A week is (apparently) a long time in politics. A month, therefore, must be seen as an eternity in context of the NHS. That just happens to be how long I have now been in post full-time as Patient Safety Programme Manager for the West Midlands Patient Safety Collaborative.
So what is the Patient Safety Collaborative (PSC)? Each of the 15 Academic Health Science Network regions has a PSC, which is based with the AHSN. The tagline for the PSCs is: “the collaboratives will empower local patients and healthcare staff to work together to identify safety priorities and develop solutions. These will then be implemented and tested within local healthcare organisations before being shared nationally with the other collaborative”.
It could be snappier, I guess, but the key message is that regions, via the PSCs’ select patient safety priorities, collaborate and share learning. Simplistically, PSCs form part of the bundle of interventions being unleashed nationally in response to Don Berwick’s report and its rallying cry for the NHS to becoming a system dedicated to continuous learning to drive quality improvement.
It’s fair to say, however, we are off the map here. There is no well-worn path we can follow which guarantees the success of collaboratives on this scale. Experienced ramblers or the parents of young children (I’m both) will recognise how simultaneously exhilarating and ever so slightly scary this step off into the complex unknown can be.
Building networks can help us to navigate this terrain I’m sure (more of this later), but first a word about words. I have been involved with some fairly esoteric discussions lately around whether we should be building collaboratives, networks or communities of practice.
It’s reminded me of one of my favourite Comic Strip Presents episodes. Some of you may remember the Comic Strip from TV in the 80’s (it starred amongst others, Rik Mayall and Ade Edmonson). One episode was a documentary about the spoof metal band Bad News. There is a scene where two members of the band almost come to blows in the back of the tour van in an argument over whether the metal band Bad News is in fact a metal band.
What has this got to do with the PSC? Well, I would suggest debating the precise meaning of networks, collaboratives and communities of practice shares about the same level of utility as that argument in the Bad News tour van. PSCs have been set a challenge and in a deeply social system like the NHS bringing people together round a common cause isn’t best served, I would suggest, by spending time debating semantics.
But what could this bringing people together round a common cause actually mean for the PSC? For good or ill, here are some thoughts.
For a given priority (West Midlands PSC’s are sepsis, harms in care homes, drug safety and building capability in human factors), we need to bring together not just a multi-disciplinary team but a ‘multi-lens’ team.
Knotty safety problems need a rich understanding of reality based on best evidence, learning from elsewhere and bringing together multiple views of a system. Patients and carers have a key role here and see and experience things from a unique perspective. What we know about human factors in safety and the concept of situational awareness tells us we can’t experience situations as a whole but only our unique ‘segment’ of reality at any given time. This has to be matched with other views of the world and mental models shared to allow us to make informed judgements on what safe should look like.
We obviously have a huge amount of clinical expertise, but there are also skills in human factors and tools and techniques used in other industries in our region that can help us get to grips with proactively looking for where safety risk exists in our systems.
Safety needs to be a systems level property built by collaboration across the pathways that patients use. Under the banner of the PSC and focused on a specific safety priority, we could build collaborative clusters across a smaller cross section of our system and learn a lot. Other industries use structured safety cases to define from the bottom up the safety of their systems. Could we build, say, a systems safety case for sepsis with patients, acute trusts, GPs, community providers and the ambulance service? How about a commissioner as owner of the safety case which informs their commissioning model of the system?
The staff who work in our system are immensely resilient in the face of processes and organisational boundaries that more often than not haven’t been constructed to design out safety hazards. This resilience tells us huge amounts about how safety can work and what best practice might look like. We do need to proactively look for safety hazards, but let’s not forget how often staff maintain safety in the face of adversity; appreciative enquiry can tell us a lot about what works. Work rounds can be dangerous but then again they can be the right thing to do in the face of a broken system, so let’s see if we can use that creativity people have.
Entirely flying in the face of my previous argument I’m going to take a stab at applying some terminology. I would say collaboratives are the multi-lens teams we can bring together to look at a specific priority. The community of practice will be all patients and colleagues across the region we can engage in sharing best practice about safety and networking to learn together. Most of all, a community can support and encourage us as the going is inevitably tough. It brings things down to the human level in the face of this complex system of ours.
I have met a lot of people over the past few weeks and look forward to working with a lot more. So, time to get back in the PSC tour van I guess.
Peter Jeffries is Patient Safety Programme Manager at the WMAHSN.