Putting patient safety first: the challenges

We know that the NHS has faced significant challenges in delivering safe, quality care in the wake of the pandemic, in part due to underinvestment in technology, training and staff, but also due to the increasing backlog and staff burnout. However, there is much within the power of individuals, teams and healthcare leaders to deliver change. 

The latest editions of CSJ (January, February, March) have featured: 

• A deep dive into the barriers that stop theatre teams complying with the WHO’s Safe Surgery Checklist
• Discussion of the latest National Safety Standards for Invasive Procedures (NatSSiPs 2)
• Strategies for prevention of surgical site infection, 
• Key issues around Never Events, including surgical fires. 

The NHS Patient Safety Strategy (2019) states that: “Patient safety is about maximising the things that go right and minimising the things that go wrong for people experiencing healthcare.” To make this happen, we need to identify and tackle safety issues that arise, but also to identify, celebrate and share what has worked well. It is easy to forget to do the latter. The NHS has tended to be reactive, rather than proactive in anticipating risk, but it also needs to get better at sharing success stories. Learning from ‘exemplars’ is absolutely vital to driving improvement but it is also important for staff to feel good about their contribution, to boost morale and to reflect on how far they have come.

It is also important that safety tools, such as NatSSiPs and the Safe Surgery Checklist, do not become ‘tick box’ exercises. With the publication of NatSSiPs 2, the discussion around safety in the operating theatre is both timely and topical. Guidelines, standards and checklists are only effective if they are implemented, however. 

The second round of a Delphi study, which sought the views of surgical teams, has shown that key steps of the checklist are being skipped – sometimes due to overruns, sometimes due to the culture within the organisation. In the face of unprecedented pressures to tackle the backlog, there may be a temptation to skip key steps such as the debrief. 

However, a study by Leonard et al (2022) considered whether the surgical debrief is just another step in the checklist or “an instrument to drive cultural change”. They found that clinicians see the value in a multi-disciplinary surgical debrief – not only to improve patient safety, but “also to positively affect the operating room culture”. The feedback received also suggested that clinicians viewed the debrief as “a method to improve communication across disciplines, influence the power hierarchy that exists in many ORs and thus improve patient safety.” So if there is widespread agreement that the debrief has value, why isn’t it being complied with?

We know that the WHO checklist saves lives. Understanding and tackling the barriers to implementation is vital to improving outcomes. The Delphi reports by Nigel Roberts, spanning three editions of CSJ, are very revealing and are a must read for perioperative teams. (The final article in the series will appear in the April edition.)

Some common themes emerge throughout this edition – to drive improvements in patient safety there is a need for better training, effective leadership, a learning culture, and investment in staff and technology. There needs to be a greater understanding of human factors science within the NHS, staff need to feel safe to raise concerns, and we need to learn from mistakes, without a culture of blame. 

Ultimately, staff want to deliver safe care. There are complex reasons why this is not always achieved. Some factors require action from the top, but staff can also be empowered. We hope some of the educational articles, featured in CSJ, contribute towards that discussion.