Patient Safety Spotlight interview with Annie Hunningher, Consultant Anaesthetist at the Royal London Hospital, Barts Health

Summary

This is part of our series of Patient Safety Spotlight interviews, where we talk to people working for patient safety about their role and what motivates them. Annie talks to us about her work training teams in safety behaviours, why productivity and safety must go hand-in-hand, and how working on patient safety is like running a marathon.

About the Author

Annie is a Consultant Anaesthetist at the Royal London Hospital, part of Barts Health NHS Trust. She sits on the steering group as a clinical lead for The Royal College of Anaesthetists Centre for Perioperative Care committee for the National Safety Standards for Invasive Procedures (NatSSIPs). Annie develops and delivers educational safety courses and speaks at safety conferences.

Questions & Answers

Hello Annie. Please can you tell us who you are and what you do?

I’m Annie Hunningher, a consultant anaesthetist at the Royal London Hospital. I am also an Institute for Healthcare Improvement (IHI) Improvement Coach and recently completed the Healthcare Safety Investigation Branch (HSIB) silver training in investigation science.

How did you first become interested in patient safety?

As a doctor I’ve always taken the duty to Do No Harm very seriously, but I’ve seen first hand how perioperative safety can affect quality of care and outcomes, as a mother, daughter, auntie, wife, sister, friend and patient. 

The motto for anaesthetics is in somno securitas, which translates to “safety in sleep,” so patient safety is something anaesthetists are all trained to think about. I started to see areas where I felt I could influence and improve things, so I got involved nationally with some safety initiatives and brought some ideas back to my Trust. From there I developed networks with other healthcare professionals interested in patient safety. 

I’ve been working in patient safety for about 12 years now, implementing standards and national ideas around safety, leading projects, writing governance reports, running safety training and speaking at conferences. I’m the clinical lead on the national committee that’s developing the National safety standards for invasive procedures (NatSSIPs 2). It brings the next step in procedural checks following the WHO checklist and aims to clarify and standardise surgical and invasive procedure safety standards across the UK. It is now led by the Centre for Perioperative Care (CPOC), which is a collaboration between a number of colleges and bodies.

Which part of your role do you find the most fulfilling?

My mum was an editor and writer and I have inherited some of her ability to use words to deliver a message. As part of the national committee writing NatSSIPS 2, I have had the opportunity to write as well as giving clinical input. I have really enjoyed having space to put ideas down on paper and using language and concepts to try and make the guidance clearer. I have always had a utopian dream for safety. Writing the standards allows me to help create the vision, and I’m finding that really fulfilling and inspiring.

What patient safety challenges does the health system face at the moment?

There is a big gap between the vision for patient safety and the reality, and closing it is a challenge. As an anaesthetist I worked very hard during Covid, as did many of my colleagues, and it was a very difficult time. On the back of that, we can all see burnout in colleagues and have a heightened awareness of how important our wellbeing is. I’m concerned that as healthcare professionals are pushed to work harder, safety and quality will decrease. 

Productivity is important because patients on waiting lists are suffering harm while they wait, but we need to recognise that safety has to be considered in this push—they must go hand in hand. This is a national challenge that all organisations are facing. We are trying to do more with less, and at the moment we’re doing what we’ve always done rather than looking for new ways of working. That’s where I hope to share aspects of safety science and strategy that help us to think in different ways.

Part of how I do that is through training perioperative teams. The courses are bespoke and we bring the content back to what the team actually does. We look at things like how they communicate, how they provide mutual support and how they maintain situational awareness as a team. I want to help people understand the value of safety steps in creating a safer system; they are often seen as just compliance based checklists, but they do enable teams to function well. I’m constantly evolving the training so it reflects national policy and safety science. I’ve brought in Civility Saves Lives, Learning from Excellence and cultural intelligence as concepts for teams to discuss in workshops. One of the challenges is that while training a team, you see many concepts and ideas that could help them improve—ideally you would go back and see that team and find out whether any progress has been made. But that ongoing relationship is challenging to achieve.

I focus on training the whole multidisciplinary team, as I think it is the only way to see real improvements. Healthcare professionals often train in disciplinary silos due to traditional models and budget issues, but we spend so much of our time as a multidisciplinary team. Other industries have really thought about the importance of team interactions—a Formula 1 team wouldn’t improve their performance by taking individuals off for specific training and then putting them back together in a room. It’s all about how individuals work as a team. A team of experts is not an expert team!

One area where we need change is in how we view and deal with incident reporting. Healthcare professionals rarely get any feedback on the incidents they report, as they are just taken on and dealt with by the trust. This makes people less likely to report again as they can’t see the impact it has. One of our training courses uses actual incidents that have happened to that team and people find it really useful. I encourage teams to report and look at incidents in different ways, particularly in terms of effective teamwork behaviours. Incidents have lots of contributing factors taking place in a complex system. What we’re aiming for is producing reliability through learning from excellence as well as adverse events. We need to move away from the commonly held view that believes a high reporting rate is bad; actually what we want is a high reporting rate and a low harm rate. 

What do you think the next few years hold for patient safety?

It’s a really exciting time in patient safety; we have the new National Patient Safety strategy and syllabus which has very bold aims and a strong vision. If we can get that delivered to every member of staff, it will greatly increase knowledge of safety and safety delivery. We need to reduce the implementation gap. We also need to build the network of more specifically trained patient safety specialists, patient safety partners and safety educators.

I think Patient Safety Learning as a charity is a great new powerhouse that’s pushing the patient safety agenda through the hub and its campaigning work. It is also focused on supporting the public at a time of increasing awareness around patient safety. With reports like the Ockenden Review coming out, people are realising that patient safety is a massive issue in the UK.

Safety has always been the poor brother in healthcare; it’s not well resourced and the structures are not clear. We need to see culture change by pushing organisations to support staff and patients to understand the complexities of safety in healthcare. We can try to increase productivity, but if we don’t realise that we need to look after our staff so they can work safely, take a systems approach, learn from excellence and take the hearts and minds of staff and patients with us, we won’t achieve the right outcomes. Although these messages are starting to hit home, there is a time lag between the science and research, and it being implemented in reality.

If you could change one thing in the healthcare system right now to improve patient safety, what would it be?

I won’t say more money, because I know that’s difficult! I would make sure national policy builds safety science into what’s already going on in organisations, for example, in inspections. If the Care Quality Commission (CQC) really took a strong focus on safety and linked their inspections to the National Strategy aims and NatSSIPs, it would support implementation for staff and organisations trying to improve patient safety.

We also need better datasets that provide insight across a suite of criteria, including culture, compliance, quality metrics, reporting and harm. This would give more useful indicators of safety across the system. We shouldn’t just be looking at numbers of Never Events. Our data needs to reflect quality and safety rather than compliance. These things are achievable with the tools we have, it just takes everyone to get behind the safety movement.

Are there things that you do outside of your role which have made you think differently about patient safety?

I am a runner, and think the experience of running is a good analogy for patient safety. You have to keep going, even when it feels very hard. You will hit walls sometimes, but at other times you’ll have breakthroughs. You might be taking small steps and you might be tired, but slowly you’re helping the healthcare system move towards safety as the goal. It’s not an easy path but we’ll get there in the end. 

Tell us one thing about yourself that might surprise us!

I go wild swimming at cold water spots throughout the year, whatever the weather. I swim in lakes, seas and reservoirs, and even take a dip on Christmas Day!