Putting patient safety first

A not-for-profit healthcare charity, Nuffield Health has achieved NHS Litigation Authority (NHSLA) level three – the highest level – for risk management after volunteering to be assessed against the standards. The accolade – awarded only to healthcare organisations who meet the highest standards of clinical, patient and organisational safety when assessed against the NHSLA standards – sees Nuffield Health hospitals join a select group of 30 NHS Trusts in the acute sector who hold the award. Specifically developed to reduce the number of negligent and preventable incidents taking place in hospitals, the standards provide assurance of safe practice. Over two days of rigorous testing, Nuffield Hospitals had to demonstrate that it was monitoring its own implemented processes for managing 50 key risks covering governance, workforce, safe environment, clinical care and learning from experience in all of its hospital facilities across the UK. The NHSLA tracks 50 key areas that are most likely to lead to a safety incident or a claim. Level three assessment ensures that Nuffield has vigorous procedures in place for tracking incidents, ensuring that any incidents are reported and a cycle of improvement is embedded throughout the organisation. “Organisations that provide the safest care are organisations that manage their risk processes very carefully,” commented Dr Andy Jones, medical director at Nuffield Health. “They monitor internal data and evaluate themselves against that data very vigorously.” He pointed out that a crucial aspect of delivering better care is ensuring that the organisation’s management and clinical leaders are focused on safety and risk is crucial to delivering better care. Also vital is ensuring a culture of openness and transparency. “We have a culture that ensures that anybody within the organisation can report an incident if they have concerns,” said Dr Jones. “It is logged into a system that allows us to collate information, with a view to evaluating the bigger picture. We can then respond to any safety issues accordingly. Our philosophy means that everybody has a voice. Things will go wrong in healthcare, but the right response is not to brush it under the carpet, or to say it was a one-off. We systematically evaluate incidents and work out how to put it right as an organisation.” Nuffield’s approach is improving patient care and its clinical quality indicators are among the best. For example, it has achieved very low rates of venous thromboembolism (VTE), at just 0.02% for the past 10 months. While these rates are low compared to the national average, Nuffield is not content to rest on its laurels, and the organisation is striving to further improve on this figure. Dr Jones explained that Nuffield assigns each patient a nursing care pathway following assessment of VTE risk. All incidents of VTE are evaluated and, if necessary, the pathway improved, while taking into account new practices and making processes clearer, if required. This approach is also used in dealing with adverse incidents. “How you handle significant incidents really defines excellence,” said Dr Jones. “As medical director, that is what I concentrate on. Every incident that happens needs to be reported openly. In fact, we take it very seriously when there is a failure to report such incidents.” Nuffield experiences between 25 and 50 serious incidents during a quarter. In 2010, 167 incidents were recorded and in 2011 there was a significant reduction to 122 incidents. Not all serious incidents relate to patients, as the statistics also include incidences such as not having the correct instruments available to perform the operation. The proportion of incidents related to overall activity runs at 1%, which compares favourably to the national average of 7%. “We are very proud of our data,” said Dr Jones. The figures are freely available in Nuffield’s Annual Quality Report. “We are very open about what we get right but also about what we get wrong. You have to be open about major mishaps – to demonstrate what you have learnt from them and what you are going to do to improve.”  

Safe surgery

Nuffield was an early signatory to the World Health Organization’s safe surgery initiative in 2008. Checklists and a culture of safe surgery are embedded into Nuffield’s core clinical pathways. Again, openness is key and everyone from porters to theatre technicians are encouraged to report near misses, so that the whole organisation can learn from it. Nuffield carries out over a third of a million procedures each year. The number of incidences of incorrect procedure or an injection in the wrong place averages five patients per year. “We have not, during my time as medical director, performed an incorrect major operation,” said Dr Jones, “but near misses make you think hard about the team, the hospital, the approach and what can be done better.” Dr Jones is keen to point out that Nuffield hospitals do not cherry-pick ‘simple’ surgery cases, although they will only admit patients that they are able treat safely, to achieve the best outcomes: “If we are not cut out to do it, we will not attempt it. However, we carry out neurosurgery, cardiac surgery, liver and pancreatic surgery, as well as surgery on weight-loss patients that is often considered ‘too high risk’ by some NHS hospitals.”