What does a manager need to do to be safe?

Patient safety is now the vogue – everyone is getting on board – but for many different reasons. Patient are leading the way and there is a strong developing patient safety movement, writes Dr. Peter Lachman.

Dr. Peter Lachman
Dr. Peter Lachman

It is a reflection of the challenge we face if it is the patients who have to worry about their safety. First do no Harm, the Hippocratic Oath is the foundation of medicine and over the years we have started to understand that harm is one of the features of modern medicine. In fact, this has always been the case and it is not something new. In antiquity, the Code of Hammurabi is an example of the approach to safety and how we have moved on. https://en.wikipedia.org/wiki/Code_of_Hammurabi

However, blame and shame are still part of the fabric of healthcare. Over the past thirty years the Science of Patient Safety has developed with numerous theories and concepts all aimed at dealing with the complexity of healthcare and the potential threats that exist, the solutions that are available and the need to engineer a culture of safety. Healthcare is a little late in the safety movement despite the early ideal of First do no Harm.

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To clinicians and healthcare providers of all types, being safe is a challenge. Particularly with an aging population and our great success in keeping people alive, with complex and multi organ problems. Our systems were not designed with safety in mind and we are now playing catch up. What does a manager need to do to be safe? There is a practical way to approach the issue. In 2014, Charles Vincent and colleagues published a framework on patient safety aimed at executives and managers as well as at clinicians. http://qualitysafety.bmj.com/content/qhc/23/8/670.full.pdf

Our systems were not designed with safety in mind and we are now playing catch up.

They stated succinctly that the proposed framework “can guide clinical teams and healthcare organisations in the measurement and monitoring of safety and in reviewing progress against safety objectives. The framework has been used so far to promote self-reflection at both board and clinical team level, to stimulate an organisational check or analysis in the gaps of information and to promote discussion of ‘what could we do differently”. Basically, there are five questions to be asked and to be examined retrospectively and prospectively:

  1. Has patient care been safe in the past? We need to assess rates of past harm to patients, both physical and psychological.
  2. Are our clinical systems and processes reliable? This is the reliability of safety critical processes and systems but also the capacity of the staff to follow safety critical procedures.
  3. Is care safe today? This is the information and capacity to monitor safety on an hourly or daily basis. We refer to this as ‘sensitivity to operations.’
  4. Will care be safe in the future? This refers to the ability to anticipate, and be prepared for, problems and threats to safety.
  5. Are we responding and improving? The capacity of an organisation to detect, analyse, integrate, respond and improve from, safety information

Now four years later they report on the impact of the use of this framework in a recent paper. http://qualitysafety.bmj.com/content/qhc/early/2018/03/06/bmjqs-2017-007175.full.pdf

The success of implementation was mixed and the conceptual aspects at times a challenge. This is not surprising as it requires a radical mind shift and a change in behaviour and normal operations. They conclude that successful implementation required leadership, time to comprehend the new conceptual approach and paradigm, and a realignment of resources and focus.

After all, that is not so surprising. There are many frameworks out there but not many succeed unless the leaders commit in word and deed. As we look at patient safety going forward I challenge the leaders of healthcare organisations to take on this commitment – to make safety the business of healthcare. This framework can work from Ward to Board with the commitment of leadership. It is what every clinical team should use on a daily basis and should be the foundation of an organisation’s approach to protecting the patients from harm with executives and the Board changing its approach to safety.

Only then can patients stop worrying about patient safety.