes. In hospitals, the programme includes initiatives such as structured handovers, surgical pauses and care ‘bundles’ covering areas including pressure ulcer prevention and early warning scores. Further information can be found at www.scottishpatientsafetyprogramme. scot.nhs.uk/programme
NURSING MANAGEMENT
Recruitment issues Simply having a programme in place is not a cure-all for patient safety issues, however. RCN Scotland warns that more needs to be done to ensure that the right number of suitably skilled nurses are in place before a safe health service can become a reality. ‘The Scottish Patient Safety Programme is only as good as the people available to deliver it, and health boards are struggling to recruit enough front line staff to provide high quality and safe patient care,’ says RCN Scotland associate director Norman Provan. The college is pressing the Scottish Government to make sure that every health board has an assurance system in operation, where data on issues affecting patient safety, such as staffing, demand and pressures, are collated in real time. ‘This will increase nursing and clinical scrutiny of decisions, and allow action to be taken to improve patient care and follow up on any concerns raised,’ Mr Provan adds. Colleagues from England are already taking the Scottish lessons on board; Ms Niven recently spent time with a senior charge nurse from the East of England, who visited Forth Valley to find out more about the Scottish Patient Safety Programme. ‘They were doing a lot of the same things, but not as standard,’ she says. ‘Not formally branded under that patient safety umbrella.’ ‘Having the national programme has really helped. It has streamlined what we were doing… it has given patient safety momentum, and that’s important.’ Jennifer Trueland is a freelance writer March 2014 | Volume 20 | Number 10 13
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