Bridging healthcare divides: how collaboration aids learning to deliver better, safer care

Cassandra Cameron profile picture

19 October 2017

Cassandra Cameron
Policy Advisor - Quality


This year’s quality strand at our annual conference and exhibition, taking place on 7-8 November in Birmingham, will explore three innovative approaches that NHS organisations are taking to bridge conventional healthcare divides, and establish cultures of learning and quality improvement which are underpinned by a systems approach to patient safety.

 

Learning from mistakes

Our first session will focus on how the NHS can improve learning through more effective investigations that take a wider view of patient safety and don’t apportion blame or liability. It is often said that the NHS doesn’t ‘learn enough’ from its mistakes. Sharing learning and good practice are key to reducing variation in care outcomes and making healthcare safer.

However, when learning in the NHS takes place and processes and behaviours change accordingly, it often remains localised to teams or services. Improving how the NHS systematically learns and improves safety has underpinned recent national policy initiatives and the NHS now reports almost 2million incidents a year to the safety-focused National Reporting and Learning System.

The persistent nature of harm begs the question: can the approach we take to learning be a reason why we struggle to improve safety and quality in care?

Cassandra Cameron    Policy Advisor - Quality

 

But the persistent nature of harm – especially falls, pressure ulcers, medication errors, ‘never events’ – begs the question: can the approach we take to learning be a reason why we struggle to improve safety and quality in care?

Healthcare has begun to examine how other safety-critical industries learn from mistakes. Common factors include thematic and systems-based analyses of accidents, and management practices and operating procedures that empower staff to be the strength in the system.

The NHS Human Factors In Healthcare Concordat drew on current safety and quality improvement science across such industries to set out key principles for changing the way the NHS approaches patient safety and preventing, investigating and learning from harm. Central to the Concordat’s ambitions is a stronger alignment of the NHS system to skillfully investigate incidents, identify organisational and system weaknesses that present risk to safety, and build genuine learning organisations.

 

Getting to know the Healthcare Safety Investigations Branch

The new independent Healthcare Safety Investigations Branch (HSIB), led by chief investigator Keith Conradi, has been established to drive this NHS-wide transformation in learning and safety improvement. Since becoming operational in April 2016, HSIB has built a 30-strong investigative team with backgrounds in the NHS, aviation and military investigations and human factors, who will collaborate with and support trusts to build local expertise.

Delegates will learn how members of the Healthcare Safety Investigations Branch (HSIB) team will work with trusts to improve local investigative capability and deliver safer care.

Cassandra Cameron    Policy Advisor - Quality

In our Getting to know the Healthcare Safety Investigations Branch session, delegates will learn from members of HSIB’s team about their wealth of experience, work with the NHS to date, what a ‘safe space’ really means in practice, and how they will work with trusts to improve local investigative capability and deliver safer care.

 

'Zero Suicide' approach

As the second session in our quality strand will discuss, joining up the learning in healthcare is critical with respect to suicide. There is a significant shift taking place incrementally in the NHS that challenges prevailing cultural views about the inevitability of most suicides.

It is driven by mounting evidence that a ‘Zero Suicide’ approach within healthcare can indeed reduce rates of suicide. To succeed, healthcare organisations and their local partners must work together to more proactively screen for and share knowledge about those at risk, improve training for staff, and learn through collaboration with families bereaved by suicide.

Mersey Care, which has developed a scientific model for Zero Suicide was an early adopter of this approach, and zero suicide has also been piloted in the East of England with impressive results. It is clear that a shared vision, based on real partnerships between community groups, the third sector and the statutory sector can unlock previously unrecognised social capital and local knowledge, and develop creative and effective locally tailored approaches that work.

Our second session on why the whole NHS must focus on suicide prevention will explore efforts underway within NHS secondary mental health services and their local partners towards improving awareness and skills for suicide prevention and new technologies to support people vulnerable to suicide. Delegates will be able to hear a first-hand account of why this matters and how it is about to become a priority for all providers across the full spectrum of NHS care.

Our second session explores efforts underway within NHS secondary mental health services and their local partners towards improving awareness and skills for suicide prevention.

Cassandra Cameron    Policy Advisor - Quality

 

Bridging the divide 

The third session in our quality strand will explore early outcomes of a programme designed to bridge another healthcare divide – that between clinicians and managers. With scarce NHS resources more stretched than ever, sustained high quality care depends on a shared understanding between managers and clinical staff of the organisation’s priorities and the decisions needed to achieve and protect them.

There is evidence that these relationships are straining as the financial, workforce and regulatory pressures bite trusts harder. Local systems transformation adds another challenge and clinical engagement in the early phase of STPs has generally not been strong.

As ‘incidental hybrids’, many NHS managers, promoted into their roles from clinical backgrounds, strive to balance the competing operational, managerial and clinical imperatives in their work.

Cassandra Cameron    Policy Advisor - Quality

 

The conflict can also often lie within an individual themselves. Many NHS managers, promoted into their role from clinical backgrounds, are constantly striving to balance the competing operational, managerial and clinical imperatives in their work.  As ‘incidental hybrids’ they tend to learn the management side of their roles on the job and can often struggle to find the time, support and appropriate training to effectively fulfil this dual role.

The Royal College of Physicians’ Chief Registrars programme aims to tackle these issues through a new role, recommended by the Future Hospital Commission, to build stronger leadership, management and quality improvement skills of senior doctors within hospitals.

A recent independent evaluation of the first cohort of 21 chief registrars across 18 NHS acute trusts identified significant benefits for those organisations. These included better communication between junior doctors, with senior clinical leaders and managers, stronger staff engagement and improved morale. 

We explore the early outcomes of a Royal College of Physicians chief registrars programme designed bridge another healthcare divide – that between clinicians and managers.

Cassandra Cameron    Policy Advisor - Quality

  

The Chief Registrar’s quality projects achieved impressive improvements to patient flow, discharge processes, safety, patient experience and rota management. Our fostering clinical leadership for quality improvement: chief registrars as ‘willing hybrids’ session will explore the benefits and challenges of the role and how ‘willing hybrids’ – strategic clinician managers’ - can help trusts improve relationships between senior leaders and the front line through strategic leadership for quality improvement.

 

Bookings for #NHSP17 are still open. Special rates are available for NHS Providers’ members, NHS, charity and public sector delegates. To find out more and register online, visit www.nhsproviders.org/2017

About the author

Cassandra Cameron profile picture

Cassandra Cameron
Policy Advisor - Quality
@cassculture

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