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Learning from what goes well in health care, not just from what goes wrong

1 November 2018 | John Illingworth  🔒

It seems strange to think that, as recently as 25 years ago, the field of patient safety didn’t really exist. At that time, the harm caused by healthcare either wasn’t routinely captured or was accepted as an inevitable consequence of treatment.

Healthcare remains a risky business of course, but patient safety issues, like healthcare-associated infections, are no longer seen as acceptable. This intolerance of harm has been a driving force for many improvements in the intervening years.

But, despite the promise, progress in patient safety has been far slower than expected. There are many possible explanations for this – but could one explanation be that this preoccupation with harm is now holding us back?

The NHS is awash with systems for capturing error, but these systems have often failed to translate into meaningful and widespread improvements. And in stark contrast, there are very few systems in place to capture excellence.

Safety II” thinking in healthcare promotes the idea that, instead of focusing on what has gone wrong, further progress can be made by understanding and learning from what goes right. As startling as it is that 1 in 10 patients are harmed because of their healthcare, 9 out of 10 patients will receive good, and often excellent, care.

Since 2014, a team in Birmingham, led by Dr Adrian Plunkett, have sought to systematically capture and study peer-reported excellence in healthcare. Using a simple online or paper form, staff can capture an episode of excellent care they observed from a colleague, answering three simple questions:

  • What did they do?
  • What can we learn from this?
  • What might we do differently in the future?

At its simplest, this Learning from Excellence approach can be an effective staff well-being intervention at a time of significant stress – and the evidence is mounting on the effect that staff well-being has on quality of care.

Used more systematically, the approach can generate wider organisational learning, improve staff resilience, and provide the basis for effective quality improvement work. Learning from Excellence has become a social movement, with a national conference taking place later this month.

To support this approach, UCLPartners is establishing a Learning from Excellence community. The aim of the community is to support teams who are interested in adopting this approach or spreading it more widely if they have already begun to use it.

Anyone can join the community – you can register for our first event here, which will take place on 28 November. At the event you will hear from Adrian Plunkett as well as from teams who are already using the Learning from Excellence approach.

Supporting improvements in culture is a major focus for UCLPartners. Learning from Excellence is one of a suite of improvement programmes we offer that have the potential to improve patient safety, boost staff morale and strengthen leadership.

Team and organisational cultures don’t change overnight, and the benefits of any change can take years to be realised. But we know it’s the right place to focus, as a positive culture can underpin the successful implementation of the next innovation, improvement or transformation, ultimately leading to better outcomes for all.