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. Maureen discusses the important role of professional standards in building a patient safety infrastructure, the need to reframe safety as a positive idea and her experience of implementing learning processes during her time as a GP.
About the Author
Professor Maureen Baker CBE is Chair of the Professional Record Standards Body (PRSB) for Health and Social Care and is the Immediate Past Chair of the Royal College of General Practitioners from 2013-16. She is also the Chief Medical Officer for Healthily, the award winning selfcare web platform. Her work in patient safety includes establishing a formal clinical safety management system for NHS Connecting for Health, developing safety standards for Health IT for the NHS in England and developing e-learning modules on patient safety for doctors in training. Maureen was awarded a CBE in the Queen's New Years Honours in 2004.
Questions & Answers
Hello Maureen. Please can you tell us who you are and what you do?
My name is Maureen Baker and I’m a GP by background. I’m currently Chair of the Professional Record Standards Body (PRSB), where we produce electronic record standards for health and care. I’m also Chief Medical Officer of Healthily, a self-care platform with a smart symptom checker and extensive health information. Previously, I was Chair of the Royal College of General Practitioners (RCGP) and Clinical Director for Patient Safety at NHS Connecting for Health.
How did you first become interested in patient safety?
As the patient safety movement was growing in the mid-1990s, I started reading articles about the harm that healthcare was doing to patients. There was a lot of focus on how that related to harm caused to people in other industries. I was hearing accounts of people working in healthcare seeing a problem and then finding a solution to deal with it. One example that I really liked was changing the design of anaesthetic taps and tubes so that the user wasn’t physically able to attach the wrong hose to the wrong gas.
Around that time I was very involved with the RCGP and we started promoting a process called Significant Event Audit (SEA), which was an innovative technique at the time, focused on learning from events in healthcare. I started using SEA in my GP practice and it was by far the most powerful learning event that we had used. We took something that had gone badly wrong, or very well (you can learn from excellence as well as disaster) and the process gave us actions that we could put in place in our practice.
One great advantage to being a small, relatively autonomous unit in healthcare is that you are more able to quickly make changes and try new approaches. We were a small practice with three partners, so when I came in with the RCGP SEA paper, I was able to say, “Shall we give this a go?” We didn’t need to get permission or go through an approval process, we just started using the technique the next week. It felt as though we were actively learning and applying that learning to make a tangible difference.
Which part of your role do you find the most fulfilling?
I joined PRSB because I saw an opportunity to improve what we call the ‘patient safety infrastructure’—the things you fix in place that you can then build processes onto. Standards for patient care are an important part of that patient safety infrastructure and I find it very fulfilling that our work at PRSB is contributing to building it. The goal is to ensure that all staff in different settings can see the full set of information required. We do that by helping providers collect the correct information that’s needed for care, and to share it reliably and in a structured way.
What are the biggest challenges to achieving that effective sharing of information across health and social care services?
The biggest challenge is implementing the standards. At PRSB, we create the standards to a very high quality and all the relevant professional bodies sign up to them, so we have this great collective backing. But the standards are pointless if no one uses them. Our role is to develop standards, but we are rarely commissioned to support implementation, and one of our great frustrations is that no one seems to take responsibility for implementation.
We do a huge amount of work to try and close this implementation gap and promote the adoption of standards. For example, the majority of health service IT providers have signed up to our Standards Partnership Scheme. One element of this is Quality Partnership, where suppliers are assessed on how they comply with our standards. It’s a really helpful scheme for patient safety; if the supplier community is working to comply with our standards then that’s a great big tick in the implementation box.
Some of our standards are not mandatory, and even those that are nationally mandated are not always applied. For example, we still don’t have universal application of the NHS number despite it being mandated three or four times in the last thirty years! We need people right across healthcare to realise why our standards are important for patient safety—this includes increasing trusts’ understanding that they aren’t there to be a burden, but to improve safety. Good standards will actually reduce burden—staff don’t need to decide what information needs to be collected for each patient, as it’s all laid out for them. The more levers we can use to help people move towards this understanding, the better implementation we’ll get.
What do you think the next few years hold for patient safety?
I’ve been working in patient safety for around 25 years and sadly I don’t see that we have made great strides forward. It seems that every generation has to discover the same lessons. But I hope that moving forward, more attention will be paid to the safety infrastructure to make it easier for healthcare professionals to do their jobs well and safely. I would like to see the health system create more safety benefits from the technology we have. I think there has been an assumption that technology will automatically improve patient care and safety, and a lack of thinking around how we maximise the benefits.
If you could change one thing in the healthcare system right now to improve patient safety, what would it be?
There’s no magic wand—there’s a whole range of approaches we need to take—but a start is changing staff perceptions of patient safety so that they view it as a positive thing. Safety isn’t something to beat your colleagues over the head with. It’s incredibly depressing that Datix, which the NHS uses to record incidents for learning, has become seen as a negative tool to threaten colleagues. The phrase “I’ll Datix you” is now common parlance in the NHS—the culture has transformed something that should be a positive boon to learning into a method of retribution, which is really awful.
I’d also like to see an understanding of safety as a fundamental part of professionalism. While it’s primarily about keeping patients safe, safety culture is also focused on your safety as a member of staff, and helping prevent you from making mistakes.
Are there things that you do outside of your role that have made you think differently about patient safety?
Throughout my time as a doctor I’ve become more and more aware of the ways in which safety is actively promoted in other areas of life and other industries. When you’re attuned to it, you see safety everywhere. My family and I like going to theme parks and we often visit DIsneyworld in Florida. One of the rides that sticks in my mind is the log flume. It had signs on the way up saying ‘danger’ and then ‘safety first’. Then about 10 metres further on there was a sign that read ‘accidents a close second’—I’ve always remembered that message!
Tell us one thing about yourself that might surprise us!
I’m the eldest of six children and until I was six we lived in Craigneuk, a deprived area in the west of Scotland. We lived in what was called a room and kitchen, a small house with no inside toilet or bathroom. That was in the early 1960s and was unusual even at that time. My mum was a school teacher and worked full time in spite of having six children. I’m not quite sure how my parents managed, but they did!