Governing for patient safety: An interview with Lesley Andrews

Summary

In this interview, Lesley Andrews reflects on her role as Head of Governance for the Cromwell Hospital in South West London. Lesley tells us how patient safety is central to her work and why culture, data and leadership are key to improving outcomes.

Questions & Answers

Hi Lesley, can you tell us a bit about yourself and your role?

I have worked in both governance and operational positions for many years, but my passion really lies in the world of governance. I lead a team of people across the hospital which includes complaints management, health, safety and risk, clinical audit and patient safety.

What is Corporate Governance? 

Corporate Governance is about structure and process within an organisation that works within legislation and regulatory requirements. It is about accountability, involves transparency and openness and monitors risk. Good governance ensures that the right policies and procedures are in place and fundamental to driving a strong and just culture forward and demonstrating that learning and improvement in performance is ongoing. 

How important is patient safety to your role?

It is paramount and at the heart of everything governance related. Nothing is ever risk free and there is always the potential for human or system error so when an incident occurs that affects patient safety it is really important to have a good incident management framework in place. This framework should enable staff to be part of an investigation and learning process so we can avoid the same things happening again. It is also important for staff to have the right policies and procedures in place that are clear, up to date with best practice and easy to locate and follow. These can then be amended if the outcome of an investigation determines this, to prevent similar from happening in future. 

How is information and data around patient safety fed back up to the Board? 

All information around patient safety is reported on a monthly basis to the Executive Team. This includes trends and themes and what actions that are being taking to address these within the specific areas and departments. There are also quarterly reports produced to a more senior level which includes what actions or improvements have been made to address any concerns.

Are there mechanisms in place for staff to contribute to patient safety improvements?  

Yes, most definitely. Governance should be part of everyone’s world as it involves the whole workforce. Anyone can log an incident, which is to encourage an open culture and one where people want to learn. Staff are included as part of the incident investigation process and the implementation of any recommendations. They are also encouraged to be part of the various steering groups and forums where discussions and decisions on future improvements take place.

What do staff need in order to feel safe enough to speak up if they have a concern and how can a Board support this? 

A good ‘just’ and fair culture. It can take time building this, particularly if there has previously been a blame culture where staff have felt afraid of coming forward. It is essential to communicate the importance of being open and honest when things go wrong and also empower staff to raise and log an incident. This needs to come via strong senior leadership so that staff know this is embedded within the organisation. Clear and regular communication and encouragement to feel empowered and confident to speak up is really important. There should also be a mechanism for staff to go elsewhere within an organisation if they don’t feel able to approach the senior managers directly.

What involvement does the Board have when there is a safety incident? 

The Executive Team become involved if there is a serious incident to ensure they are fully informed and understand what their contribution needs to be in managing the effect or impact of the incident. This involvement can be managing any reputational or financial risk etc as well as supporting the governance team to ensure there is a detailed and comprehensive investigation and to support and help to implement any necessary changes efficiently and effectively. 

Can you share any ways of working that have improved the Board's ability to support patient safety?  

Yes, improving the way that data is presented to enable a better understanding of the themes and trends around patient safety. This allows an Executive team to prioritise where improvements may need to take place and if they require financial investment for example, enabling them to make key decisions efficiently. Having a clear risk register that is also presented on a monthly basis enables senior managers to understand where the bigger risks exist and if the mitigating factors are sufficient or if further support is required.

What are the challenges for Boards looking to strengthen their patient safety focus and what advice would you offer? 

I think you need the right governance structure in place and the right leadership to ensure governance is part of all discussions and decision making. You need to have governance threaded right through the organisation which you can have via an agreed framework and a ‘voice’ to continually promote and drive this culture.

If you invest in the right leadership it will start to become implemented and then embedded very quickly.