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Guidance is only the first step in ensuring safety

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Suzette Woodward on putting safety initiatives into practice

With a strapline of ‘Everyone’s responsibility, your chance to act’, the second annual Patient Safety Congress is nearly upon us.

One of the aims of the congress is to help healthcare staff put safety initiatives into practice. This aim, whether you are attending the congress or not, is one that deserves consideration by all of us, since consistently and reliably implementing the safest possible practices appears to be one of health care’s biggest unconquered challenges.

Despite, or because of, the wealth of guidance available, effective and timely implementation of knowledge into practice remains fragmented and inconsistent. With well over two million articles and guidance on health care published annually, how can we keep abreast of what the latest changes are? How do we know which ones to implement and which ones to put to one side?

This situation isn’t helped by the current approach of passive diffusion of information to inform health professionals about new safer practices. Simply telling people what to do and then expecting them to do it is the least effective strategy for change. Equally, it isn’t about shouting louder and louder. It is clear we need to understand what the effective implementation strategies are.

‘Simply telling people what to do and then expecting them to do it is the least effective strategy for change. Equally, it isn’t about shouting louder and louder’

Over the past decade, there has been increased debate in relation to implementation because of the growing awareness of this knowledge practice gap. Studies suggest that it takes, on average, 17 years to turn 14% of research findings into practice and that less than 30% of the changes are sustained. This debate has led to an understanding of what works and what doesn’t work.


Strategies that we know work are:

  • Demonstrating the evidence, giving a reason to change;
  • Showing the benefits but also being realistic about what it will take to make the changes in terms of time and resources;
  • Being creative when generating new approaches - there may be some really simple things that could make a big difference;
  • A bottom-up approach to change, for example change led by those affected, with appropriate role modelling and targeted peer-to-peer influencing;
  • Understanding the people who will be affected by the change, those who can help and support, and those who may challenge it;
  • Understanding the environment and context in which the change will be made;
  • Targeting the approach by choosing the right implementation method for the particular safer practice and the particular people who will need to change;
  • Considering the different methods for sustained success and measuring progress to help understand what works and increase momentum.

A key principle should be that those who produce guidance should put as much effort into supporting implementation as they do into creating the guidance in the first place. What is needed is help: help to prioritise which safer practices are right for which care settings; help to identify the right approach and the right method of implementation for the particular audience and safer practice; and, help to use improvement tools and techniques to make the changes required.

‘The future is already here - it’s just not evenly distributed’ is a great quote from writer William Gibson (The Economist, 4 December 2003). What this means is that there will be someone out there who will have tried, worked out what works and what doesn’t, and achieved some success in terms of change. However, because their success is not shared and therefore not known about elsewhere, others cannot benefit from their story. So a vital step to effective implementation is to share with and learn from the stories of others. We don’t do this nearly enough in health care.

You can do this by attending events like the Patient Safety Congress. You can also do it by visiting websites such as the Patient Safety First Campaign in England, and similar websites for the campaigns in Scotland and Wales, to share your story, read the stories of others and learn about how to use patient safety improvement techniques. In addition, you can get help from organisations such as the National Patient Safety Agency, the National Institute for Innovation and Improvement and The Health Foundation, all of which have developed expertise and provide various tools, training and resources to help you.

Patient safety is about trying to deliver the safest possible care to every patient, in every place, every time. This is something we all strive to do every time we come to work. Unsafe care results in far too many individual tragedies every year, with both patients, their families and those who provide their care suffering as a consequence.

Therefore, more energy is needed from everyone to close the implementation gap in a way that successfully achieves sustained change. By supporting implementation of safer practices we will go a long way towards closing this gap. By implementing safer practice and sharing your story, this is your ‘chance to act’.

Click here for further details on this year’s Patient Safety Congress

Suzette Woodward is director of implementation, Patient Safety First, and nursing lead for patient safety, National Patient Safety Agency

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Readers' comments (1)

  • All well and good but until the numbers of staff available on wards increase the 'individual tragedies' will continue. NT published an article just weeks ago re. research highlighting the link between lack of staff and safety. In the hospital where I work there is a 'flexible beds' policy - in practice this means that the bed availability on an already short staffed medical ward can increase fron 20 to 28 with no extra staff available. Whilst stressed and overburdened staff are just trying to keep patients alive, tell me when they have the opportunity to 'be creative'?

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