This is part of our new series of Patient Safety Spotlight interviews, where we talk to people about their role and what motivates them to make health and social care safer.
Julie talks to us about how attitudes to patient safety have evolved since the 1990s, the role of the World Health Organization in improving quality and safety, and the need to learn lessons from infection prevention and control approaches that were adopted during the Covid-19 pandemic.
About the Author
Julie is co-founder and director at S3 Global and has twenty years' experience working at both national and international levels on a number of campaigns and patient safety improvement programmes, including for the World Health Organization.
Questions & Answers
Hi Julie! Tell us who you are and what you do
I’m Julie Storr and I trained as a nurse and health visitor in the UK in the 1990s. I worked as an infection prevention and control (IPC) nurse and for a time managed the IPC team at Oxford Radcliffe Hospitals. I then worked for the National Patient Safety Agency (NPSA) when it was starting up and led a seminal, national campaign on hand hygiene improvement using behavioural theories.
In 2005, I was invited to work for the World Health Organization (WHO) to help develop the first WHO guidelines on hand hygiene in healthcare. They really wanted to learn from the UK, which was one of the first countries in the world that had tried to address hand hygiene improvement as a patient safety issue nationally. Zoom forward a few years and I worked for WHO on a twinning programme across Africa and Europe around patient safety improvements. For the last ten years I have worked with WHO’s quality, water sanitation and hygiene in health care (WASH) and IPC teams, which included getting involved in work to tackle Ebola back in 2015.
In between all that, I have done further studies and been involved in charitable work around access to healthcare information, and was for a time the president of the UK & Ireland Infection Prevention Society. It’s quite a diverse portfolio, but the thread that runs through my career is infection prevention as a key part of quality—and therefore safety.
How did you first become interested in patient safety?
The late 1990s/early 2000s was a pivotal moment for patient safety - there had been a number of scandals and high profile investigations around the world, and there were new reports bringing patient safety to the fore for the first time.
I was a senior nurse working in Oxford and started to hear from leaders in my organisation about a report called ‘An organisation with a memory’. It was the first move to try and draw ideas from other industries on how we could improve the safety and quality of healthcare. It piqued my interest, because infection control is so central to that—to this day, a huge cause of adverse events in healthcare globally is healthcare infection. I became more and more involved in infection prevention, risk management and patient safety.
Hand hygiene is one important part of the picture—it’s seemingly a tiny thing, but is a fundamental element of delivering care safely. WHO positions hand hygiene as the “entrance door to patient safety.” I like that description - and we certainly find that hand hygiene is a very tangible entry point in many middle- and low-income countries.
Which part of your role do you find the most fulfilling?
Although to an outsider these factors seem like the fundamentals - patient safety, infection prevention, water sanitation and quality improvement - they exist alongside so many competing priorities for those who have to resource healthcare. So having a voice to try to influence the policy agenda and the decision makers in different countries is important to me. As we move forward, quite rightly, with expanding access to healthcare, we must not forget the importance of safety and quality. Given everything that has happened with the Covid-19 pandemic over the past two years, that’s as important in the UK as anywhere in the world.
Communicating about the value of infection prevention in a balanced and evidence-based way is what drives me forward. Critical and analytical thinking and the ability to communicate a strategy and a vision are really important.
What patient safety challenges do you see at the moment?
Before the pandemic there was a creeping element of fatigue around the patient safety movement and infection prevention. There was a feeling that there had been so much attention given to safety and IPC, that we had ‘done that’.
I am hopeful that we are now seeing a renaissance in patient safety and IPC, and quite rightly so. My concern is that we seize the opportunities we now have to make sure this renewed interest continues, that we have a voice that’s heard around the table and that we are open to doing things differently and better.
What do you think the next few years hold for patient safety?
The areas in which I work - safety, IPC, water sanitation and hygiene, and even quality itself - are always in danger of being seen in siloes rather than being seen as part of the whole picture of effective health care delivery. But many current initiatives and reports on improving IPC, for example, talk about the need for an integrated approach. There’s lots of talk, and we need to try and make that a reality. I think that’s one of the reasons that WHO has a value; on the one hand it is criticised for being a generator of report after report, but in fact often those reports and guidelines truly drive action in many countries.
One of the things WHO should continue to do is give us data and evidence that we can use to sell the case for continuing to invest in safety, quality and infection prevention and control, but coupled with humanity, compassion and a real world perspective.
Over the past few years, it has become clear that many of the things we do in the name of safety and IPC have a collateral impact on mental health and wellbeing. Some IPC interventions necessitate isolation or physical separation of a patient from other patients, to halt the spread of microbes. The pandemic has seen an extreme version of this that resulted - in many cases - in the total exclusion of loved ones both in hospital and in residential and nursing home settings.
Up until now we may not have fully addressed the psychosocial impact of IPC measures and I’ve been getting more involved in trying to do this. I think we need to look at compassion in the context of what we do in the name of keeping people safe. We need to balance interventions to keep people safe with the impact they have on people’s lives beyond the infection you are trying to prevent.
There is a big movement in the field of healthcare quality to address compassion as an evidence-based intervention in its own right and I want to see this permeate patient safety and IPC much more.
If you could change one thing in the healthcare system right now, what would it be?
I would like to have an open, solution-focused conversation both nationally and internationally, on the lessons to be learned from what we did during the pandemic in terms of “visitor” exclusion, including assessing the harms this resulted in.
As part of this, we need to develop an approach that will make sure we use IPC to enable safe healthcare for everyone. At the very least, this will require someone with a strong credible voice to stand up and make the case for this at the highest level - and I am not hearing that just now.
Are there things that you do outside of your role which have made you think differently about patient safety?
I often get inspiration and ideas on leadership from less conventional routes - podcasts, fiction, films, TV and even comedians help me think through different aspects of my day job. I look at how leadership is addressed outside of healthcare and what I can learn from that in how I try to influence others.
Tell us something about yourself that might surprise us!
I got interested in hypnotherapy about ten years ago and I’m a trained clinical hypnotherapist. It does link to my long standing interests in behaviour change and communication to some extent, and occasionally people still randomly ask me to hypnotise them!
Infection Prevention and Control should be an enabler, not a barrier to safe, compassionate human interaction
Seconds save lives – let’s not forget that: a blog by Julie Storr
Visiting restrictions and the impact on patients and their families: a relative's perspective
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