In a series of blogs, Gina Winter-Bates, Associate Nurse Director Quality and Safety at Solent NHS Trust, shares her experience of implementing Safety Chats. In this first blog, Gina explains what motivated her to introduce Safety Chats into her Trust.
A personal perspective
I was a newly qualified nurse working in cardiac care in the wake of the Kennedy report into deaths at Bristol Royal infirmary between 1984-1995. The response nationally was the introduction of governance frameworks which sought to standardise and monitor safety. It was needed, it brought about improved safety and allowed the NHS organisations to monitor compliance to safety measures.
Governance and safety
Healthcare, like in many industries, has adopted a large array of, at times, bureaucratic processes attached to this. These can be onerous for clinical staff and can yield little change in actual patient safety. There are still large numbers of serious incidents across the NHS every year. The National Patient Safety Strategy (2019) suggests that as many as 1000 lives a year could be saved if safety was improved. This continues to occur despite the enormous time and effort, including national initiatives in place across the NHS, to comply. This world of governance, safety and compliance is my world.
The impact of Covid
Like many, I was redeployed to work on the wards. It was a great experience. Staff were caring, kind and working incredibly hard. National guidance changed rapidly and there was significant fear of both infection and of getting the rules wrong.
I worked with a number of experienced staff of all grades and noticed that at times their work was hampered by some real or perceived 'rules'. I asked them how they would change things and, do you know what?, they knew the answers. This was their world. I asked them why they didn’t change things and the usual answer was “we wouldn’t be allowed”. I successfully pursued some of their ideas and didn’t meet any of this resistance.
Was this a command-and-control issue? Was it about grade? Surely, they were best placed to make the ward safer? They knew it best. I reflected on my years in clinical settings and remembered this scenario:
I was a junior staff nurse in acute ward. Kit boxes were introduced so that equipment was available for emergency scenarios. We had them but they were often over-stocked and difficult to grab the right equipment rapidly. So we kept a separate supply that we could get our ‘hands on’ quickly. The ward nurses and doctors all knew where it was but none of us (very junior) staff considered asking the Trust to change the boxes. In our world we knew how to make care safer, but we didn’t share this or try to influence the 'rules' on standardised kit boxes.
Why choose to do Safety Chats?
It was a revelation to ask the staff on duty questions about how they would make their ward safer and see this reluctance to challenge and make changes was still the case 20 years later. This, despite working in a values based, empowering organisation that wants to learn and make the care safer. The staff survey for Solent has consistently shown that our staff consider the organisation to place a high regard on safety and that they are able to ‘speak up’ when they need to.
It occurred to me that we do not spend enough time asking staff how to make things safer in their world and use that innate knowledge to prevent incidents occurring. Staff commented that they had valued my interest and respect of their knowledge. I wanted to continue this when I went back to my role.
I am lucky enough to be a Florence Nightingale Foundation Scholar which has led me to explore many aspects of care delivered – mine and others. This project was supported by them and my sponsors from Health Education England (SE).
I also work for a Trust that has a great history of encouraging ‘speaking up’ and have a strong safety culture. I was encouraged to ‘get out there’ and ask staff about their work as done and how they thought we could make it safer.
With this support, I worked with two clinical teams to talk about safety in their world. I wanted to really understand how safe staff feel, to understand how they may hold the key to truly understanding the issues that affect safety in the work as ‘done’ and how they have the insight and knowledge to make significant changes that can improve safety for the whole organisation.
In my next blog...
We measure safety via a series of, usually, negative events that have already occurred and in some cases cannot be rectified. It was a revelation that we had failed to ask the staff delivering the care what ‘safe’ looked like in the work as done. Our staff repeatedly report that they feel safe and they are free to speak up about safety concerns, but in the next blog I will describe how conversations with staff reveal how this is not always translated in to staff confidence in making the changes that they know will help.
If you would like to discuss Safety Chats further, please email me at: Gina.Winter-Bates@solent.nhs.uk
Other blogs in the Safety Chat series
- Part 2 -Safety as measured
- Part 3 - Starting the conversation
- Part 4 - Talking about safety and creating safer environments
About the Author
I have been a nurse for 25 years with experience in acute and community care. I specialised as a cardiac nurse practitioner in ED and as a diabetes specialist nurse in the community and acute settings.
Throughout my career, patient safety, governance and service improvement has been key elements of my interest. I believe that engaging with our people and respecting their knowledge is key to quality improvement. I work closely with colleagues in education, equality and diversity, Just Culture and psychological safety to ensure that we are continuously improving. I am a very proud Florence Nightingale Foundation Scholar (2021/22).
I want to be part of an NHS that will look after people safely when they need it which is what drives my passion at work. I am married with adult sons and a granddaughter.
Linkedin: Gina Winter-Bates
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