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Patient Safety Specialists - building much needed expertise or more of the same with a different name?

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I am interested in what colleagues here think about the proposed patient safety specialist role?

https://improvement.nhs.uk/resources/introducing-patient-safety-specialists/

https://www.independent.co.uk/news/health/nhs-patient-safety-hospitals-mistakes-harm-a9259486.html

Can this development make a difference? Or will it lead to safety becoming one person's responsibility and / or more of the same as these responsibilities will be added to list of duties of already busy staff?

Can these specialist be a driver for culture change including embedding a just culture and a focus on safety-II and human factors? 

What support do trusts and specialists need for this to happen?

Some interesting thoughts on this here:

https://twitter.com/TerryFairbanks/status/1210357924104736768

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Hi Jon 

I worry about yet another layer of ‘management’. 
I work clinically too, working here allows me to see what work is being done and why it’s being done in that way.  
having a specialist is great, but they will need to understand what actually goes on in that department as each department has its own culture and nuances. 
a safety specialist can give advice, guidance and have an overall gauge on the safety of a trust, but I don’t think they should be solely responsible or the implementation of providing a safe place for patients, it’s everyone’s responsibility.

Claire  

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Hi Claire

I have mixed feelings about the concept and it really depends on how it is implemented. You're right that a specialist without knowledge of the working environment and culture won't be much use but this is where human factors should help as the focus should be understanding work at the sharp end and difference between work as imagined and work as done.

I do worry though that having a 'patient safety specialist' means everything could get pushed to that person which isn't right. I think the focus should be less on having individual specialists but building more expertise amongst the workforce and those in existing patient safety / governance roles rather than inventing a new role.

I think there is an idea that this role will help drive culture change with more focus on quality improvement, human factors and safety-II but without clear direction as to what these roles are for you'll end up with more of the same or responsibilities tagged on to someone's already heavy workload.

I guess it is a case of watch this space, I think there has to be a lot of support, guidance and training for this role to deliver what is intended in the NHS patient safety strategy

 

Jon

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I do see some value in having a specialist with the right training as a hub to span boundaries and apply the safety sciences to the work of envisioning, designing and implementing safety strategies. See this white paper by the American Institute for Safe Medication Practices on the value of a medication safety officer...some similar arguments could be made here to support the UK strategy.

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Reading this dialogue made me think about the "freedom to speak up guardian" role as these people champion and advocate for the right of staff to be heard. A patient safety specialist role could have the same ethos; empowered to challenge the status quo. In other safety critical industries, they deliberately move people with this responsibility on after a fixed period so they don't "go native".

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I worked in internal communications for many years and this involved a lot of work around change (both culturally and in response to enforced change). I believe that for positive change to happen within large organisations, the following elements are needed:

  • The leaders need to have time to truly understand the need for change and feel informed
  • You need people with the tools and skills to communicate that knowledge to others with passion and influence (identify those who do and those who don't)
  • Champions need to be identified at all (clinical and other) levels 
  • One or two key objectives identified and prioritised to prevent it becoming an impossible task
  • A very clear comms plan focusing on just a few repeated key messages that reach the right people in the right way at the right time (face-to-face is so important where possible)
  • Regular check-ins with the champions and time allocated to this so that champions are not overwhelmed with an extra responsibility but instead feel inspired to act as an important driver in the change
  • Admin and project management input

I believe that a patient safety specialist could actually come from any of the above areas (clinical, project management, comms, senior manager etc). 

No one individual will have the capacity or skill to do all of those points alone, effectively. What is important is that they are the type of person who is able to listen and learn from others and identify the team they need around them to give real change for safety a chance. Obviously this requires resource.... bullet points one and two may help inspire others to allocate resource. 

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