I am often asked by the team why we do not do anything in particular around safety. What this tends to mean is that they’ve come across an organisation who wishes to commission some training labelled “safety”, often around significant event analysis and often involving the patient safety incident response framework. This is prescribed process training, and as we are experts in the dark arts of change, death by PowerPoint is not what we do so I decline.
In fact Xytal does a massive amount to promote safety, we just don’t call it that.
Our heritage stems from process improvement in primary care. The science that we brought to the original “Productive General Practice” program draws on the operations management theories of;
- Toyota production system.
- Lean Six Sigma.
- Model for improvement.
These models all draw their kudos from their success in reducing process errors. If we take the NHS England working definition [1] that “patient safety is the avoidance of unintended or unexpected harm to people during the provision of healthcare” then it becomes obvious that process reliability is the be all and end all of patient safety. For example, our work on process mapping, visualising and understanding the patient journey, “involves identifying potential hazards and implement strategies to prevent harm before it occurs” [2]
Healthcare is delivered by people, unfortunately “human beings are not machines; machines when maintained properly are on the whole very predictable and reliable. In fact, compared to machines, humans are unpredictable and unreliable”[3] , so the techniques lifted directly from the car industry need adaptation, to incorporate an understanding of individual’s
- Knowledge
- Skills
- Attitudes
So we deploy techniques such as “Skills Audits” and BECKS (behaviour, environment, clarity, knowledge and skills) analysis to incorporate these human dimensions.
Healthcare, more so as time goes on, is delivered within systems. Our work on systems thinking, incorporated in our leadership development programs, “recognises that safety is a property of the entire healthcare system not just individual actions.”[4] We work with systems to surface and visualise drivers that cut across organisational boundaries. The very simplest of this can be “Concern, Cause, Countermeasure”, and maintaining the focus on cause, through to a complex “Soft System Analysis” with “Root Cause Analysis” of the interrelationships that if not managed can derail the best intentioned initiatives.
But finally, because it is in my opinion most important of all, we foster and protect “open communication, transparency and non-punitive responses to errors, fostering trust and continuous improvement”[5] . The evidence on how the work of Nancy Kline[6] , Amy Edmondson[7] and Michael West [8] leads to increased safety is now well established in aviation and only becoming established in healthcare.
So, although not safety experts, we are experts in safety.
References:
[1] https://www.england.nhs.uk/patient-safety/
[2] WHO patient safety Curriculum Guide https://www.who.int/publications/i/item/9789241501958
[3] Runciman W, Merry A, Walton M. Safety and ethics in healthcare: a guide to getting it right, 1st ed. Aldershot, UK, Ashgate Publishing, 2007
[4] Runciman W Et Al, Towards an International Classification for Patient Safety: key concepts and terms. International Journal for Quality in Health Care, Volume 21, Issue 1, February 2009, Pages 18–26,
[5] WHO patient safety Curriculum Guide https://www.who.int/publications/i/item/9789241501958
[6] e.g.; Kline, N. (1999). Time to think: listening to ignite the human mind. London: Ward Lock.
[7] e.g.; Edmondson, A.C. (2018). The fearless organization: Creating psychological safety in the workplace for learning, innovation, and growth. Hoboken, NJ: John Wiley & Sons.
[8] e.g.; West, M.A. (2012). Effective teamwork: Practical lessons from organizational research. 3rd ed. Chichester: John Wiley & Sons.
