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  • The problem with policies – a blog by Lynne Williams

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    • Health and care staff, Patient safety leads

    Summary

    How can we turn the good intentions of a policy into a working model that people use? How can we ensure policies are translated into real, practical solutions?

    In this blog, Lynne Williams discusses why effective policy implementation is as crucial and important as the content and why we need to look at policies as a collaborative project, headed up by Governance, but written in partnership with the staff that use them to ensure we provide consistent, safe care.

    Content

    Healthcare is inherently a messy business. It is complex and filled with hazards.

    If I asked you to list the things that could potentially go wrong, I suspect you would be there for a while...

    So, how do you even begin to bring some consistency and safety into a system such as healthcare? How do you ‘head off’ incidents at ‘the pass’ before they occur?

    My experience of healthcare in the last 30 years, and of investigating complaints, incidents and errors in the last 10 years, is that we often immediately check if the appropriate policy has been followed. The ‘horror of horrors’ would be to find that there wasn’t a policy that covered that particular set of adverse circumstances.

    If the answer is yes – there is a policy, but it was not followed – there is one simple answer… the policy was there but it was not followed, so that must be why the adverse event occurred... right? It was a reckless violation! However, is that really the case?

    Question: How many hours are devoted to policy writing/revising, compared to the time spent clearly communicating them? I do not know the factual answer to that, but I would bet that an email to staff to say there has been a policy change is as good as it gets in many cases.

    What mechanisms do you employ to ensure that policies are translated into real, practical solutions, to allow “work as done”, rather than “work as imagined” to be safe? Once that email is sent to ‘All Users’ to inform them of a policy update, do you think, “job done”? I know that I have done that in the past.

    Effective policy implementation is crucial and is as important as the content. How do we turn the good intentions of a policy into a working model that people use because they ‘get it’ and because it works for them? This, I believe, is the defining factor for a policy failure or success.

    We should be ensuring that policies are a collaborative project. Policies should be part of the DNA of normal working practices.

    "So, great theory, Lynne... but how can this happen in reality?”

    The simple answer is that policy making needs to be removed from the margins and be embedded into normal working culture.

    Policy adaptations obviously must be made when national changes occur – due to research, for example. However, the instigation for local changes should come from a central point in our departments and companies – where the right people have an input.

    If a policy is written or updated in conjunction with those who will utilise it most, then logically, it will ‘stick’ better!

    So, we need to look at policies as a collaborative project, headed up by Governance, but engendered by research and quality patient care, and written in partnership with the staff that use them. The life of a policy should begin and end with those that will refer to it the most. Remember, that just doling out a policy does not ensure compliance. Communication of policy changes need to be clear and appropriate to all.

    The point of having a healthcare policy is to provide consistent, safe care, based on research and best practice. However, the avoidance of errors is dependent on many factors, such as environment, individual capability and human nature. The other factor, however, is the demand of the task itself and, if standards and requirements are unclear and not embedded as part of a ‘Just Culture’, then we can expect adverse events to occur.

    Summary

    • Policies are essential.
    • Policy writing should be done in conjunction with the main users of the policy.
    • Policy writing must be paired with an implementation plan.
    • Policy implementation relies on good communication.

    About the Author

    Lynne has 30 years working in healthcare, with 10 years in the British Army, 10 years in the NHS and 10 years in independent healthcare. She has a radiography degree and post-grad in medical ultrasound. She is a member of the ultrasound board for the Society and College of Radiographers and an assessor for the Public Voluntary Register of Sonographers.

    Lynne has undergone professional training in clinical governance and also human factors and non-technical skills and is currently studying Human and Organisational Performance (HOP).

    Lynne is passionate about healthcare quality and effective communication, also learning from errors and promoting the recognition of the non-technical, human factors and fallibilities that are as important as clinical training.

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