A Patient Safety Culture, put simply, saves patients’ lives. It also has a positive impact on organisational finances, and significantly improves staff wellbeing.
What is Patient Safety Culture (‘PSC’)?
In 2019, the NHS Patient Safety Strategy: Safer culture, safer systems and safer patients was introduced with the aim to continuously improve patient safety by ‘maximising the things that go right and minimising the things that go wrong for people experiencing healthcare…’
At the time, it was estimated that the NHS Patient Safety Strategy could save 1,000 lives and £100 million per year. Five years on, the latest figures from June 2023, indicate that the NHS is halfway to achieving that aim.
Safety Culture is one of the key foundations of the NHS Patient Safety Strategy.
NHS England define a positive safety culture as one where the environment is collaboratively crafted, created, and nurtured so that everybody (individual staff, teams, patients, service users, families, and carers) can flourish to ensure brilliant, safe care by:
· Continuous learning and improvement of safety risks
· Supportive, psychologically safe teamwork
· Enabling and empowering speaking up by all
What impacts PSC?
NHS England have acknowledged that ‘…positive patient safety and healthy organisational culture are two sides of the same coin…and a culture in which staff are valued, well supported and engaged in their work leads to safe, high-quality care.’
PSC is significantly affected if staff feel restricted and unable to raise concerns due to fear of reprisal, or they may have reached the point of disengagement due to inaction when concerns have previously been raised.
A workplace culture can intentionally enable dysfunctional teams, creating poor working relationships between colleagues, which in turn have a detrimental impact on PSC. Poor working relationships and dysfunctional teams often lead to poor staff communication of safety critical information – a key feature in many patient safety incident investigations.
One of the key initiatives introduced in 2022 under the NHS Patient Safety Strategy, the Patient Safety Incident Response Framework (‘PSIRF’), is now fully implemented and we are seeing first-hand, in our role as PSIRF investigators, how PSIRF is beginning to contribute to the required continuous learning and improvement of safety risks.
NHS England are exploring how a focus on staff safety can support patient safety. This includes a focus on staff psychological safety and physical safety, staff wellbeing, engagement, fatigue, burn-out, presenteeism, and the impact these can have on risks to patients and staff alike.
Why PSC matters
A Patient Safety Culture ensures staff have the ability to perform all functions of their role – including any professional regulatory duties to raise concerns where they believe that patient safety or care is being compromised by the practice of colleagues, or by the systems, policies and procedures in place in the organisations in which they work.
Further, the Care Quality Commission’s (‘CQC’) Single Assessment Framework, against which all health and social care providers registered with the CQC are assessed, also has a heightened focus in the ‘Safe’ domain on ensuring providers have a ‘Learning culture’ and meet the following quality statement:
‘We have a proactive and positive culture of safety based on openness and honesty, in which concerns about safety are listened to, safety events are investigated and reported thoroughly, and lessons are learned to continually identify and embed good practices.’
If the CQC find that a provider is failing to cultivate a ‘Learning culture,’ there is a risk of a downgrade to the ‘Safe’ domain rating for the service. Establishing a PSC with a learning focus is vital to achieving and/or maintaining a ‘Good’ or ‘Outstanding’ CQC rating in the ‘Safe’ domain.
What organisations should do
In order to obtain assurance and to understand the extent of any regulatory risk, organisations registered with CQC should undertake an analysis of their current PSC, and then act on the outcomes and adopt a clear and open approach of educating staff about, and promoting, a PSC.
At ibex gale, our Governance & Assurance and Organisational Culture teams work closely together to undertake Patient Safety Culture Reviews (‘PSCRs’). PSCRs provide an in-depth assessment of an organisation’s PSC, at both an organisational level and within specific divisions and teams. On completion of the review, a comprehensive report is produced outlining the issues and themes and regulatory risks identified by the review, along with clear, structured and practical recommendations to address any areas of concern, and provide Board assurance.
If you feel your organisation would benefit from a PSCR, or you would like to discuss a patient safety investigation or workplace investigation which has a patient safety element, please get in touch to start a conversation and find out more.
Author: Kimberley Fradley, Governance & Assurance Specialist
