Sep 172019

Mike Fealey, Head of Patient Safety at 1000 Lives Improvement, shares his thoughts on the use of the words “Patient Safety”

The use of the term “patient” has often been queried in some areas of healthcare. In maternity they have expectant mothers – not patients; some areas of mental health and learning disability use service user – not patients. But soon, 1000 Lives Improvement service will be transitioning into Improvement Cymru, and our remit will expand to include social care where the term ‘patient safety’ has even less or no meaning. So, a bold question coming from  Head of Patient Safety but there is an argument that it is time to change the focus from ‘patient safety’ to just ‘safety’ or ‘safety culture’.

I’m in good company because Liam Donaldson, writing in the foreword of IHI Patient Safety Officer’s Guide (2009) stated “Patient safety should not ultimately be a field in itself but be deeply ingrained throughout the field of (health) care industry” 1

There has been an increased focus on Patient Safety in the UK since the launch of the National Patient Safety Agency (NPSA) in 2001. At that time it was estimated that 840,000 incidents and errors occurred in the NHS every year.

The idea behind the NPSA was to create a learning system that used tools, developed in other safety critical industries i.e. aviation, nuclear, rail, etc., to improve organisational safety and reduce avoidable harm. These tools had been proved successful in creating and sustaining a ‘safety’ culture in the industries in which they were used and have had some success across the NHS since 2001.

Wales further promoted the patient safety agenda with the launch of the 1000 Lives campaign in 2008. This was based on the ‘Saving 100,000 Lives’ campaign in the USA that promoted the use and monitoring of evidence based ‘bundles of care’ to reduce avoidable harm in a number of specific areas, generally in hospital. These included Ventilator Associated Pneumonia, Hospital Acquired Thrombosis, Lower Segment Caesarean Sections, and others.

The first time the term ‘Safety Culture’ was used was following the International Atomic Energy Agency’s initial report into the Chernobyl disaster (IAEA, 1986).  Although there has been many studies, publications, articles and reports relating to safety culture, there is still no agreed definition. Some definitions include2:

  • ‘The way we do things around here’ (Confederation of British Industry (CBI) 1990);
  • ‘A set of attitudes, beliefs or norms’ (Turner, 1989);
  • ‘A constructed system of meaning (or shared understanding) through which the hazards of the world are understood’ (Pidgeon, 1998);
  • ‘A safety ethic’ (Wert, 1986).

There is another reason why I think we should start to focus more on ‘safety culture’. We must deliberately include the staff who work in those areas and the relatives and contractors who can also interact with the system: Harm figures in healthcare do not usually include the workforce! As well as the potential physical injuries that the workforce can suffer, they are often negatively impacted by being involved in the harm of a “patient”. This psychological harm can lead to isolation, depression, self-harm and in extreme circumstances, even suicide.

Zero harm to “patients” and the workforce is only possible with both a robust culture of safety and an embedded organisational learning system.

So, as part of Improvement Cymru’s new way of working, we will return to an emphasis on the six ‘Domains of Healthcare Quality’ as described by the Institute of Medicine in 19993. They state that any quality system or improvement must be Safe, Timely, Effective, Efficient, Equitable and Person-Centred with ‘Safety’ always shown as Principle number 1!

There is no doubt that creating a safety culture starts at the top. The Board and Senior team have the responsibility for setting the vision and the direction of their organisation and this is another area we look forward to supporting in collaboration with our stakeholders. It’s an exciting time for 1000 Lives / Improvement Cymru, and we recognise that we must adapt our approach to make us relevant to all we work with.

So ditch the words ‘patient safety’? I think I’m becoming ever more in favour.

What do you think?

1 – Institute of Healthcare Improvement: The Essential Guide for Patient Safety Officers: Leonard M, Frankel A, Federico F, Frush K, Haraden C (editors). Chicago: Joint Commission Resources with the Institute for Healthcare Improvement; 2009)

2 – accessed August 2019

3 – Institute of Medicine (IOM). Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, D.C: National Academy Press; 2001

Find out more about the 1000 Lives’ transition to Improvement Cymru here

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