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. Claire talks to us about her role as a Patient Safety Lead and why she thinks the new Patient Safety Incident Response Framework will make her work more practical and patient-centred. She also describes why she set up the Patient Safety Management Network and highlights why patient safety roles would benefit from more standardisation across trusts.
About the Author
Claire is an experienced nurse of over 25 years. She has worked in numerous specialities in the NHS and in different places around the world. From 2011, Claire worked as a Critical Care Outreach Sister, where her desire for patient safety was ignited.
In September 2020, Claire began an exciting new career in patient safety, and she is currently a Clinical Patient Safety Lead at a London hospital. She co-founded and chairs the Patient Safety Management Network which started in June 2021. This network has grown to over 400 members nationwide and meets weekly to discuss the evolving management of patient safety.
Questions & Answers
Hi Claire! Please can you tell us who you are and what you do?
My name is Claire Cox and I currently work as a Patient Safety Lead in a London hospital. I cover five care groups, supporting the team with their investigation reports and looking for emerging themes and trends. I also help support teams with serious incident investigations, duty of candour and to involve patients and families in investigations. At the moment, my role is in a time of flux as we move to the new Patient Safety Incident Response Framework (PSIRF), trying to introduce it alongside the old Serious Incident Framework (SIF).
How did you first become interested in patient safety?
I’ve been a nurse for many years and have worked in a wide range of roles including as a resuscitation officer, an outreach nurse and a heart failure nurse. I first became interested in patient safety when I worked in outreach, which acts as a kind of hospital ‘safety net’ for deteriorating patients. When patients become unwell, the outreach team scoops them up and gets them into intensive care. It's at this point that you can see where things have gone wrong and how key issues have been missed—you see the Swiss Cheese model in action.
I’ve been in coroner’s courts a few times, giving evidence about what’s gone wrong, how it went wrong and why we didn’t do what we should have done. That experience motivated me to start some improvement work in the hospital I was working in, but trying to do improvement work while you’re working full time in a clinical role is really tricky. I managed to start some initiatives, but wanted to do more. So I applied and was accepted for a Darzi Fellowship, which is a postgraduate certificate in clinical leadership, and that’s where I realised that patient safety is where I wanted to work.
Darzi is about clinical leadership, leading people on the ground to introduce improvements in services. It’s focused on ‘how’ you lead people and I think if I hadn’t done it, there is no way I’d be doing what I’m doing now. It taught me skills in engaging with lots of different types of people, which is something I do all the time now, from both inside and outside the NHS. It’s important to understand where each person is coming from and what lens they’re looking through, so that we can negotiate what can be done, and what can’t.
Why did you establish the Patient Safety Managers Network?
While on my Darzi Fellowship, I was trying to understand why the health system wasn’t learning from incidents, and came across Patient Safety Learning, where I ended up working full time for a couple of years. It gave me such a fresh perspective as the organisation sits outside the NHS hierarchy that I was used to. I was able to see the whole system ‘from above’ and understand the issues more clearly.
I helped set up the hub by collecting resources, from small quality improvement projects in local hospitals to the big national inquiry reports. The aim was to share everything that could be shared! There are so many resources on the hub, but I realised people would need support to make changes and implement the ideas they found. So when I left Patient Safety Learning and started a role as a Patient Safety Manager in a hospital, I saw the opportunity to build an environment of support and discussion.
I couldn’t find any networks or connection points for patient safety managers working on the ground, so I decided to set up the Patient Safety Management Network (PSMN). The aim was to talk about and collaborate to tackle everyday problems we were all facing: How do you implement duty of candour? How do you involve families? Do you have a template for an SUI investigation? How do you apply human factors to your investigations?
Patient Safety Learning helped me set up the network a year ago and we now have over 400 members and meet weekly on Teams. It’s an amazing, vibrant network and we talk about what we want to talk about, when we want to talk about it. There’s a sense that we are all in it together, rooting for the same changes.
I want to inspire other people to get involved in patient safety. If you’re thinking that you want to get involved but don’t know how to do it, please get in touch. It’s a really exciting time for patient safety at the moment, and it’s not all desk work and incident management.
Which part of your role do you find the most fulfilling?
The things I find most fulfilling are working with families and helping people on the ground with quality improvement work. Unfortunately, due to the way that the SIF is set up, that part of my job is minimal, but improving care and involving families are what carries me through. Yesterday, I was on one of the wards where we are trying to flesh out how we can improve handovers, because these transitions of care are linked to a lot of serious incidents. So, I’m working with the team to try and make improvements, but I don’t have as much capacity as I’d like to because of the way that the current SIF is set up. I spend a lot of my time on the computer doing admin and chasing people to write reports.
The way that the SIF is set up also makes it really difficult for us to share reports with families, as they need to be signed off. So patients are waiting exceptionally long times for reports and then once they get them, they’re often not happy with them because they haven’t really been involved enough in the process. It’s almost a system that sets us up to fail. But the new PSIRF turns the system on its head and should mean we can do more improvement work and work with families. That’s what I’m living for at the moment! It’s quite a hard transition as the two frameworks are so different, they don’t really blend. But it’s part of the messy reality of trying to institute change and I’m holding out hope that by this time next year, things will be so much better.
What patient safety challenges does the health system face at the moment?
Sadly, we see the same issues coming up over and over again. If you read the big reports, they often have the same recommendations, but the health system still isn’t working any differently. For example, the Ockendon report looks very similar to reports we have had before, but nothing seems to change. Making those changes happen is a huge challenge that we really need to tackle.
Another major challenge is that we have a workforce which is tired, and lots of people are leaving. People move around a lot in the NHS and that lack of consistency can make implementing lasting change difficult. Introducing PSIRF in that environment will have its challenges as it's the most radical shift we have seen in patient safety for many years.
Coming out of Covid, another patient safety challenge is treating all of the patients that we haven’t followed up. We haven’t yet seen the full fallout of the backlog, which will create new issues.
A further challenge is lack of standardisation across patient safety staff. We don’t have a professional body, we all have different roles and job titles, and we don’t get paid the same. We come from a diverse range of backgrounds; some of us are nurses, physios, pharmacists or doctors, and some are non-clinical. I think some work to give us clearer standards, skills and pay structures would make it easier for us to progress our careers and help people understand and value our role. It should be that investigations are run by people with the same skills and competencies wherever you are in the country.
What do you think the next few years hold for patient safety?
I’m glad that Health Education England has a new Patient Safety curriculum coming out, as this gives us a level of standardisation. There are now a lot more courses we can go on as patient safety managers, such as human factors training, but they are not standardised at the moment as it’s such a new area.
I feel that we’re just starting to get our approach to patient safety right, but there’s a long way to go. When PSIRF comes in, we will have more family involvement and that will become the driver for change. At the moment, the system is set up for trusts to seek assurance and make sure things are safe in their eyes. But it needs to be safe everywhere and for everyone, and a huge culture change will be needed to achieve that. Once patients and relatives get more involved, I hope we’ll see a real difference.
If you could change one thing in the healthcare system right now to improve patient safety, what would it be?
I would change the culture of blame. The NHS needs to be a learning organisation, which involves being more open and less defensive. We need to be less scared of litigation, and of the people that we serve. I think if we change the blame culture, everything else will follow.
Are there things that you do outside of your role which have made you think differently about patient safety?
In the past, I’ve done voluntary overseas aid work, and that really opened my eyes to the value of some of our NHS systems. Back in 2016, I did some work with Syrian refugees on the Macedonian border. I travelled naively in the back of an ambulance with some colleagues to support about 40,000 refugees in a field, with no infrastructure at all.
Before that experience, I had always felt constricted by policies, procedures and governance. But when I was there, I realised how important those things are—I learned more about governance in a field with 40,000 refugees than I have anywhere else. There were only three of us. People were coming to us and sometimes we couldn’t help them—pregnant women saying they couldn’t feel their baby moving, people needing urgent tests, people turning up with empty insulin pens. We had very few resources to offer the people we were serving. It was an awful thing to witness—babies were being born and washed in puddles which was so distressing. It was so tempting to just go over the border to Macedonia and buy basic drugs and bring them back, but that’s not sustainable and it undermines the systems that do exist.
When I returned to help a couple of years later, they had set up more formalised, indoor camps. The conditions still weren’t ideal, but it was much better. I was helping create people’s health records so that they could seek asylum in other countries, making sure all their vaccinations were up to date and recorded. It was an incredibly difficult task, as we were writing on random bits of paper and trying to keep track of it all. I learned the value of a solid admin system!
Tell us something about yourself that might surprise us!
I have a black belt in judo. I don’t practice it now, but could still use it if I needed to—I’m like a lethal weapon!
If you are a patient safety manager or lead and would like to find out more about the Patient Safety Manager's Network, you can get in touch with Claire by email or on Twitter, or apply to join the network when you sign up for the hub.