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Cultural shift needed in the face of large-scale risk

Writing for HT World, Phil Taylor, chief digital officer of patient safety tech firm RLDatix, on the strategies needed to reduce harm in healthcare.

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The challenges of COVID-19 have underlined the need for greater efficiencies in healthcare.

UK health secretary Matt Hancock’s recent focus on the need to reduce bureaucracy and the CQC investigating how health and care services can work better together, provided a fresh opportunity for healthcare organisations to look again at improving processes and better managing data.

Using data more effectively and applying the experiences of high reliability organisations can improve efficiency and reduce costs, and also have a dramatic impact on patient safety.

Healthcare is a classic example of a potentially high reliability industry. High reliability organisations work in situations with the potential for large-scale risk and harm, and must balance effectiveness, efficiency and safety.

In healthcare there is hyper-complexity, tight interdependence between different departments for patient outcomes, and multiple levels and hierarchies for decision making. There is also the requirement for fast, emergency action with critical outcomes often within compressed timescales.

Managing data – valuable lessons to be learned

A long-standing strategy for improving healthcare quality and reducing the high cost of patient harm has been to leverage the power of data. Big Data analytics can help identify opportunities for improvement that would be difficult and expensive to track and manage through manual analysis alone.

A move away from paper-based records is an essential step in the journey to better analytics, and something for which the NHS has numerous targets. Digital transformation will bring many benefits which are already being seen in industries such as financial services, aviation and utilities. These sectors also offer numerous lessons on what works and what does not, and can help avoid making the same mistakes in Healthcare which could cause significant harm.

Connecting the data stored in incident reporting solutions with other healthcare systems such as EHRs, will enable organisations to track patient safety data, gain insights and take action.

For example, increased admissions in an ICU can lead to a corresponding increase in the instance of pressure sores.

Identifying such relationships and triggers means that by monitoring the instance of one, we’re alerted to prepare for the other.

The importance of becoming ‘an organisation with a memory’

Learning effectively from the past is essential to ensure patient safety. A key to achieving this goal is to banish information silos. This ensures that opportunities for developing insights into improving patient care can be clearly identified, centralised and triaged. This supports the flow of information through the entire learning cycle.

Taking a systems approach, where best of breed solutions are connected, opens a gateway to insights and creates a transparent learning information system. Such a strategy provides not just a memory for the organisation but also a nervous system. This helps the organisation to learn, develop and respond by applying intelligence as a single high reliability-focused entity.

Culture, safety and why organisations need to be better at listening

To reduce harm it is vital to move from a ‘blame culture’ that can jeopardise patient safety and discourage learning and reflection. Staff fearing a negative response to reporting a patient safety incident, can lead to incidents going unreported. This impairs the ability to analyse and rectify issues, increasing the likelihood of similar incidents occurring in the future.

Two attributes of high reliability organisations are that they are sensitive to operations and defer to expertise.

Effective incident reporting is a key tool in listening to expert feedback, e.g. from the clinicians and people on the frontline with the in-depth knowledge of the processes involved in care delivery.

In a high reliability healthcare organisation everyone is constantly aware of how processes and systems affect patient care and, what is, and what isn’t working.

This focused attention on processes leads to accurate information to support decision making and to introduce or amend processes where required.

Building a high reliability culture

High reliability culture has been proven to deliver significant tangible benefits. Following NHS reforms to create a culture of openness and transparency, studies have shown that openness is indeed associated with lower mortality rates in hospitals.

This approach is encapsulated by the ‘Communication and Optimal Resolution’ (CANDOR) process we use at RLDatix.

Generally, the CANDOR process begins with identification of an event that involves harm and proceeds through response and disclosure, to investigation and analysis, and final resolution.

To support safe outcomes the gathering and analysis of data needs to be targeted at the correct areas and measures.

Research has shown that the three major components in encouraging a safety culture are:

  • a just culture
  • a reporting culture, and
  • a learning culture

How FREDA helps

The CQC is applying the five principles of FREDA (Fairness, Respect, Equality, Dignity and Autonomy – which form the basis of international human rights) to regulate health and social care services.

Everyone should now feel confident to report incidents and give open and honest feedback when responding to staff surveys. Supporting staff to be open about mistakes allows valuable lessons to be learnt so the same errors can be prevented.

Analysis of mortality and high harm events should cover details such as whether an event was reported earlier, if communications with staff and patients or relatives was prompt, and if this led to an outcomes assessment.

This is not possible, if employees do not feel confident to report in full when something does go wrong, so it’s vital to foster the right culture to encourage the behaviours needed, underpinned by supporting process, systems and data.

The benefits of building the right culture

Encouraging and embedding the right culture will help reduce patient harm. Even small improvements in patient safety for procedures that are performed thousands of times per year means the risk is reduced and lives will undoubtedly be saved. Other benefits include:

  • Reduced staff burnout– adopting a process that enables people to report incidents truthfully, without blame or fear of recrimination, reduces stress on staff, already heightened by COVID-19 and enables the organisation to learn from mistakes.  Reducing staff burnout also means fewer employees exiting the profession with the loss of many years of valuable experience.
  • Cost and resource savings– the cost of additional treatments and care for patients that have suffered avoidable harm goes into many £millions per year, and so too does the cost of legal action from victims.

Learn and act now

Applying the experiences of high reliability organisations will improve efficiency and reduce costs. Developing the right culture and better using the data which employees are more comfortable sharing will also have a dramatic impact on patient safety.

Action now will drive real change – and deliver life-saving benefits.

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