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. Jonathan talks to us about the importance of leadership in creating a safety culture and the role of Patient Safety Learning in fostering collaboration and establishing standards for patient safety.
About the Author
Jonathan's patient safety career began at Datix, where he worked with organisations around the world to design and implement patient safety reporting and learning software. He stepped down as Chief Executive of Datix at the end of 2015 and started work in 2016 on what was to become Patient Safety Learning. Jonathan is now Chair of the Board of Trustees of Patient Safety Learning. Jonathan also works as an advisor to healthcare and technology startups and is Chair of HotRad.tv, the music livestreaming business.
Questions & Answers
Hello Jonathan. Please can you tell us who you are and what you do?
I’m Jonathan Hazan, Chair of the Board of Trustees at Patient Safety Learning. Before this I spent many years as Chief Executive of Datix, a patient safety and incident reporting business. When I left that role in 2015 I wanted to continue in patient safety, so I helped found Patient Safety Learning to focus on some of the safety themes I had encountered while at Datix.
How did you first become interested in patient safety?
I first became interested in patient safety when I started as a programmer at Datix (which is now called RLDatix) after leaving university in 1995. From my earliest days at Datix I picked up an appreciation of the importance of patient safety. Near the beginning of my time there, I gave a presentation to the Royal Society of Medicine about a new version of the software. It was an eye-opener for me as I got to meet people who were deeply involved in patient safety, which back then was known as ‘clinical risk management’. It helped me understand how reporting incidents can enable us to work out why they happened and, therefore, establish ways to prevent them from happening again.
During my time at Datix I was involved in a whole range of activities, including training users and selling the software, and this gave me an appreciation of the breadth and depth of patient safety. As my career progressed, I got involved with organisations such as AvMA, which gave me opportunities to meet people affected by patient safety incidents, including relatives and patients themselves. I witnessed first hand how badly these people had been affected. I also got to meet staff who had been involved in patient safety incidents, or who had witnessed unsafe care and been badly affected as a result of their whistleblowing.
One tool that has really helped me in my patient safety career is social media—it enables me to connect with a wide range of people involved, including patients, doctors, nurses and other healthcare professionals. Every two years we held a Datix conference and I was able to invite people I had spoken to on social media to come and share their stories. We had some great talks, including from leaders in patient safety and people who had been on the sharp end of whistleblowing and hounded out of their jobs.
These connections drove me to ensure that everything I did at Datix was about patient safety and to make sure everyone in the organisation understood why they were there. It wasn’t just about creating software, but helping to protect patients from harm. While I was Chief Executive, I helped to craft a new mission statement: “We help our customers protect patients from harm by creating opportunities to learn from things that go wrong.” That really sums up what I wanted to achieve when we set up Patient Safety Learning; it's so important to help organisations and people learn from issues. One of my top priorities is enabling organisations to easily share their learning with others who might be facing the same issue but are unaware that someone else has found a solution.
Tell us a bit about Datix and how it’s used in the NHS
Datix is a software tool for reporting anything that goes wrong in a health or social care setting. It allows that incident to be recorded and investigated, and make sure that actions are put in place to try and prevent harm from similar incidents happening again.
Datix started off as software for clinical negligence claims management. If a patient sued an NHS hospital, the litigation and risk management department would use Datix to manage the claim process. But fairly quickly, we realised that each claim had to start with something going wrong, and we decided to build in incident reporting so that information could be recorded in Datix at the time of the incident. This would help hospitals to assess the causes of incidents and potentially prevent patient harm—and therefore claims—from occurring in the future.
Datix is very widely used in the NHS and is now primarily for incident reporting; for example, to record medication errors, patient falls or wrong site surgery. When an incident happens a healthcare professional will say, “I need to Datix that!”
Sadly, the system is sometimes misused when staff threaten to ‘Datix’ their colleagues, but this is based on a misunderstanding of its purpose and function. Datix is used for learning from things that go wrong, it’s not designed to be used in a punitive way. It’s important to stress that this is not a problem with the Datix software, it’s an issue of organisational culture—if you have a culture where people are bullying others, systems will be misused to that end. Another reason we set up Patient Safety Learning was to try and counter this “I’m going to Datix you” culture, and to help people on the sharp end to realise that it's an empty threat. Culture is set by leaders and these threats can only exist because the culture is poor. That’s why I believe that transforming culture has to start with individual behaviour change at a leadership level.
Which part of your role do you find the most fulfilling?
It’s really fulfilling to see how quickly the influence of Patient Safety Learning has spread, both in the UK and worldwide, from our small beginnings a few years ago. As Chair, I primarily work with our Chief Executive Helen Hughes and the board of trustees to help Patient Safety Learning focus on priorities that will best achieve the aims of our charity for our beneficiaries. Our goal is to help improve the health and wellbeing of people within the healthcare system.
I find it very fulfilling to hear positive feedback on what we’re doing. We are still a small charity, but I like to think we “punch above our weight” as a trusted resource for patient safety. the hub has been incredible and has grown massively from small shoots; to hear people say they use the hub as their first stop for information if they have a patient safety issue is really wonderful.
It’s also great to see the hub being used by campaigns and groups as a space to get together and drive patient safety improvements. An example of this is the Patient Safety Management Network (PSMN), which has created a safe space for patient safety managers to discuss issues without feeling scrutinised. Another great use of the hub is by patient campaign groups, such as our work with campaigners on the issue of painful hysteroscopy.
What patient safety challenges do you see at the moment?
Leadership and its effect on culture is the biggest concern I have for patient safety. If you have a poor culture, people can be too scared to engage with learning and improvement processes. Staff become fearful about reporting when things go wrong, or where they see resource issues such as an understaffed ward—but if they don’t feel safe to report concerns, improvements can’t happen.
The problem starts right at the top of the health system hierarchy—where the chief executive of an NHS organisation is fearful for their own job because of pressure from above, that will permeate the whole organisation. The end result is that staff won’t feel safe, learning won’t be happening and patients will come to harm. The healthcare system is under tremendous pressure at the moment, which exacerbates the issue.
What do you think the next few years hold for patient safety?
Over the next few years I would like to see more sharing of learning and more focus on reaching consistency in patient safety among different organisations. This is something that we at Patient Safety Learning have an opportunity to influence. At the moment, we are contributing to the common goal of shared learning through the hub. We are also creating the first ever set of patient safety standards for organisations to aspire to meet, and this has the potential to cause a sea change in patient safety. I think standards are very important as they allow us to reduce variation and create a more consistent approach to improve safety.
If you could change one thing in the healthcare system right now to improve patient safety, what would it be?
In the UK, I would make sure there is a recognition of the importance of patient safety, including the role of leadership and culture, at Government level. Ministers would understand and commit to tackling the issues we see, to ensure that the NHS is properly managed for patient safety.
Are there things that you do outside of your role that have made you think differently about patient safety?
Outside of my role at Patient Safety Learning, I work with people across different industries and at many levels. I help young people and career changers with startups and work with corporate finance and investment bankers to look at investment decisions. Whatever I’m doing, my focus is always on finding what motivates and focuses people, and what makes good leaders.
I’m interested in how to encourage people to do the right thing and have a positive impact on society—it’s about motivating people through positive encouragement, rather than negative threats and intimidation. I believe in nurturing people rather than demoralising and scaring them, and this carries through to my work on improving safety in healthcare.
Tell us one thing about yourself that might surprise us!
Over the past couple of years I have taken up crochet and have created a variety of animals and vegetables. I wanted to take up something different and challenging that didn’t involve sitting in front of a screen. I love seeing the amount of happiness my creations bring to people!
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