In this interview for Patient Safety Learning, Josie Gilday, qualified nurse and Global Medical Advisor for Save the Children, tells us more about working in the humanitarian and developmental field, and why she feels so passionately about patient safety.
Questions & Answers
Hi Josie, can you tell us a bit about yourself and your career?
I qualified as a nurse in the UK and the plan was always to get involved in humanitarian and developmental work and so as soon as I could I applied to work with Médecins Sans Frontiers (MSF). I spent several years setting up and managing primary and secondary healthcare facilities in countries including Haiti, Ivory Coast, South Sudan, Ethiopia, Myanmar and Bangladesh. However, during this time I realised I wanted to have a wider impact on the quality and safety of humanitarian and developmental care.
I took an MSc in Public Health in developing Countries and starting working as Health Adviser for the British Red Cross, I then went back to MSF to conduct research of how to ensure safe nursing staffing levels in humanitarian settings before joining Save the Children International. In my current role as a Global Medical Adviser my priority is to ensure our direct healthcare services are safe.
Why is patient safety important to your work?
As a nurse you are caring for patients and their families during a really hard time and the thought of possibly harming a patient that you have built a trusting and caring relationship with is heartbreaking. I’ve felt that and want as few people as possible to feel it.
But as humans we make errors. None of us are immune to that, so we must admit it and be fully aware of it. We need the systems and processes around us to reflect this too, so that the safest thing to do is the easiest. For example, if the sharps bin is fixed to a wall across the room, I am going to walk across the room with a used needle in my tray. If I can take the sharps bin to the point of care delivery, the used needle will go straight into the sharps bin, reducing the risk of an injury.
Are there any projects you are currently working on to improve patient safety that you'd like to talk about?
I don’t really think I have a particular project, but just promoting patient safety as a whole, starting conversations with teams and getting them enthusiastic about improving patient safety. Often it is about the team at the healthcare facility having the voice to say this is what we are doing, this is what is working well and this is where we need support.
My current role is to start this discussion and help teams identify areas for improvement. To help us initiate these conversations, we developed a set of minimum standards and a few different checklists to go through with the teams. I’m also hoping that we will soon be able to start a a bit of a forum, so teams are able to share their experiences and learnings with each other.
What do you think the barriers to patient safety are in your field?
Fear. The fear that people and teams have about admitting there is room for improvement or asking for help is the biggest barrier to us improving patient safety.
With the checklists I’ve been developing I have been very clear that if teams do not feel they are meeting a clinical standard they are not going to be reprimanded for that. This is not about pointing fingers, and it is about teams having the confidence and the ability to say “we hadn’t thought of that”, “we have actually never had any support or guidance on that”, “we just haven’t had the time” or “we didn’t know where to start”. And for me to say “great, let me see how I can help and support you with that”.
Which patient safety challenges are you particularly passionate about and why?
That’s a tough question, as I think it changes every month or so depending on what aspects I am working on. At Save the Children right now, I am working with the safeguarding team to develop guidance that ensures that children and adults in healthcare facilities are safe from any forms of abuse and that any signs of abuse are detected, and an appropriate care package offered.
I think the challenge I am probably most passionate about is ensuring teams feel comfortable enough and are empowered to come to me and others and say they think they have a patient safety issue, or that they think they could be doing something better.
What is the most memorable thing a patient or colleague has ever said to you?
These are really good questions! I think one of my favourite things was a colleague recently told me was about ‘failing forward’. A failure or mistake only remains a failure or a mistake if you don’t learn from it. So when you fail, if you learn from it, it isn’t a step back but a step forward.
What support do you think nurses need to be able to deliver safe, quality care?
I think we need to ensure a culture of learning. No one enjoys making a mistake and if you then feel you have to hide it, then nothing comes of it. Also, processes and systems involving nurses need to be designed with the input of nurses. I think we have definitely got better at this, but there is still a long way to go.
Are there any wider system changes that you feel would make a huge difference to patient safety?
Nurses make up nearly half of the world’s healthcare workforce and deliver almost 80% of the hands-on care (Annette Kennedy). I would like to see their position for ensuring patient safety recognised to make sure there are the appropriate staffing numbers and that patient safety measures have nurses leading on the design and implementation.
Is there a personal story you’d like to share of something that has affected you and your journey to prevent avoidable harm?
When working in Bangladesh I noticed that nurses were often leaving the ward because they shared a lot of equipment and paperwork with another ward. This meant the ward was often left understaffed or completely unattended for short periods of time. The nurses openly admitted it was annoying, as did the department manager, but none of them had taken it any higher or thought to highlight it as a patient safety issue. When I mentioned that I think they should discuss it at the next team meeting they were really shocked that the senior management team were completely unaware and said it needed to be fixed immediately and they would order the extra equipment and paperwork.
It becomes so easy to do something because that is ‘how it is’ or ‘how it seems to have always been’. Having the ability to stop and think about what you are doing and how the system or process affects patient safety is key. We can only ensure that is happening by discussing patient safety regularly and ensuring nurses and healthcare teams have the ability to voice safety concerns when they see them.
If you had three wishes, what would you like to see to improve patient safety?
- A culture of learning and ensuring we are failing forward.
- Focus on making the safest thing to do, the easiest thing to do.
- Small solution thinking, patient safety can seem like a huge and overwhelming topic, but often the smallest things can make the biggest difference and everyone can be involved in this.
Can I have a 4th?
It would be that time is given to listen and be receptive to healthcare teams concerns about patient safety.
What do you love most about being a nurse?
The relationships I’ve been able to build with patients and colleagues and the impact I’ve been able to have on supporting safer care. Whether it’s seeing a patient getting better or a colleague having the confidence to come to me and tell me they made a mistake or need help.