Patient Safety Spotlight Interview with Tracey Herlihey, Head of Patient Safety Incident Response Policy at NHS England

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. Tracey talks to us about how her love of applying psychology led to her role in patient safety, the importance of putting users at the centre of developing the Patient Safety Incident Response Framework (PSIRF), and what we can learn from magicians about patient safety.

About the Author

Tracey Herlihey is the Head of Patient Safety Incident Response Policy at NHS England (NHSE), where she is responsible for day-to-day strategic leadership and subject matter expertise for the Patient Safety Incident Response Framework (PSIRF). Tracey is a chartered Human Factors Specialist, Chartered Psychologist and has a PhD in Applied Psychology from Cardiff University specialising in Human Perception and Performance. In 2020, Tracey was awarded the title of Visiting Fellow in Human Factors in the School of Design and Creative Arts at Loughborough University.

Questions & Answers

Hi Tracey. Please can you tell us who you are and what you do?

My name is Tracey Herlihey and I am Head of Patient Incident Response Policy at NHS England and lead on all things related to PSIRF. I’m a chartered Human Factors specialist and chartered psychologist, and have a PhD in Applied Psychology around human perception and performance. My background is in academia and patient safety investigation in healthcare.

How did you first become interested in patient safety?

I had a bit of a long journey into patient safety. I have always had an interest in psychology and how we apply the knowledge it gives us. How do we take all that we know about people, their capacity, attention, memory and so on, and apply it to make a difference? While I worked in academia, I really struggled with the lack of application of the knowledge we have. My first move into applying psychology was working on the design of night vision goggles for landing aircraft at night. I looked at how we can take information about depth perception and how we perceive our environment and apply that to the design.

After a brief return to academia, I ended up in the world of user experience design, and to be honest, I found it underwhelming. Some of the projects involved redesigning consultancy companies' intranets, which wasn’t really making the difference I knew that applied psychology could make! That’s when I moved into healthcare safety. I started working for an organisation called Healthcare Human Factors which was based in Toronto General Hospital. I got into the world of patient safety and Human Factors, looking at things like the design of medical devices, procurement processes and implementing e-health technologies. I loved it! But at the time we really struggled to actually influence the safety practices of the hospital, even though we were right there in the building.

Then a job came up back in the UK for the newly set up Healthcare Safety Investigation Branch (HSIB). It was such a great opportunity to be part of a world-first organisation that would help improve investigations and make system recommendations. From HSIB, I moved across to NHS England. What I really like about my current role is that I get to read and understand the academic research and directly apply it to patient safety—it’s been important in modernising the way we go about learning from patient safety incidents. There are lots of opportunities to collaborate with academic researchers, for example, to inform how we design our guidance.

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

PSIRF is a hugely complex intervention, and one of the things I like most about the role is the complexity that comes with it. I really enjoy problem solving and working with other people to help solve problems.

I see a huge value in speaking with people who actually do the work—they are the absolute experts in how things are done—my role is more to try and understand that and close the gap between 'work as prescribed' and 'work as done'. I have really enjoyed working with our early adopters to test and trial the framework, identifying changes to make it more useful. We’ve tried to work with other stakeholders in PSIRF’s development to really make sure we’re representing those who are going to have to pick it up and actually use the framework. But we’re just getting started and the complexity will continue as we fully implement PSIRF!

What patient safety challenges do you face at the moment?

A challenge for me at the moment is to ensure that as a national organisation, we are using our time effectively to support organisations to transition to PSIRF. We have a plan to support the system, including hosting transition webinars and specific workshops for providers in different sectors. We’ve set out a 12 month preparation guide and offered support through our patient safety collaboratives. 

However, it’s really important that our plan is flexible—we need to make sure we’re being responsive to the challenges being fed back and that we produce information that is actually useful. Peer learning and sharing is really important, I can’t emphasise that enough. That’s what’s at the forefront of my mind at the moment. The next few months are crucial as it’s so important to get those foundations right, and make sure we’re not just continuing to respond to patient safety incidents in the same way but with a different name.

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

In patient safety there are no silver bullets or quick changes, so maybe that would be my one change—that we stop trying to chase quick fixes and low-hanging fruit! I once read an article around silver boomerangs, ideas that keep coming back again, and we forget whether they worked (or how they didn’t work) the first time.

I would also love to jump ahead two to three years to show people how PSIRF will make a difference. We’re in the thick of it right now, trying to understand what PSIRF is about and how we can make it work. It is hard work, and at times it will feel like we’re not making any progress. One thing that our early adopters programme has shown is that things do improve—our early adopters talk about ‘feeling’ a difference in culture. I would love people to be able to see the pay off from all the hard work.

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

I enjoy going running to get away from my computer screen, and like to listen to safety podcasts. I really enjoy Todd Conkiln’s PreAccident Investigation podcast and The Safety of Work podcast. There are lots of threads you can gather and interesting areas to learn from—for example, Todd talks about how you can learn about user experience design from the development of underwear! Tim Harford’s Cautionary Tales is great for stories and Dr Informed from the BMJ has a strong clinical focus. Then there’s the classic psychology related ones, like No Stupid Questions and Freakonomics. While I’m running my mind does wander, but often there will be great nuggets that I’ll write down as soon as I get home!

Tell us one thing about yourself that might surprise us!

I think my interest in applying psychology comes from having a magician in the family! I grew up with magic—I met Paul Daniels, one of the greats. If you think about magicians, they are the ultimate professionals at understanding how humans work, how they allocate their attention, or don’t. There’s so much we can learn from their ability to trick humans into believing things that may or may not be there!

Related reading

• NHS England - PSIRF Early Adopter interview: Acute healthcare provider perspective (15 August 2022)
• NHS England podcast - Introducing the Patient Safety Incident Response Framework (PSIRF) learning response toolkit (6 October 2022)
• HSIB blog - PSIRF: a fundamental shift in how the NHS responds to patient safety incidents (26 September 2022)

You can find lots more information, resources, events and case studies relating to PSIRF on the hub.