How can good ideas to improve patient safety become a reality?
Six years ago, the then Prime Minister, David Cameron, asked Professor Don Berwick to lead a review of patient safety in England. The review came in the wake of a number of high-profile failures in care, most notably at Mid Staffordshire.
Professor Berwick’s report marked a step change in the discourse around patient safety; it was a ray of light amidst the gloom that preceded it. The workforce that had been so heavily criticised was seen again as part of the solution, rather than part of the problem.
Notably, the report stated that “rules, standards, regulations and enforcement have a place in the pursuit of quality, but they pale in potential compared to the power of pervasive and constant learning”. It recommended the establishment of a network of safety improvement collaboratives to achieve this. As a result, the National Patient Safety Collaborative Programme was born, and UCLPartners has been part of it since its inception in 2014.
The Berwick report stated that “the best networks are those that are owned by their members, who determine priorities for their own learning”. We’ve tried to embody this, believing that frontline teams can make improvements more quickly and effectively working together rather than in silos; that if one team has a problem there’s a good chance another has solved it. The work we supported in 13 hospitals to drive improvements in the management of Sepsis and Acute Kidney Injury is a brilliant example of this.
Our work on deterioration also shows the difference that can be made when the “blunt end” of the system (where resources are generated, or policies established) are aligned to the “sharp end” (where care is delivered). But more often than not, the blunt end can get in the way of good ideas becoming reality.
Therefore, in February, we invited bids from frontline teams across our region as part of a new Innovation Adoption Fund for Patient Safety. Teams could bid for up to £10,000 to support the further testing, adoption or spread of an intervention or innovation to improve patient safety.
The idea was simple – that many great ideas already exist across the NHS, ideas that teams are keen to adopt, but practical barriers often stand in the way. These barriers are usually a lack of resource and protected staff time to implement them.
After receiving nearly 50 applications and inviting 9 teams to pitch their idea to a panel, we recently announced the five successful teams. They are:
- Princess Alexandra Hospital: to introduce a procalcitonin test to improve the management of patients with suspected sepsis in the Emergency Department
- Royal Free London Hospital: to implement a new pathway to improve the management of women suffering from post-partum haemorrhage
- Whittington Health: to introduce a programme to train health care assistants to provide enhanced care (one-to-one) for vulnerable or critically ill patients in hospital.
- Homerton Hospital: to introduce an “electronic whiteboard” to enable better detection of patients at risk of deterioration
- Barnet Hospital: to implement a programme to transform the care of babies in the neonatal unit, which makes parents primary caregivers in partnership with clinical teams.
As an Academic Health Science Partnership, we’re well placed to support fantastic ideas like these, at the interface between research, practice and industry. It’s also a privilege to be able to do so.
Learning from innovation
Along with the teams, we’re going to learn a lot over the coming months. Some of the questions we hope to be able to answer include, what types of adaptations will teams need to make in order to make the intervention a success, and how might this benefit others who want to adopt the interventions in future? We’ve already learnt a few things from the process so far:
- No boundaries: Despite the often quoted “not invented here phenomenon”, teams in the NHS seem all too willing and enthusiastic to adopt ideas developed elsewhere
- Not just technology: “Innovation” comes in many forms, often as service or process improvements, not just the introduction of new technologies
- Local solutions to national challenges: Local teams have ideas to address challenges that are common to many if not all organisations, and this Fund provides a unique opportunity to test them and understand their potential to scale
None of these projects will be easy to implement. Some of them are complex, requiring significant shifts in culture and behaviour. But six years on from Professor Berwick’s review, by embracing the wealth of ideas and enthusiasm generated by our workforce, we are taking significant steps forward in continuously improving patient safety.