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 final blog of the series, Gina shares the next steps for Safety Chats in her Trust and how they will be building more ways of supporting staff to discuss safety, to seek advice and support, and to receive clear assistance when things have gone wrong.
In my previous blogs, I explored why I developed the model of ‘Safety Chats’ and how they were conducted. The essential elements of these chats are very simple:
- Talk to staff about safety in the real world of their team.
- Ask them to explore what is safe and not safe.
- Engage them in the idea that they are the best people to suggest or lead change in their team.
None of this conversational approach is particularly complicated and yet it is so often not undertaken. The exploration of positive experience (what makes you safe/feel safe?) is so often not considered when assessing safety within our healthcare teams. Usually the blunt measures of numbers of incidents reported and complaints are used as an accurate measure of how safe a ward, team and system are. These totally fail in assessing what is actually going on (see the iceberg in blog 3) and where good examples of safety exist. The amount of time and energy used by healthcare organisations looking back at events and investigating them can leave little time to look forward, explore what is worth keeping and how this could be built upon.
Energising people to create safer healthcare
In his work about 'Rekindling Democracy', Cormac Russel describes Asset Based Community Development and comments that: “You can never know what a community needs until you first know what a community has”. In the NHS each one of our teams is their own small community who make up a series of inter-connected communities. Unless we actively and regularly ask what they 'have' in terms of safety we will not know what they need or can offer to the wider community. We need to ask them, we need to allow them to improve where they can and we need to step in when they cannot make the changes required to make their work place safe for them and their patients.
Don Berwick describes how in restoring trust in our staff (and making safe errors in creating improvement) we can restore the ‘joy in work’ for the people who deliver healthcare. This builds resilience and problem solving skills in to the very heart of care and a civic responsibility that underpins why many people entered healthcare in the first place. However, in order to achieve this we must speak to our people and truly hear what they say and allow them to guide us in how to improve their world.
Could Safety Chats be the answer?
Safety Chats play a small part opening up these conversations with our staff and enabling improvement at such a local level. There is no desire here to underestimate the complexity of creating true psychological safety. It is only in creating this that we will be able to really improve safety in healthcare. This does not mean improving things that improve the measures (reducing incidents/harm free days), but truly creating an environment where staff can:
- recognise challenges to safety
- speak up
- make changes
- ask for help in those things that they cannot change.
In my organisation we acknowledge how complex this is. We are introducing a whole range of new processes and building on those resources already in place to assist staff in openly discussing issues that concern them.
Most are not unique to Solent – Schwartz Rounds, Equality and Diversity groups, Freedom to Speak up Guardians and many other staff support mechanisms exist in many places. We are aiming to recognise what we, the ‘Solent Community’, already have in order to understand what we need. This is how Safety Chats came about and how we will be building more ways of supporting staff to discuss safety, to seek advice and support, and to receive clear assistance when things have gone wrong. To quote Cormac Russel again “…to build on what is strong not what is wrong”.
Solent are proud that our staff survey shows that our people rank the organisation highly in aspects of safety and ability to speak up. This means we cannot rest on our laurels though and it drives people from across the organisation to continually strive for even greater improvement. This graphic above is our planned approach to supporting staff. It is a small part in “Making it easy for our staff to do the right thing every time for our patients”, which is the test for any work undertaken by the Quality and Safety team. All of the processes that support staff to be open and safe are being hard wired into our Patient Safety plan. Increasing the ability of staff to improve safety is the key to making patients safe.
Safety Chats are now being rolled out across the organisation for all teams to have open and safe conversations about safety in general. We will gather the themes of these whilst ensuring confidentiality. These themes will be our vehicle for change and spread of ‘good’ practice and areas that need further work before an incident happens. It has already proved valuable for supporting some teams who were struggling with finding their voice. This has led to them asking for the support that previously they did not think they could request. It has built trust within the teams and with their managers as it is a safe space to be open. This roll out will carry on over the summer of 2022, as face to face meetings become increasingly possible. The themes and wider outcomes can be shared via similar blogs in the future if you, the audience, would find this useful. However, one community’s themes will not be identical to another communities themes – only by talking to your teams can you truly understand their perspective. I can promise you, it will be worthwhile, it will enlightening and maybe even inspiring.
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
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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