Board Update on Patient Safety Strategy
1.Background
NGH has been participating in a programme called Leading Improvement in
Patient Safety and has signed up to the Patient Safety First campaign. This is a
result of a successful bid in which we were required to illustrate how this organisation
could demonstrate a commitment to the improvement of safe standards of care.
At the executive workshop in June the Principles of a draft NGH Safety Strategy
were agreed and these were further developed at the core module attended in July.
This is being pulled together into a formal strategy. An outline of some key elements
was presented in July. A much more comprehensive outline strategy has been
presented to HMG and will be developed further with input from key members of
HMG and the Trust.
2. Principles of the strategy
At NGH we wish to improve the quality of outcomes so that we move from being
average to being in the best quartile for our clinical standards.
In order to do this we need to involve the whole organisation in recognising the 3
fundamental parts of achieving this goal.
They are to ensure:


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Lack of any avoidable harm
Quality of outcome of clinical intervention- give the right treatment
Favourable patient experience
Patient Safety and Clinical Quality are in this sense facets of the same goal.
In order to achieve this we have decided to learn from other patient safety projects
where they have identified key leverage points . These are:
 Set specific system-level aims and oversee their achievement at the highest
level of governance
 Build an executable strategy to achieve the aims and oversee at the highest
level
 Channel attention to system level aims and measures
 Get patient and families on your team
 Engage the Finance director in achieving the aims
 Engage doctors and nurses in achieving the aims
 Build improvement capability necessary to achieve the aims
3. Key Elements of the Strategy
1.Set a Specific Breakthrough Goal for the Organisation
The Goal set was to reduce Hospital Mortality by 20 % over 18 months- 2 years.
 This was felt to be a high level goal that would be easy to understand at every
level in the Trust
 If achieved it would reduce the HSMR from 107 to 87
2.Commit the Executive Team to support the levers needed to achieve this goal.
This will mean they need to :
 Support the development of tools to allow mortality, harm , patient outcome
and views and staff satisfaction at board level
 Allow adequate air time for all safety and quality issues in a balanced portfolio
at all major decision making meetings
 Demonstrate this to staff through leadership or safety ward rounds ( executive
visibility and commitment in the organisation)
 Support a portfolio of projects which will be used as levers
3.Build on the portfolio of projects already in place and use them to track
progress against the main goal- These are the levers- the How
Current portfolio of projects:
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•
•
•
•
•
•
•
Leading Improvements in Patient Safety
(National Project) (Overseeing role) (Development of Metrics)
Safer Care of the Acutely Ill Patient
Productive Ward
HCAI work to be extended and the scope increased to look at :
– Line infections
– Surgical Site infections
– Care bundles for Ventilator associated pneumonia
– Catheter related sepsis
Right Bed, Right Place , Right Patient , Right Time Project
Clean and modern environment project- follow up from the deep clean and
address all the high volume areas of the hospital
Lean/continuous improvement work as started in pathology ( plan , do , study,
act in a cycle to implement change)
Thromboprophylaxis project
Possible additions
• Peroperative Care – WHO checklist
• Reduction of Harm from High Risk Medications
4. Develop a Harm Index and present this at each level in the organisation in an
appropriate format ( this will result in improved risk management)
5. Identify essential components for success ( this will improve staff and patient
engagement)
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•
•
•
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Focus on leadership ( clinical leads – doctors and nurses and manager working
together)
Focus on measurement ( use this to track progress) ( measure process and
outcome)
Agree time frame
Permission to do things to allow change( continuous improvement)
An agreed communication strategy
6. Principles of a Communication Strategy( essential for staff and patient
engagement)
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•
•
•
•
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Shared vision from board to ward
Identification of champions from all parts of the organisation
Include patients
Demonstrate reward for success
Value clinical time
Avoid blame
Link to organisational development
7. Formally identify the resources needed to complete this work
Patient safety requires consistency which means the approach has to be top down in
emphasis and bottom up in ownership. This is to move away from the situation now
where we have pockets of excellence in a sea of ordinary to a situation where the trust
has high levels of safety everywhere.

Patient Safety requires time – time at every important meeting is the
biggest investment that can be made
Currently we have clinical leads for the acutely ill patient project and we have
commitment to the LIPS programme from other clinicians. We need to identify
support in terms of measurement tools and support the involvement of clinical teams
through targeted help from a project lead.
The current focus has been developed by the Medical Director but would ideally be
supported by a strong nursing lead devoted to this project. There is an agreement
that a senior nurse will work directly with the Medical Director to embed this
work in the trust.
8. Present progress at Ward , DMB, HMG, Integrated governance and at Board.
Each project should have its own metrics to track progress and these should link to the
overall goal.
Examples might look like this: For illustrative purposes only. Idealised graphs.
Patient Safety improves where this information is presented at every level and is
visible to staff and patients
Patients can be involved in the design of information displays and in understanding
what this means for their relatives.
Board:
Board summary outcome data
SMR or percentage
120
100
mortality
80
harm index
60
staff satisfaction
40
patient satifaction
20
0
1
2
3
4
5
6 monthly data
6
7
8
HMG:
160
140
120
number of outliers
100
medication errors
index
80
60
bank numbers used
per week /ward
40
20
0
1
2
3
4
5
Ward:
compliance hand
washing
ward safety
days since last
MRSA
percentage compliance
140
120
NEWS scoring
compliance
100
80
mortality elective
surgery
60
40
mortlity
emergency
medicine
mortality
emergency
trauma
mortality stroke
20
0
1
2
3
4
6 month intervals
5
Stroke Unit:
stroke unit indicators
6 monthly progress
120
100
percentage
admitted stroke
unit
80
60
percentage
scanned in 4
hours
40
20
percentage
thrombolysed
0
1
2
3
4
percentage
5
6
9. Use the Safety Strategy to address some of the issues identified in the external
reports.
Some of these are:
• Improve patient assessment
• Focus on training of staff
• Focus on policies ( red rules single page)
• Focus on joint clinical leadership
• Engage staff and patients to contribute
• Focus on measurement
• Focus on changing Culture
Changing culture will result if the Safety Strategy does the following:
• Clarity of Vision from the Board
• New mechanism to encourage closer working relationships
– Board to ward
– Patient stories to board
– Executive team on the wards
– Professionals working together across boundaries
• Demands demonstration of performance through measurement
• Celebrate pockets of good care
• Fair and just culture for safety as a model for reporting arrangements generally
4. Next Steps for the Patient Safety Strategy
 Comments and input invited form all the members of HMG and Head Nurses
 Patient Safety Strategy Group setup
 Lead Nurse for the project has been identified
 Full Strategy to be agreed following input from staff and patient
representatives
 Work has already started and will be continued while the Strategy is still being
refined
5. Summary
A Patient Safety Strategy is in development . This will reinforce the work underway
and will be focused through the LIPS programme. It will underpin key initiatives
designed to improve quality of care. Progress will be reported to board with suitable
metrics.
6. Recommendation
The Board is asked to note the content of the outline strategy and give support to
further development of this initiative.
The Board is asked to approve the concept of monitoring progress of this project at
Board level and to understand that this will provide assurances concerning quality of
care
Sonia Swart
Medical Director
August 2008.