Patient safety toolkit from NHSE: five areas of focus

NHS England has published ‘Improving patient safety culture – a practical guide’, in which they set out a toolkit aiming to give teams “an understanding of how to craft, create and nurture a positive safety culture and provide a theoretical underpinning to how to shift the culture.”

The toolkit focuses on five key areas to focus on in order to improve safety culture: teamwork and communication; a just and restorative culture; psychological safety; promoting diversity and inclusive behaviours; and civility.

On teamwork and communication, the guide sets out what good looks like in this area according to Professor Amy Edmondson, describing the concept of ‘teaming’ with the four steps required to achieve it. These steps are aiming high with clear, ambitious and compelling visions; teaming up with emphasis placed on valuing the diversity of the team; providing opportunities to fail well and intelligently, providing information for future improvements; and learning fast, maximising the learning from mistakes with focus, discipline and structure in place when reviewing them.

It goes on to provide some practical tips, including using NHS Scotland’s safety culture discussion cards as a basis for starting informal conversations about safety and risk within services alongside more structured conversations, and adds that approaches like safety huddles can be an effective way to communicate, improve cohesion and reinforce shared purpose.

With regards to providing a just and restorative culture, the guide provides a change idea for organisations to try, encouraging them to gather their team for a discussion what a just and learning culture means to them. It emphasises the importance of involving everyone in the discussion so that all perspectives are heard, and states: “There is a need for a shift in the language that we use and the approach to incidents that focus on the learning – what happened not who was involved.”

It also emphasises the importance of recognising staff as the victims of unsafe systems too, encouraging use the Improvement Academy’s Second Victim Support website where necessary, along with highlighting the NHS Just Culture Guide as a useful tool.

Looking next at psychological safety, the guidance shares “three ways to help create psychological safety in healthcare” from Amy Edmundson’s ‘The Fearless Organisation’. Firstly, Edmundson says, an organisation must set the stage, framing the work, setting expectations, emphasising purpose and shared expectations. The next stake is to invite participation, demonstrating “situational humility” by acknowledging gaps, practising inquiry by encouraging questions, and creating forums for input. The final stage focuses on responding productively, with leaders expressing appreciation and de-stigmatising failure, with focus on discussing and considering next steps.

The guide makes a number of suggestions, including using a survey to try to measure psychological safety within the team to understand different perceptions, and for leaders to share stories about things that went wrong for them and what they learned.

Next, the guide explores the promotion of diversity and inclusive behaviours. It provides three change ideas to try out: to support staff wellbeing and joy in work, by making the most of available resources in this area; reverse mentoring, through which a leader is partnered with a more junior member of the team from a different background to help understand their perception; and embedding ‘always events’, which stipulates that in order to keep the patient at the heart of the care, there are aspects of the patient and family experience that should always occur when they interact with the system.

Finally, the guide highlights the significance of civility in maintaining a positive patient safety culture. It points to the Civility Saves Lives campaign, which aims to raise awareness of the negative impact that rudeness can have in healthcare, for example leading to increased feelings of vulnerability for patients who notice incivility between team members. It also notes the NHS England Civility and Respect Toolkit, which provides a number of resources to support teams.

To access the toolkit in full, please click here.