Women in patient safety: Interview with Claire Cox

Summary

Claire, a Critical Care Outreach Sister, Darzi Fellow and Associate Director for Patient Safety Learning, talks about her passion to make a difference in patient safety and how her two very different roles come together to achieve this ambition.

Questions & Answers

Can you tell us a little bit about yourself? 

I'm a practising nurse – although I have been practising for 23 years, still not got it quite right yet! I qualified in 1998 and have been a critical outreach nurse for nearly 9 years.

After completing my Darzi fellowship last year, I entered the world of patient safety and joined Patient Safety Learning. This is a space that is exciting, frustrating and difficult. With feet in both camps, I intend to make a difference to the safety of patients.

Can you tell us more about what you do and the purpose of your role?

In my critical outreach nurse shoes, my role is to:

• reduce emergency admissions to intensive care
• ensure timely admissions to intensive care
• ensure a robust track, trigger and response to deteriorating patients is used in the Trust
• offer support to all staff when caring for sick patients
• be an integral part of the medical emergency and cardiac arrest team
• teach and support staff with clinical skills
• be a role model.

As Associate Director at Patient Safety Learning I am involved in:

• patient safety horizon scanning – best practice, poor practice, new innovations
• identifying potential safety gaps within all aspects of healthcare
• facilitating new and existing content for the hub
• project managing patient safety campaigns
• and being the clinical voice for the organisation.

Talk us through a typical day

At Patient Safety Learning every day is different. I am not good with routine; I prefer to have variety in my work. I can be working from home, in our London office with the rest of the team, or I might be visiting a Trust, speaking to clinicians, safety leads or patients about innovations that they are implementing, their experiences and ideas.

Much of my time is horizon scanning for information to add to the hub – new innovations, techniques, training, articles, resources. I have links with many organisations, such as the CQC, HSIB, NHSe, NHSi, AvMA, NICE, GMC, RCN, NMC and the Health Foundation, to name a few, and this is where I find safety alerts, new reports and guidance to put on the hub. The aim of the hub is to have all these resources in one place.

I have built up trusted relationships with many harmed patients and their families and I am able to help them share their stories and to get their cause highlighted. This is the same with clinical staff. Many staff on the frontline would like to share their stories and experiences but are too fearful of being identified or the repercussions. My role is to encourage them to share these insights on the hub, which they can do anonymously, and then highlight the issues they raise with policy makers and people who can influence.

I travel to different Trusts and different healthcare settings to see clinicians – one day I might be at a large teaching hospital, another day a GP surgery, and another at a prison – anywhere that healthcare is delivered. Each has their own innovations for problems, each has their own challenges.

Teaching the next generation of healthcare professionals about patient safety is key. At Patient Safety Learning we speak at numerous conferences, meetings and universities about our work and how they could get involved. Trying to create a social movement around patient safety involving everyone is my goal.

What do you think is the most effective way to engage frontline staff in patient safety?

As a nurse on the frontline I've found there is little engagement from ‘above’ on patient safety. We may be told to ‘do things a different way’ or get notified of a change in policy, but we don’t know why or the circumstances that brought about the change.

We have Datix but we receive no feedback from the reports we submit. We are not often consulted on how to make our jobs easier or how to make it safer for patients. If we do have solutions – and as an outreach team we often see safety opportunities that we would like to change – we do not have the capability or the time to commence a change project or get the 'buy in' from the top. This is frustrating, so it is little wonder we carry on doing what we have always done.

I would like to see:

Visibility – If safety teams were more visible, had a quality improvement strategy that was linked with the safety team, then frontline staff may form a relationship with safety.

Training – Training for patient safety for frontline staff is almost non-existent. If staff knew the underlying principles of patient safety, we would more likely be involved.

Listening and acting – Listen to what your staff are saying. As a group we are often not heard; we make lots of noise, but our narratives are not heard or acted on.  

Involvement – Please involve us in how policy is changed. Work as imagined and how work is actually ‘done’ is a real issue and is part of the reason why incidents happen.

How do you engage patients in patient safety?

In my opinion, these key areas are the same for engaging patients as they are for engaging staff.

Visibility – Somewhere where patients can report and someone to speak to about a safety issue they may have. 

Training – Information about what patients can expect from the department they are engaging with. What standards can they expect? When things go wrong – who can patients/families go to?

Listening and acting – Patients often do not feel empowered to speak up, but if they do they are often vilified or ignored by the Trust. We are far off of patients being an equal partner with Trusts when it comes to improving services.   

Involvement – Designing for safety should include how patients use the service and how they move around the system. Co-production and co- design are a vehicle to safer systems which are designed around how patients engage in healthcare.

What three words best describes a culture that promotes patient safety?

Understanding. Open. Humble.

What are the main barriers to patient safety for frontline staff?

Capacity – Policies, standard operating procedures, checklists, training – then throw in the complexity of patient care – these are competing priorities. Patient safety is compromised to reach unachievable targets. 

Staffing – Work faster, more efficiently, more safely while on a depleted staff template is not possible. Staffing is a big problem. Bringing in more staff but with less skill is not the solution.

What do we need to do when it comes to patient safety?

Start listening to patients and staff and ACT on issues. Involve frontline staff and families in investigations and in developing policy/services that reflects the way work is done in healthcare. Start sharing information: patient information, databases, investigations, solutions...

Stop vilifying staff and patients for speaking up. Yes we have Freedom to Speak Up Guardians, but this behaviour is still going on. Stop waiting for harm to happen and then investigate it. Be proactive, look for safety opportunities, report and act on near misses. Stop doing the things we have always done. Patient safety needs to change radically if we want to see a reduction in avoidable harm and death.

Can you share an example or anecdote about how you or your team have had a positive impact on patient safety?

The work I undertook during my Darzi fellowship, ‘Why are we not sharing learning from deaths and serious incidents?’, led me to Patient Safety Learning where I have worked with an amazing team to develop the hub – a free online platform dedicated to patient safety, which everyone can access and use and share their knowledge, opinions and experiences.

What are you passionate about?

• Prevention of harm with the involvement of patients and families.
• Making the right thing easy to do, while making it more difficult to do the wrong thing.

If you could jump to 2050, in an ideal world, what would healthcare look like?

• All healthcare services designed around the patient.
• Patient information sharing across sector/CCG/establishment.
• Staff:patient ratios agreed, and all Trusts fully staffed with happy, well-paid, well-trained staff.
• A focus on prevention in general – prevention in illness and in harm.
• More people being treated at home.
• Health inequalities are a thing of the past
• Still free at the point of need.

Can you tell us about a woman who has inspired you when it comes to patient safety?

I am lucky enough to be led by two amazing women, Denise Hinge and Helen Hughes.

Denise is my manager at Brighton and Sussex University Hospitals Trust. She set up the outreach team back in the late 1990s and has been an inspiration to me and most of the nursing population of the hospital where I work and beyond.

Helen is the CEO of Patient Safety Learning. She has been an inspiration and a source of great strength for me to grow as an emerging leader.

Both these women have things in common. They lead with courage; they are driven by purpose. That purpose is for the good of our patients, not for self-promotion or gain. They have a strong vision and surround themselves with people who are experts in their field. They reach for the stars. These women do not aim low. They want the best and expect the best out of their staff and for patients.

They are open to new ideas and they listen. They take on board what everyone in the team says and values each member.

They support. Both these women know I will make mistakes on my journey. They allow me to make them and allow me to learn from them.  Having permission to experiment with new ways of doing things and challenging the way we do things is liberating. If I mess up, they have my back. They trust what I am doing is being done with the best intentions – so have allowed me to grow.

Without these women, I would not be who I am today!

What advice do you have for young females who are just starting out in their careers, whether in the healthcare industry or otherwise?

Learn your craft, be curious, have courage and use your voice.u

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