Last week the Secretary of State for Health delivered a speech on how safety would be improved in the NHS and bold pledges were made to reduce avoidable harm. Patient safety has long been a priority for healthcare. So what will need to be different if these pledges are to be met and where might we look for new ideas?
As Head of the North East Transformation System, I lead a team that works to develop and deploy a common approach to improvement across the local NHS. Inspired by improvement practices from industry, the North East Transformation System is an approach to change that consists of a simple framework – vision,compact and method.
The vision is a clear and shared aim of what we’re setting out to achieve.
Compacts are agreements which provide a common understanding of mutual expectations between staff and the organisation. They facilitate understanding of the human dimensions within the change process and help to make new behaviours stick.
The method is how we go about making changes and improvements that deliver our aims and help move towards our vision. Our core methodology is comprised of transformation and change techniques from international exemplars in industry as well as healthcare and draws heavily on the experience of Virginia Mason Medical Centre.
Based in Seattle in the US, Virginia Mason has earned an international reputation for improving the quality and safety of care through the adoption of systems approaches from industry. This has been achieved through a sustained effort by Virginia Mason’s most senior leaders to create a culture of learning in which systems techniques can be applied successfully to drive continuous improvement. Leaders take administrative and clinical staff out of their comfort zones to learn about essential elements of improvement culture and improvement tools at the source in world class production facilities such as Boeing, Hitachi and Toyota.
Japan’s automotive industry, for example, is renowned for its quality through applying error proofing principles. A key quality philosophy, error proofing can be thought of as ‘building quality into the process’ and involves the practice of ‘stopping the process when a problem occurs’. It’s woven into the fabric of industrial exemplars such as Toyota and is a key driver of their continuous improvement and knowledge generation process. Error proofing practices represent a set of organisational routines that facilitate knowledge generation and adaptation of existing work processes for the purposes of improvement.
The quality principle of error proofing has helped leaders at Viriginia Mason to introduce safer systems throughout the organisation. Using participative time out development sessions – in which leaders expose staff to experiences that challenge their assumptions about current levels of quality and how work is designed – has been key. Virginia Mason directly attributes innovations such as their patient safety alert system and primary care safety screens to their team experiences in manufacturing facilities.
So what have we learned from Virginia Mason that we can use in the NHS? For me, it’s that leaders need practical approaches to shape the organisational norms and values associated with safer care. These norms and values include:
- safety culture – a focus on creating safety-conscious behaviours
- just culture – a subset of safety culture, just culture provides an environment in which errors are viewed as learning opportunities
- high levels of incident reporting and root cause analysis.
Certainly the NHS has great examples of these norms and values but we’ll need to build on this if we’re to succeed in making major step changes to patient safety. We need to embrace new ways of thinking about organising and delivering services, including looking outside of our cultural norms for ideas and inspiration from other industries.
With skill, our NHS leaders may be able to use experiences gained by other industries not only as platforms for idea generation, but as opportunities to create group experiences which unfreeze fixed ideas, build awareness of the need for change, create a receptive environment, and build commitment to act to make tangible improvements.
Iain leads the development of the North East Transformation System (NETS),www.twitter.com/nhsNETS