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Patient safety special focus

Leading the way to the safest possible care

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This intervention informs nurses about how boards should lead the way in improving patient safety throughout their trusts

Keywords: Leadership, Accountability, Management


The goal

The aim is to ensure a leadership culture at board level that promotes quality and patient safety and provides an environment where continuous improvement in harm reduction becomes routine throughout the organisation.


Outmoded views of hospital governance sometimes suggest that hospital boards are responsible primarily for their organisations’ financial health and reputation. These responsibilities are unquestionably important, but the board’s duties do not end with financial stewardship; boards oversee mission, strategy, executive leadership, quality and safety. Boards especially guard quality of care.

The intervention

Patient Safety First asks the leaders of participating organisations to begin, at a minimum, by focusing on six actions (outlined below) to improve quality and reduce harm.


1. Develop explicit strategic priorities and goals

Specific aim: Organisations that develop a specific aim statement for patient safety improvement, effectively integrated into its strategy, provide clarity and direction for all staff. The aim should be aspirational and translate into measurable objectives. An example could be: ‘We will have no preventable injuries or deaths by July 2010.’

Patient voice at the board: The patient voice is particularly powerful when heard directly at board level. This can be achieved through the use of patient stories at board meetings to aid understanding of the nature and sources of hazards in a complex healthcare organisation, and their impact on patients, families and staff.

2. Provide demonstrable leadership

When leaders commit genuine attention to improving quality and safety, other staff will also do this. To make the organisation’s commitment to prioritising safety explicit, executives and senior leaders should consider the following activities:

Board agendas: progress towards safer care should be the first agenda item at every board meeting and the way in which the board is supported by the work of any sub-committees should be made explicit. This approach can be implemented throughout the organisation.

Safety diary exercise: Leaders could carry out a review of their diaries to assess how much of their time is spent directly in the pursuit of safe care within their organisations. As a result, realignment of activities may be considered as part of their personal development programmes.

Executive safety walk rounds: Leaders need to interact with staff frequently, visiting their workplace and asking for frank input. When all executives commit to regular visits to front-line clinical and patient services, it can create a shared insight into the organisation’s safety issues.

Establish an environment that responds appropriately to adverse outcomes: Commit to establish and maintain an environment that is respectful, fair and just for all who experience the pain and loss as a result of avoidable harm and adverse outcomes – patients, their families and staff at the sharp end of error.

The ‘How to Guide’ for Leadership for Safety outlines a number of tools available to help organisations make changes in their safety culture.

3. Ensure executive accountability

Chief executives need to oversee the effective execution of a plan to achieve improvements in quality and safety and reductions in harm. They should report personally to the board on the progress of measurable improvements and engage clinical leadership for the overall campaign.

Specific director accountability should be allocated for each campaign stream and other leadership interventions as appropriate. The chief executive should ensure that there are clear links between the campaign and the wider quality, performance management and governance arrangements.

4. Establish and monitor explicit system level measures

Safety scorecard: Boards should be asked to agree and regularly review a small set of system-level measures, based on the best in the UK where possible, as a way to monitor organisation-wide progress. This set of measures will, where possible, form part of an overall dashboard or scorecard of organisational performance, alongside activity and financial performance.

An initial audit of harm: In the first instance, the board could commission a review of the notes of the last 50 consecutive deaths in their organisation using a matrix tool based on the reason for admission and the site the patient was initially admitted to. The results of this would then be presented back to the board.

5. Monitor progress and drive execution of plans

Boards can monitor progress more effectively when they receive meaningful safety data and information in a format that is easy to interpret.

The organisation’s leadership should ensure a project plan for each of the interventions with clear milestones. There should be appropriate and timely reporting of progress against the plan with clear actions with accountability.

6. Build patient safety and improvement knowledge and capability

The board should be fully conversant with the campaign’s aims and the role they can play in ensuring its success. To achieve this, the board need to determine their own learning needs. Learning on patient safety and harm reduction should start with the board and a planned learning programme can help to set an expectation of training and education for all staff.

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