Improving Patient Safety

on the Wards:
Introduction
Linda Watterson
Programme Manager
Evaluating and
Improving
The size of the problem
 78% EU citizens think medical errors important
problem in their country (Eurobarometer)
 44 – 98,000 deaths annually caused by medical error
(To err is human)
 Adverse events occur in around 10% of hospital
admissions, or about 85,000 adverse events per
year. (An organisation with a memory)
 Spain, France and Denmark have similar figures.
Similar types of intervention related adverse event
happen in all health care systems despite different
organisational and financial systems
 The patient perspective
 Patient evaluation
of care
 Patient
involvement
 Digital Stories

www.patientvoices.org.uk
The nursing contribution
‘nursing staff can
provide their hospital
with information about
the organisation,
management and
resourcing of care,
that can be used to
improve patients’
experiences’
Views from the sharp end of care

 Blame culture
Feedback

Raising concerns
Views from the sharp end of care

Competing priorities
Workload

Staff deployment
 The two words ‘information’ and
‘communication’ are often used
interchangeably, but they signify
quite different things.
Information is giving out;
communication is getting through.

Sydney J.Harris
The 3-bucket model for
assessing risky situations
(Reason, 2005)

SELF CONTEXT TASK

 Human factors
 Blunt’ end of care ‘Sharp’ end of care
Decisions made here Impact here

Leadership
Institutional context Culture The clinical team
Communication
Feedback
Organisation Targets The individual
&management of Priorities healthcare worker
care Equipment
Professional development

Working environment Planning The patient

Capacity management
Workload
Staffing
Skill-mix
Health & Safety

Latent failures Active failures

(Based on Nolan, 2000; Reason et al 2001)

 Antecedents, determinants and components of safety performance
(Adapted from : Neal & Griffin, 2002)
ANTECEDENTS
Management commitment/leadership
Communication
Rules/procedures/protocols/guidance
Appreciation of risk(s)
Involvement Safety
Work environment Climate
Supportive environment
Priority of safety
Personal priorities
Safety climate is one of many
antecedents of safety
performance, for example,
management commitment
and leadership are felt to play
an important role in shaping
workers perceptions of the
safety climate in their
organisation
DETERMINANTS
Knowledge & Skill
Motivation
If an individual does not have
sufficient knowledge and skill to
comply with safety regulations or
participate in safety activities, they
will not be able to perform these
actions. If they do not have
sufficient motivation to comply with
safety regulations to participate in
safety activities they will choose
not to carry out these actions.
COMPONENTS
Safety Compliance
Safety Participation
Compliance and participation represent
behaviours that individuals perform
whilst at work. Safety compliance
describes the core activities that must be
carried out to maintain safety; safety
participation describes behaviours that do
not directly contribute to safety, but which
help to develop an environment that
supports safety.
 Management Communication:
commitment: The nature and efficiency
of health & safety
Priority of safety:
Perceptions of The relative status of
management’s overt communications within
health & safety
commitment to the organisation
issues with the
safety organisation

Safety rules &

procedures:
Views on the efficacy Involvement:
and necessity of The dimensions covered by The extent to which
rules & safety is a focus for
procedures
the Safety Climate Tool everyone and all
are involved

Personal priorities:
The individuals view of
their own health &
Work environment:
Perceptions of the
safety management
Nature of the
and the need for feel safe
Supportive Physical
Personal appreciation environment
environment:
of risk:
The nature of the social
How individuals view
environment at work,
the risk associated
and the support
with work
derived from it
 Dimension, Descriptor, Associated Questions
 Dimension:
Perceptions of management’s overt commitment to safety.

 Descriptor:
Management act decisively when a safety concern is raised

 Questions:
- Management acts only after accidents have occurred
- Corrective action is always taken when management is told about
unsafe practices
- In my workplace management acts quickly to correct safety problems
- In my workplace management turn a blind eye to safety issues
- In my workplace managers/supervisors show interest in my safety
- Managers/supervisors express concern if safety procedures are not
adhered to
REASON, 2005
Strengthening the nursing
contribution
 Reporting and learning
– Value of reporting
– Valuing the nurses understanding of safety issues
 Developing positive cultures
– Blame culture
– Empowerment
– Training opportunities
– Improving communication
– Work environment
Staffing level /skill mix /workload issues
Use audit and benchmarking
 Sharing solutions
– Valuing the nurses role
– Sharing best practice
– Tools and techniques

 Patient / consumer involvement

Proposed approach
 Focus for patient safety

 Support and strengthen the value of the

nursing voice
 Provide members with appropriate tools to
review safety at all levels
 Provide learning and development resources
and opportunities
 Consider the value of the patient voice for
learning and challenging
Sharing best practice

Contact: linda.watterson@rcn.org.uk
 References and useful reading
 Anderson DJ. Webster CS (2001) A systems approach to reduction of medication error on the hospital ward
Journal of Advanced Nursing 35 (1) 34 – 41
 Attree M (2007) Factors influencing nurses’ decision to raise concerns about care quality Journal of Nursing
Management 15 392 - 402
 Currie L, Watterson L, (2007) Challenges in delivering safe patient care. A commentary on a quality improvement
initiative Journal of Nursing Management 15 (2) 162 - 168
 Department of Health Expert Group An organisation with a memory: report of an expert group on learning form
adverse events in NHS Chairman :Chief Medical Officer London: The Stationery Office 2000
 http://ec.europa.eu/health/ph_information/documents/eb_64_en.pdf
 King L Macleod Clark J. (2002) Intuition and the development of expertise in surgical ward and intensive care
nurses Journal of Advanced Nursing 37 (4) 322 – 329
 Kohn LT Corrigan JM Donaldson MS eds To err is human: Building a safer health system. Washington, D.C.
National Academy Press 2000
 http://www.saferhealthcare.org.uk/ihi
 Mrayyan MT, Huber DL (2003) The Nurses Role in Changing Health Policy Related to Patient Safety JONA’s
Healthcare Law, Ethics and Regulation 5 91
 Meurier CE (2000) Understanding the nature of errors in nursing: using a model to analyse critical incident
reports of errors which had resulted in an adverse or potentially adverse event Journal of Advanced Nursing31
(1) 202 - 207
 Sorlie V, Torjuul K, Ross A, Kihlgren M (2006) Satisfied patients are also vulnerable patients – narratives from an
acute care ward Journal of Clinical Nursing 15, 1240 – 1246
 Storr J TopleyK, Privett S. (2005) The ward nurses role in infection control Nursing Standard 19 (41) 56 – 64
 Sdottir H A, Bjornsdottir K (2008) Nursing and patient safety in the operating room Journal of Advanced Nursing
61 (1) 29 - 37
 Walker AC, (2002) Safety and comfort work of nurses glimpsed through patient narratives Internationaol Journal
of Nursing Practice 8: 42 – 48
 West E, Barron DN, Reeves R (2005) Overcoming the barriers to patient – centred care: time, tools and training
Journal of Clinical Nursing 14, 435 – 443
 www.npsa.nhs.uk
 www.who.int/patientsafety
Key action areas for ward nurses in preventing infection

Ref: Storr J. et al The nurses role in infection control Nursing Standard 19 (41) 22 June 2005