Patient Safety in the NHS: The Culture Change Agents

By John Tingle and Jen Minford 

It is important to take a broad holistic approach when looking at patient safety policy development and practice in the NHS. There cannot be a one size fits all approach and a number of possibly quite disparate organisations and stakeholders in the NHS and beyond must be consulted and involved so that effective and positive culture change takes place.

The  CQC (Care Quality Commission) is a major patient safety culture change agent whose job is to ensure that health and social care services provide people with safe, effective, compassionate and high-quality care. The CQC encourages care service providers to be on an upward trajectory of improvement. They have recently produced a report to analyse what impact they have on quality and improvement in health and social care. The report provides evidence that the CQC is having a significantly positive impact  on regulating care and ensuring good standards.

A majority of new providers and registered managers responding to a CQC survey said that their guidance and standards are clear. The CQC approach to regulation and their standards have an influence on how some providers measure their own quality. CQC inspection reports were also said to be useful.

The HSIB (Healthcare Safety Investigation Branch)

The HSIB is the new kid on the patient safety block and it has only recently started work in the area. It became operational on 1st April 2017 and it now has an informative web site which spells outs in purpose and remit:

“Our purpose is to improve patient safety through effective and independent investigations that do not apportion blame or liability. We do this by determining the causes of health safety incidents, encouraging safety action and making safety recommendations to prevent it happening again. Although funded by the Department of Health, we operate independently.”(Website)

It is important to maintain a sense of proportionate reality when talking about the potential impact of the HSIB on the NHS in England. Having a staff of only 30 and with plans to investigate only 30 cases a year will not lead to a drastic culture shift and impact. It’s not a large organization with lots of capacity to investigate things that go wrong in healthcare. It does maintain an excellent potential to help develop an ingrained patient safety culture in the NHS.

The Law of Tort

The law of medical and nursing negligence creates itself a framework for understanding competence and accountability in health care. The law can be a positive patient safety culture change agent.A good illustration is a recently reported  Court of Appeal case involving the issue of standard of care required of an A & E Senior House Officer as compared to a more senior doctor in the context of taking a patient history in A & E.

FB (Suing by her mother and litigation friend WAC) v Princess Alexandra Hospital NHS Trust (2017) [2017] EWCA Civ 334.

The court said patient history taking was a basic skill that all hospital doctors were expected to possess. A senior house officer had been negligent and had broken her duty of care towards her patient when she failed to ask a child’s parents what symptoms had made them come to A & E at 4am.The standard of competence required was the same no matter who performed the task the court said. There was no evidence that there was any difference between the standard required of an SHO or a consultant in taking a patient history in A & E. Inexperience is no defense.

John Tingle

John Tingle is a regular contributor to the Bill of Health blog. I am a Lecturer in Law, Birmingham Law School, University of Birmingham, UK; and a Visiting Professor of Law, Loyola University Chicago, School of Law. I was a Visiting Scholar at Harvard Law School in November 2018 and formerly Associate Professor at Nottingham Law School, Nottingham Trent University in the UK. I have a fortnightly magazine column in the British Journal of Nursing where I focus on patient safety and the legal aspects of nursing and medicine. I have published over 500 articles and a number of leading texts in patient safety and nursing law. My current research interests are in global patient safety, policy and practice, particularly in African health care systems. My most recent publication is: "Global Patient-Safety Law Policy and Practice," edited by John Tingle, Clayton O'Neill, and Morgan Shimwell, Routledge 2018.

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