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At a Patient Safety Management Network meeting last year, Amy Wood gave a presentation on her experience of managing change in the NHS. Speaking about her time at Chase Farm Hospital, Amy presented to the Network how Chase Farm Hospital moved to a new hospital building and implemented a new Electronic Patient Record (EPR) system whilst ensuring patient safety was maintained. We asked Amy to share her insights in a blog for the hub. Amy highlights the challenges she faced, how she engaged staff, the issues that came up and key takeaways from it. Background Chase Farm Hospital, part of Royal Free London, is a small elective, surgical hospital. At the time, it was made up of old buildings, not fit for purpose, spread across a large area. Example of the old building From August to September 2018, we moved the hospital to a new building with theatres, including a barn theatre and a 50-bedded ward. The new hospital had been designed to be paperless and so we also had to implement a new EPR system at the same time. Example of the paper-based system before the move The challenges As with all big organisational changes, there was a lot of meetings held with various staff members. At the time, the Royal Free London was divided into business units, each with their own executive management teams. One of the challenges was that not all of the staff who worked at Chase Farm Hospital and who would be affected by the changes were managed by our business unit. This meant they weren’t always invited to meetings and they didn’t always hear the crucial information. We had to find ways to ensure that these staff not only heard the key messages but that they felt included in the process. The move meant there was going to be new ways of working required and, as expected, we encountered reluctance to change with some staff. Naively we saw this change as two different projects, not one big change. However, when we spoke with staff we realised that they saw the projects as one big change and that we were going paperless because we were moving to the new hospital building. This became apparent when we began to engage with staff in small groups or one on one. We had to weigh up change fatigue with the benefits achieved of finishing the project. Engaging staff There was a long period of working with staff beforehand. It took 5 years to build the new hospital building, so we had time. We knew that for this to work well we needed to engage staff. We made sure that we spent lots of time with staff preparing them and listening to their concerns. We recognised early on that most staff couldn't attend dedicated meetings as generally these are only attended by managers. This meant that messages were not always being conveyed to staff and that frontline staff were not given the opportunity to ask questions or raise concerns directly to the decision makers. We needed to meet staff where they were, so the governance team were asked by the medical director to block out time to go to clinical departments and admin offices to speak with staff directly. Why the governance team? Because we were already well-known to many of the staff and had a reputation for being people that they could be open and honest with. We had the skills to listen to staff concerns, reassure them, and tactfully reiterate their concerns to senior leaders and decision makers. Through this engagement, we were able to adjust communications and identify areas or individuals who may benefit from additional at-the-elbow support. There was involvement from staff in the design. The new building was designed to use space and resources more efficiently; some old workflows were not going to work in the new building. An example was that we moved to a ‘barn theatre’ with four surgeries going on at the same time in one operating theatre. In our old building, staff were used to single theatre rooms. We had to talk through the benefits of this with staff but also hear their concerns. Some people didn’t want to move, they liked their current set up and there was some anxiety about the move and the digitisation. We identified those who may struggle more and made plans to make additional support available to them if they wanted it. We found the influencers—those who were going to champion the move and the changes—and they helped us get their colleagues on board. For the EPR part of the project there were staff members who had a greater interest and underwent 'superuser' training to be able to support their colleagues. We provided additional at-the-elbow support to those that wanted it. We took staff around for tours of the new building and the layout at different stages. How did it go? Not everything will go as planned or expected. How you respond to these issues is important. There were issues daily and we made sure we did huddles and had floor walkers to capture these issues quickly, escalate them to those that can resolve them. Importantly, our floor walkers fed-back to staff so that they knew the issues were being addressed. The move occurred in a phased approach, with new services moving every few days. As each new service moved, their department leaders joined the huddles. There was shared learning between services, with early-moving departments helping those that moved in later. We continued to hold regular huddles until all initial snagging issues had been raised and resolved, just reducing frequency when it felt right. Department leaders were advised that they were welcome at all huddles but could stop attending when they felt it was no longer of benefit to them. We did the same thing when we went live with the new EPR system. Once staff were in the new building, we asked them how it was working. On paper we had great pathways that would work well but in reality in some places the pathways were not working. Luckily the flexibility of the design of the hospital and the honesty of the staff in raising when workflows didn’t work meant that we were able to review and amend pathways. There were still things that we didn’t pick up on. Some staff weren’t happy. But we listened. It was important that the leadership team listened and were responsive to the feedback. We had good relationships with the CEO and Medical Director and we were able to talk to them and feed back. They took this onboard really well and discussed how to address it. It’s important the leaders are visible to staff and do walkabouts. Even though the staff may not always tell them how they felt, it was still important they were seen. Some staff were initially suspicious of the governance team being in their departments, particularly in clinical areas and with staff that did not know us previously. There was concern that we may be there to audit them or tell them off. We addressed this by introducing ourselves and explaining why we were there. Something that really helped us gain trust was being able to fix something for staff, either in the moment or by raising it to the team that could fix it. Importantly, we always tried to feedback directly to staff so that they knew that we had listened and were trying to help them. There were also patient facing elements. We had factored in the obvious changes that would affect the patients; for example, with the check-in process, and this was worked through. However, other factors had not been considered; we recognised early on after the move that more support was needed for patients to navigate the pathways and the changes that impacted them. Key take aways Team approach – decision makers, experts and influencers. Staff engagement – do not expect staff to come to you, you need to go to them. Plan for issues – how are you going to pick up issues and feedback to staff. The project doesn’t end at implementation. To earn staff trust – listen and fix something for them. Going live isn’t the end. There has to be continued conversations and observations. Find the truth. The new Chase Farm Hospital Patient Safety Management Network You can apply to join any of our networks by signing up to the hub today. When you complete the registration form you’ll see a section called ‘Join a private group’, please tick the box by the relevant Network. If you are already a member of the hub, please email [email protected].

This series of webinars by FEFO Consulting looks at how to identify psychosocial hazards at work and manage the associated risks. You can watch the four webinars on FEFO's YouTube channel: ISO 45003 vs Model code of practice – Getting started Change management – Managing psychosocial risks Mental fitness – Opening up conversations HR vs safety – Psychosocial ownership

Peter Lachman explains why safety must be embedded into what we do every day, not what we do only after harm has occurred, and why we need to constantly ask ourselves “what do we need to do to be safe?” His new book, Oxford University Press Handbook of Patient Safety, translates the complex patient safety theories into actions that frontline staff can take to be safe.  It is 22 years since the publication of To Err is Human and An Organisation with a Memory. Patient Safety has become a priority worldwide with the passing of the WHO Global Action Plan on Patient Safety. Almost every country has a plan or set of interventions to decrease harm and make healthcare safer. And the development of the science of patient safety has been exponential with increasing evidence of what is required to be safe. We now know what we need to do to prevent harm. In the report led by Sir Liam Donaldson it was stated that four actions were needed to improve safety in the NHS: unified reporting an open culture mechanisms for change a systems approach to solving the challenges of patient safety. Twenty-two years on this challenge remains only partially fulfilled. As is reported in the recent Patient Safety Learning's Mind the implementation gap - The persistence of avoidable harm in the NHS, there is a major problem of taking the lessons from incidents and implementing them at scale so that processes can be changed. The report highlighted four themes, focusing mainly on the lack of a systems approach to safety, learning, oversight monitoring and evaluation, and a lack of leadership. If we are to be safe in the future there must be a fundamental change to the way we think about safety, and the need to incorporate both improvement and implementation science in addressing the implementation gap. There are many reasons for the gap in applying what we know to what we do. This is not uncommon in healthcare where new knowledge takes time to percolate to frontline staff and applies to clinical theory as well as to patient safety theories and methods. So while we may state that we need a systems approach and leadership, we cannot expect frontline staff to be safe if they do not have easy access to the latest theories and methods on patient safety. I believe that to make a difference we need to equip every healthcare worker with the knowledge and skills to be safe. From that frontline revolution we can then look at having a safer NHS in which safety is what we do every day, not what we do only after harm has occurred. This includes learning from everyday practice and constantly asking ourselves “what do we need to do to be safe?” The Oxford University Press Handbook of Patient Safety aims to bridge the knowledge gap so that the implementation gap can be narrowed and eventually closed. The book has been written by a combination of experts in the field of patient safety science and frontline staff, i.e. people who practice safety every day and know what it takes to be safe. The book translates the complex patient safety theories into actions that frontline staff can take to be safe. We hope that the book will make a difference in changing the paradigm and that it becomes the daily companion of every healthcare professional in the NHS. Knowledge is the driver of change and will make a difference. The Oxford Professional Practice: Handbook of Patient Safety is available at the discounted price here.

In this blog, Siân Slade shares how, through her research interest into the difficulties of navigating the healthcare system in Australia, she created a policy and advocacy project: #NavigatingHealth. The aims of the project are to streamline the silos and address the fragmentation of healthcare by bringing together all those who are developing solutions to enable patients and carers to better navigate healthcare journeys.  Background About 10 years ago, I listened to a friend’s experience navigating cancer and puzzled over the challenges encountered. These made me question my prior assumption of 'patient-centricity' across healthcare. In 2015, the Organisation for Economic Co-operation and Development (OECD) released a report highlighting the complexities of the Australian healthcare system. This led me to realise that while we do have patient-centred care, it is often provider dependent, not system-wide, and relies on the patient (or carer) to navigate the system; a time when individuals are at their most vulnerable. Given 'the standard you accept is the standard you walk past”, I decided to do 'my bit' to address this. I enrolled in a Master of Public Health, researching healthcare navigation in Australia. I found there was a fragmented approach to try and address an already fragmented problem. This led me to embark on a PhD as well as develop a policy and advocacy platform: #NavigatingHealth. Setting up a national network and community of practice My focus has always been on a practical approach that solves problems for individuals but also seeks to understand how to scale these at a systems level to sustain change in the long-term. If this was a known problem, why was nothing being done to address it? Surely this was something government were addressing... or there must be an app? I spoke to lots of people—patients, carers, speakers at conferences, those who had written books of their healthcare experience and, yes, those developing apps. Everyone agreed it was a problem, but nothing was addressing the totality of the problem. The problem was not just in navigating healthcare, but also the challenges navigating related systems, such as those for people with disabilities, or for aged care, as well as social services and education. #NavigatingHealth started life as two, 60-minute webinars held in mid and late September 2021, supported by the Australian Disease Management Association. The inaugural webinar speakers provided vignettes across a life journey—from childhood through to getting older—based on their own lived-experiences as patients, carers or professionals (not-for-profit, health services and government). The positive reception of the webinars led to setting up a bimonthly national network and community of practice in Australia that ran until the end of 2024. The meetings were deliberately not recorded to build a safe space for people to share ideas, build tacit (word of mouth) knowledge and a like-minded solutions focused community. Summaries of all the events and speakers are available on the #NavigatingHealth project page. In health, information and projects evolve. Building an online community was low-cost and accessible to everyone. The success of the Australian approach led to a series of global webinars using the same format of expertise provision from individuals in research, policy, and advocacy and health services. The first global webinar was held in 2022 attracting over 20 countries. Connecting and collaborating The 'glocal' community continues to grow. Projects are constantly evolving, elevating and expanding as well as exiting often impacted by funding constraints. In the spirit of a complex adaptive learning health system, core to our success is the community knowledge built through relationships, trust, like-values and non-linear interactions. Taking an approach that is resourceful versus one requiring constant resourcing (we use accessible tools such as LinkedIn and more recently Bluesky) to provide an effective, free platform to keep individuals in touch with one another. Our dedicated #NavigatingHealth project page on the Nossal Institute for Global Health website at the University of Melbourne acts as a central hub for events and resources. The genesis during the pandemic and expansion virtually through Teams and Zoom, as well as in-person post-pandemic, has enabled different ways to expand the national community, the global network and we welcome all-comers. The project is voluntary and our success is based on linking people, developing relationships, sharing expertise, maintaining momentum and the opportunity we all have to impact into #NavigatingHealth. The annual forums, 2024 #NavigatingHealth Simplifying Complexity and 2025 #NavigatingHealth Enabling Patients, System-Wide, focused on bringing together colleagues nationally in Australia. The in-person workshops created the opportunity to build community, share ideas, leverage learnings and also provide educational content. These collaborations have allowed development of materials for curriculum and teaching, and an evolving conversation about the importance of systems-thinking. We developed a short global project collecting stories from individuals who are happy to be involved. Our video, NavigatingHealth - why this matters, provides a glimpse of our approach. Looking forward The Future of Health Report published in 2018 highlights that our health systems, locally and globally, will change from 'one size fits all' to one that is personalised. The challenge is how? Future of Health Report, CSIRO 2018. The 'secret sauce' is that by working collaboratively we can all be part of evolving and effecting systems change. The work is underpinned by equity and a focus on enabling early access to care, addressing barriers, such as financial or cultural constraints, and helping to make visible information asymmetries and power imbalances to ensure effective collaboration and co-production. Building on the success of our past forums, planning for 2026 is underway. Block out 1 April 2026 in your calendar for the inaugural #NavigatingHealth Day! Our collective expertise is our power—let’s do this! Want to know more? Please get in touch with Siân at [email protected] or via LinkedIn. Further reading on the hub: The challenges of navigating the healthcare system How the Patients Association helpline can help you navigate your care Lost in the system? NHS referrals