Patient Safety Spotlight Interview with Mark Smith, National Patient Safety Partner and South West Yorkshire Partnership Foundation Trust Patient Safety Partner

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. Mark talks to us about his role as a National Patient Safety Partner (PSP). He explains the important role that PSPs play at national, regional and local levels of the healthcare system and identifies key opportunities and challenges they face in bringing the voice of patients and families at a strategic level. He also highlights the challenge of implementing the Patient Safety Incident Response Framework (PSIRF) across a diverse range of providers and the complexities arising where PSIRF interfaces with systems and processes outside of the NHS.

About the Author

Mark Smith is a Chartered Chemist and Scientist and has worked across the water, chemical and nuclear sectors. In addition he provides scientific and technical advice to the television and radio advertising industry.

Questions & Answers

Hi Mark! Please can you tell us who you are and what you do?

My name is Mark Smith and I’m a chartered scientist and chartered chemist by profession. I’ve been involved in patient and public experience for 20 years and in patient safety for around ten. I am a National Patient Safety Partner (PSP) and have recently also been appointed as a local PSP for an NHS mental health community services trust, helping them embed their PSPs and advising on strategy and policy. I also sit on the Medicine Safety Improvement Partnership Board and the National Response Advisory Panel, which looks at and comments on draft patient safety alerts from NHS England, though I am probably best known for my work on PSIRF.

How did you first become interested in patient safety?

Safety has always been a big thing in my professional life—I’ve spent my career dealing with the safety and security of water, chemicals and nuclear installations. I have personal experience of mental health issues and have always been interested in how patients experience the health service, so patient safety seemed a logical fit. My first role in healthcare was on an NHS Improvement committee on patient safety in mental health. I only attended one meeting before the group was disbanded due to funding issues, but I moved on to become involved in the new approach to patient and public involvement being developed by NHS England and NHS Improvement as they merged into one organisation.

Tell us about your role as a National Patient Safety Partner—what do you do and who do you work with?

The role of a National PSP is to act as a critical friend to NHS England and bring a lay-person’s perspective to the professionals. I have found that I can be quite open and challenge what’s being shared, as well as being supportive. Sometimes as a lay person, you can say things that people working in healthcare would like to say, but don’t feel they can. Our voices are heard and taken account of and I have been able to assist with decisions on national policy. I hope l have influenced patient safety changes that benefit patients and families, and staff as well.

There are currently 16 National PSPs and there is a wide variety of experience and expertise across the group. When a project comes up, a job profile is prepared and we have the opportunity to apply to be involved. Projects differ in length and complexity so the number of National PSPs on each project varies—for a smaller piece of work there might be just one of us and on larger projects there might be six or more. Although most of our work is with national teams, we do sometimes work with local teams, such as the PSIRF early adopters.

One of the main areas I have been involved in is the development of the Patient Safety Incident Response Framework (PSIRF). About eight years ago, we started looking at what changes could be made to investigations in the Serious Incident Framework (SIF). It became obvious fairly early on that changes to the existing system weren’t going to work and that it needed to be completely redesigned—hence the development of PSIRF, which has now been implemented. I have had many opportunities to help shape PSIRF—I was involved in the early adopters programme, have given presentations on the framework nationally and internationally and helped develop the guidance for dealing with patients, family, friends and staff.

I was also involved early on in the original specification and proposals for Patient Safety Specialists and PSPs.

I’ve recently been appointed to the expert group looking at the possibility of using safety management systems in health and social care.

The most important part of our role is to bring a lay person’s perspective, but on some occasions we are able to bring our expertise from outside of healthcare into discussions. 

I don’t know anyone who has not been a patient at some point in their lives, and the art of being a PSP is trying to get the professionals involved in the group to think in terms of their own experience as a patient or carer, alongside their professional knowledge and expertise. I highly recommend the book And Finally by neurosurgeon Henry Marsh, where he talks about going from being a healthcare professional to a patient in the hospital where he used to work. It’s enlightening reading about how the power dynamics shifted.

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

I quite enjoy it all! But the most enjoyable thing is being able to help make things better for patients and families, at both a national and a local level.

I also enjoy sharing information, which seems to have become one of my main roles when it comes to PSIRF—some people call me the PSIRF historian because I’m the only person that has consistently been on the project since the start! It’s helpful as I can keep reminding people of why we decided to do it and what we were expecting. It’s very easy with a long project like PSIRF to get ‘mission creep’—you can lose focus and start adding in new priorities. 

What patient safety challenges do you see at the moment?

PSIRF was always going to be a system which would not just apply to NHS trusts, but also independent healthcare and primary care. That means there needs to be nuance in how it is applied. But there are a lot more interfaces and complications in health and social care than I realised before getting involved. We always need to consider how PSIRF and other patient safety approaches interact with other organisations and pieces of regulation. When you are trying to make a fundamental change, as we are with PSIRF, there is the challenge that other systems have used the principles of the previous system to develop their own approach. Only NHS trusts used the Serious Incident Framework (SIF). 

Documents and reports come out that make me think, “Ah, here’s a new area to consider.” One example is independent providers who are also charities having to report serious incidents to the charity commission. 

There are questions around how some providers satisfy the other regulators’ requirements that a particular PSIRF learning response is adequate, where there would formerly have been a serious incident investigation. It’s an ongoing challenge to try and achieve continuity of principles across these interfacing systems and processes.

Under the SIF, patient safety became very convoluted—with fitness to practise, legal issues and interactions with the coroner’s office—so there’s a real task to try and get all these things focused and aligned with PSIRF so we can create a learning, no-blame culture in healthcare. It’s a major cultural shift, so it’s not going to happen overnight. I always say, “It’s a marathon not a sprint!”

Another challenge is that something can be written with a very clear intention, and when it is being applied, the meaning can change due to the preconceived ideas of the people at different organisations. Providers are moving from being told explicitly what to do and how to do it, to a situation where they are taking responsibility for patient safety—which is right, as they are providing a service. For the first time we will have principles that apply across the whole of the health service that will be tweaked according to the size and characteristics of each organisation. We have to remember that not all organisations are starting from the same point, so one size doesn’t fit all. That’s a difficulty which I think people are still struggling with, because they are so used to having to follow what comes from the centre rigidly. 

A lot of organisations are also used to using metrics which don’t clearly show improvements in patient safety—for example, the number of incidents or good catches. These metrics don’t show how an organisation is performing in patient safety, they show how strong the culture of self-questioning and honest reporting is. When results are compared and used to judge how safe an organisation is, it’s total nonsense. Under the SIF, the number of serious incidents failed to accurately represent how safe an organisation was, as different organisations have different risk profiles. For example, a provider offering cutting-edge transplantation services will have a different risk profile to a primary care group. We need to focus on defining metrics that can give an accurate picture of safety across a disparate base of organisations, and that’s very difficult. It’s part of moving towards a Safety II approach where we learn more from good catches about how to prevent incidents.

What do you think the next few years hold for Patient Safety Partners?

PSPs have a really important role in getting organisations to continue thinking about patients, families, friends and carers in amongst all this system change. However, we aren’t fully clear on how the different PSP roles will evolve over the next few years. National PSPs are well established and the role of local PSPs is developing. Some regions have regional PSPs while others don’t. We’re not quite sure how all of these roles will interact with each other and with other bodies such as ICBs, independent healthcare organisations and Patient Participation Groups in GP practices. How it will all join together is a work in progress. But because PSPs are in place from the outset, they can help shape what this looks like at each level of the system.

How will the Patient Safety Partners Network help PSPs to maximise their role?

The network is extremely important as in many cases the role is new. There have been differences in the way people were appointed which means PSPs are approaching the role at different starting points. 

What has shown up for me in the meetings is how some organisations are not using the role as originally planned. Local PSPs were intended to bring the patient, family and carers’ perspective at a strategic level of the organisation, which fits in with what happens nationally. Each provider should have two PSPs on the top level safety committee of the organisation.  But you listen to the conversations, and some network members are working at the right level, while others are working at a totally different level. This is either because that’s where they feel they should be working, or because they have been told that’s what they must do by the organisation.

The feedback at network meetings shows that some organisations are unsure of the bigger picture of national patient safety policy and how it affects them. The trust placed in national PSPs by NHS England is not something most local PSPs have—it has shown me that NHS England has a level of maturity in its approach. It is able to accept criticism and listen to the voices of lay-people. When I’m presenting, I am able to speak on what I feel is going to be helpful and I am trusted to present and answer questions, often working in collaboration with members of the national team. I don’t have to follow a script and that’s important when trying to help patients and healthcare staff understand new policy. PSPs have got to somehow show organisations that they have nothing to fear. 

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

I would ensure that all provider organisations have a no-blame culture—in reality and not just in theory—that takes on board all patient, family, carer and staff views equally and honestly. 

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

My work in patient safety is hugely influenced by my scientific and analytical background. I don’t get phased by data and the length of reports! I think a scientific background also makes you willing to speak your mind and ready to evidence and defend your position.

Tell us one thing about yourself that might surprise us!

I’m a cricket umpire in my spare time.

If you are a Patient Safety Partner and would like to join the Patient Safety Partners Network, you can join by signing up to the hub today. When putting in your details, please tick ‘Patient Safety Partners Network’ in the ‘Join a private group’ section. If you are already a member of the hub, please email support@PSLhub.org to apply to join the PSPN.