Making Health Care Safer: What Good Looks Like

It’s fair to say that patient safety and health quality reports in recent years have tended to focus on what is going wrong in the NHS and what needs to be done to put things right.We have had some dramatic health care systems failures which have resulted in unnecessary deaths of patients.The naming and shaming of errant health care providers has taken place and we have now through the CQC (Care Quality Commission), a much more open, stronger, intelligent and transparent way of regulating health care quality than we have ever had before.

The health care regulatory system does seem to be making a positive difference to NHS care judging from recent CQC reports with some good examples of health quality and safe care practices taking place. Other trusts can learn from these practices.

The CQC have just published a report which includes several case studies illustrating some of the qualities shown by care providers that are rated good or outstanding overall. These hospitals known as hospital trusts in the NHS have been on a journey of improvement some going from special measures to good (CQC inspection ratings). The views of some of the people involved in the care improvement initiatives are stated in the case studies revealing important insights on improvement strategies and the nature of the problems overcome.

The case studies in the report clearly show what it takes to drive improvements in care quality and patient safety and several common themes are identified. Trust’s had to move from a position of disjointed and remote management to one of full engagement with staff and communities. Bridges had to be built over existing gulfs between trust management and staff. There was poor visibility of leaders who were not seen to be engaging with the staff or the community. Staff were left feeling vulnerable, un-empowered and disenchanted. Trusts maintained an introspective and not an outward facing view.

These are just some common themes that can be seen to emerge from the case studies in the report. The remedial solutions adopted by trusts are notably novel and thoughtful. They provide excellent learning tools to help other trust’s move forward to develop ingrained patient safety cultures. They show very clearly what ‘good ‘looks like in this area. The report puts these themes under several headings.

The report states that trusts knew that they needed to change their approach to quality improvement. The ways in which they all did this is a key feature of the report and there are some excellent examples of initiatives.

The Barking, Havering and Redbridge University Hospital NHS Trust case study shows the trust and its staff adopting PRIDE values which are stated on their web site:

Our PRIDE values


  • I give the best of myself, I work with compassion and kindness and I make a difference everyday.


  • I do what I said I would do, I step up, I speak up and I recognise other people’s contribution.


  • I solve problems, I keep it simple and I look for opportunities to improve our care.


  • I deliver with pace; I lead by example and I welcome a challenge.


  • I support my colleagues, I listen to understand, I delegate and trust people

The PRIDE initiative seems an excellent way of advancing the patient safety agenda and securing health quality. It sends simple and powerful messages. The initiative reflects the values of the trust and the standards staff are working to.

The report is to be welcomed and should be essential reading for all staff concerned with patient safety and health quality.

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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