The challenge of safety

Most people join a healthcare profession because they want to make a positive difference to people’s health and wellbeing and working on the front line of care can make a real difference to the world. At the same time healthcare organisations are too often in the news at the moment for not so positive reasons. A number of scandals in which people receive poor quality care or even purposeful mistreatment have caught the public’s attention. Healthcare can be quite a risky environment – in fact going in to hospital can be a pretty dangerous thing to do.

The poor-quality care at Mid Staffordshire NHS Foundation Trust during the mid 2000s was one of the most well reported cases of quality failure. A very lengthy public enquiry led by Lord Frances led to an extensive report and recommendations to improve safety and quality and reassure the public. See a link to a summary of the report below.

Executive summary of the report

What do you think went wrong?

What are the key causes of poor quality care?

You can think about:

  • Individual factors
  • Group factors
  • Organisational factors
  • Policy and system factors

How isolated do you feel the ‘Mid Staffs’ case is?

Quality improvement

Although healthcare organisations are clearly different in some ways from business organisations, such as manufacturing or service industries, there have been many efforts over recent years to bring in ideas, tools and techniques from other industries to help improve quality in healthcare. Manufacturing organisations for example often have a strong management focus on reducing the variability in their products and reducing errors in the production process. Treating patients is evidently different to making products, but some similar ideas have been used in healthcare. In particular, there is an increasing focus on learning from current practice – what goes right and what goes wrong – to try to improve quality in a systematic way.

Closely related to the idea of Quality Improvement is the movement for greater patient safety. Hugh McCaughey, the National Director of Improvement at NHS Improvement has produced the following video on the topic:

International experts have also provided many videos on the topic. For example, see these clips from Don Berwick, a leader in patient safety at the Institute for Healthcare Improvement in the USA:

Organisations like NHS Improvement have developed lots of tools and resources to help us engage in quality improvement efforts. One of the key tools in widespread use is that of the Plan Do Study Act cycle, which is intended to act as a guide to help us continually learn from our current practice in order to make continual improvements. Engaging in these types of activities is seen as increasingly important to for professional development and career progression.

Have a look at this information sheet.

Can you think of an area of practice you have seen that would benefit from a process of quality improvement?

What would be the first steps of a PDSA cycle in this area?

Who would be the important people (or groups of people) to engage to begin to make improvements?