For nearly two decades patient safety experts have looked to the airline industry as a model for safety and reporting practices.
I remember the excitement in 2000 when the Department of Health published An Organisation with a Memory, which compared healthcare safety practices with those of the aviation industry.
At the time, the suggestion that healthcare should actively work to detect, analyse and act on incidents and near misses as well as identify potential safety risk seemed obvious. That requires staff to feel able to report these things without fearing punishment, yet nearly two decades later we are still discussing the need for a no-blame culture.
“Many health professionals are still fearful of blowing the whistle on poor standards of care”
The consequences of staff failing to report and act on their concerns were vividly highlighted by the Francis Report. Yet over five years later many health professionals are still fearful of blowing the whistle on poor standards of care.
One of the problems for nurses and other health professionals is they cannot down tools and walk away from unsafe situations, so they learn to cut corners and cope. They are often not empowered to report concerns or feel that their concerns are not acted on. One of our readers summed up the dilemma:
“Pilots don’t take off if they don’t have the tools to do the job and that includes adequate cabin crew … we rarely close wards/depts, cancel patient care when we don’t have enough staff – we just get on and do our best to keep patients safe. It’s commonplace in the NHS to function with inadequate equipment that is years old, prioritise who needs it the most, use IT kit fit for the bin … since when does a plane take off with dodgy kit, insufficient staff?”
It is against this backdrop that the Health Service Safety Investigations Bill (HSSIB) was introduced to parliament in 2017 by the health secretary Jeremy Hunt, who described it as a “key part” of his plans to develop a “more open, learning culture across the NHS”.
The bill seems to be a positive move away from the defensive blame culture around reporting error, particularly as it seeks to provide “safe space” for staff discussing serious patient safety incidents. It proposes setting up a Health Service Safety Investigations Body to conduct investigations, focusing on learning from serious patient safety incidents in the NHS, to reduce harm and improve patient care.
However, in evidence to the Health Select Committee last week, the Royal College of Nursing suggested that the new body will only succeed if healthcare is redefined as a “safety-critical industry”, like aviation.
Dame Donna Kinnair, director of nursing, policy and practice at the RCN, suggested the HSSIB focused too much on blaming individuals and ignored the wider issues that lead to errors, such as poor staffing levels.
“Nurses are doing the best they can with often limited resources”
She added that frontline staff risked being unfairly blamed for circumstances that were beyond their control, meaning the true cause of errors would not be rooted out.
Nurses are doing the best they can with often limited resources. Every day they have to make choices and compromises and it is not surprising that things go wrong. What nurses actually need is a system that says “if you are concerned about safety we will listen and act on it”.
I wish this new legislation well and hope it results in improved patient safety, but any improvement will only come when individual concerns are acted on. As Dame Donna said, “Appropriate levels of accountability have to exist at all levels, including government”.
I wonder what odds a bookmaker would give me on a government minister being held directly accountable for failings for which it held the government responsible?