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  • Collaborating for safety: We need to make space for each other

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    In this blog, Patient Safety Learning's Content and Engagement Manager, Stephanie O'Donohue highlights some of the common barriers to collaborating for safety. She argues that we need time and space to listen and build trust between different groups if we are to really harness the power of collective insight and make safety improvements. 


    When I joined Patient Safety Learning in 2019 I was shocked to discover there are 11,000 preventable deaths each year in the UK due to unsafe care. And deaths of course are not the only measure of harm. Unsafe care can also leave patients with chronic pain, psychological trauma, permanent damage and life-limiting repercussions.

    My role includes proactively seeking opportunities to engage, collaborate, listen and create content that will help to influence positive change around key safety issues. I work with patients, researchers, clinicians, charities, healthcare leaders and families who have an interest in patient safety and reducing harm in healthcare. It is always a privilege speaking to such a range of people driven by a desire to improve outcomes.

    Comms people like me often focus on making sure their content connects with key stakeholders, but my work has increasingly become about connecting stakeholders with one another. I mean this in both the traditional sense of introductions and also in the way I facilitate and create content. Because when it comes to those involved in patient safety, it has become clear to me that you are destined to fail if you don’t collaborate. If key voices are missing from around the table, your solutions will never be as whole or effective as they could be.

    So why doesn’t it happen more? Why don’t patients, frontline staff, decision makers and researchers just work together to approach safety issues with combined wisdom and insight? 

    5 common barriers to collaborative working in patient safety


    When patients, relatives and campaigning organisations seek answers and to share their experiences and insights around safety, they are too often met by a wall of defensiveness. Most of the time, these people are reaching out trying to help the system prevent harm from occurring. They are offering their time and input; it should be welcomed. If the response to this is to dismiss, deny or shut them out, their desire to work with the system can be replaced by a new sense of anger, frustration and injustice.  


    If people are consistently shut out of key and central conversations around patient safety of course they will become distrusting of the system, of course they will want to advocate loudly given any opportunity, of course they will want to call out the treatment they have had. This can influence the ferocity with which people engage with leaders and clinicians via public channels like podcasts, online conferences and social media. Unfortunately, this can reinforce a fear of inviting people in, even among those clinicians who want to hear from patients and be informed by lived experience.

    Lack of time

    Even when patients, clinicians and others do manage to come together, time often constrains the effectiveness of conversation. There is little opportunity to provide background, introduce individuals fully, understand their experiences and motivations, and establish shared aims. Lack of time to communicate and connect at the start of a collaboration can create very rocky foundations for what should essentially become a ‘team’.


    We know from the NHS survey that many staff still do not feel safe to speak up when they have concerns. While other industries actively promote and welcome individual insights and wider conversations around risk and system safety, healthcare lags behind with individuals fearful to talk openly about avoidable harm or to share learning when things have gone wrong. Leaders need to walk the walk when it comes to sharing failures with candour, taking action to prevent future harm and developing a culture where staff feel safe raising concerns that, if acted on, could be life-saving. Strong and respectful lines of communication between the frontline and leaders have to exist to make sure no one is frightened to speak up for safety, and valuable insights do not get ignored. Leaders should also be consistently modelling and evidencing the value of patient engagement for safety, so that frontline staff feel inspired and safe to follow their lead.  

    Absence of proactive engagement

    At Patient Safety Learning we do a lot of proactive engagement work. Because we understand the value of the insights and knowledge that exist outside of our team. And honestly, it’s not difficult. People respond really well to being approached in this way – often commenting on how refreshing it is to be invited in and to be heard. It shouldn’t be refreshing though, reaching out to those who have expertise outside of your organisation should be a given. The healthcare system should be investing time in actively seeking out and contacting researchers, patients and campaigners who can help them understand the bigger picture when it comes to patient safety issues. And not just when harm or inequality has been highlighted. It needs to be interwoven as a preventative measure, a way to manage risk.

    4 ways to support collaboration in patient safety

    Make space for each other

    We all know resources are stretched but collaborating for patient safety takes time. Making time to listen to a patient’s experience is important. You may need to listen several times because that is part of making space for people at the table and being reminded that the human impact should be core to any safety project. Listening will help you understand motivation and any anger present, and respond with compassion and hopefully a desire to make a difference. Listening to the clinical perspective is equally important, we need to allow time to ask questions, translate medical terminology into plain English and for clinicians to explain the challenges they face in delivering safe care.

    Keep an open mind

    Constantly being dismissed by the healthcare system as a patient or campaigner can take its toll on your trust of individuals. But to move forward, an open mind is needed because there are people who will share your aims, motivations and are equally driven to help. Just as the system needs to let people in, those who have been harmed by unacceptable past interactions need to be open to those who genuinely want to collaborate moving forward. Not always easy to rebuild that faith but it opens up more opportunity for progress.

    Be curious

    Asking questions is one of the most powerful communication tools. It shows respect, interest and a desire to learn from others - three key components of good collaboration. If you want to know what the barriers are to someone implementing change – ask. If you want to know how an experience made someone feel – ask. If you want to know what each person in the room wants to achieve – ask. If you want to know how you can help – ask. If you’re not asking anyone any questions – ask yourself why!

    Invite people

    Use your channels to start conversations and ask people to share their insights at the beginning of any project. You will never have all the answers (and be wary if you think you do), reaching out to others will give you more of a chance of finding them.

    My reflections come from a communication perspective and from witnessing the power of collaboration when people come together for safety. We need everyone to speak up for safety but, more importantly perhaps, we need to acknowledge the time and space that is needed to really listen to each other. 

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    Excellent.  I would add others: epistemic exclusion( 'we are experts ');Also where trauma means criticism of whole system it cannot be accepted  (read https://blackwells.co.uk/bookshop/product/9781541602953?gC=5a105e8b&gclid=CjwKCAjwq4imBhBQEiwA9Nx1Bm3D3359eYA8MqVfgsgoh5JPPRBzq60mOKmcKZqgAlm_I8nuyQ0cexoCmNkQAvD_BwE ) also: interest ( professional,  system,  financial,  personal,  political, historical) meaning challenge is not possible because of implications.  also 'othering'- patholigising , blaming,  individualising.  All linked.   Solution: Patient inclusion,  leadership, empowerment,  centering. No one dares do this!

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    In my trust the top "issue" found from analysis of data in connection with "Getting It Right First Time (GIRFT) and NHS Resolution (NHSR) Learning from Litigation Claims" was "communications". I have no detail on this but suspect that this is what the problem really is.

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