PATI ENT SAFE T Y
Patient safety: the devil is in the data
With the recent announcement from Matt Hancock about reducing bureaucracy and the publication of the consultation document, ‘Busting bureaucracy: empowering frontline staff by reducing excess bureaucracy in the health and care system in England’,1
the time is ripe to look at how
managing data more efficiently and applying the experiences of high reliability organisations can have a dramatic impact on patient safety.
The CQC is taking an in-depth look at how health and care services work together and how they can evolve in order to meet people’s needs and improve outcomes for all concerned. In doing so, patient safety is being pushed firmly to the top of the agenda. As eloquently argued in ‘Still Not Safe’ by
Robert L. Wears and Kathleen M. Sutcliffe, the modern patient safety movement (now in its third decade) has yet to realise its potential. They argue that, for the potential to be realised, healthcare has to embrace the expert process and knowledge of safety science. To quote: “change will require health professionals to … develop truly
substantive and equal co-partnership with safety scientists”.
The identification of opportunities to learn and improve safety is a critical facet of safety processes and is core to successfully implementing three of the five characteristics of high reliability.2
of a potentially high reliability industry, with its hyper-complexity, tight interdependence between different departments for patient outcomes, multiple levels and hierarchies for decision making, and the requirement for fast, emergency action often in compressed timescales with critical outcomes that can be a matter of life and death.
Healthcare is a classic example
Safety has always been a key concern and there have been numerous investigations and reports after certain scandals. All of these highlight that the focus on opportunities to improve patient safety is often overlooked, a fact acknowledged and something the CQC is looking to address in its latest strategic consultation paper.3 This lack of investment is not, we believe, due to a lack of commitment, but due to the challenge of being able to show that investment in one area will not have a greater detrimental impact on other areas of care. Data is where the answer to this problem will be found.
Incident reporting is a key tool in listening to the experts, i.e. the clinicians and people on the frontline who may not have the most seniority, but have the most in depth knowledge of the processes involved in the care being provided
FEBRUARY 2021
Managing data – not as easy as it sounds A long-standing, key global strategy for improving healthcare quality and reducing the high cost of patient harm has been to leverage the power of big data to identify opportunities for improvement, that would be expensive and difficult to track and manage through human analysis alone. A move away from paper-based records is an essential step in this journey, and something for which the NHS as a whole has numerous targets. Digital transformation will bring many benefits which are already being seen in other industries such as financial services, aviation and utilities. In reaching for these benefits, we as an industry should look to learn from the early experiences of these other sectors. We have seen that a naively executed big data strategy can be incredibly damaging to the performance of organisations and – given the complexity of modern healthcare systems – making the same mistakes could cause significant harm. Unlocking the value of data, by
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