Surgery


and from improvement activities, and continue to promote organisational and professional responsibility. They harnessed these three areas which have re-appeared in NatSSiPs 2 Table 1 clarifies how NatSSIPs 2 has emphasised the three key areas in both the organisational and sequential standards. The learning from NatSSIPs 1 is that the


standards, at that time, were inconsistently implemented and challenging. The main barriers to implementation were: a) Time pressures and lack of protected staff time.


b) Lack of opportunities for multidisciplinary training.


c) Increasing focus on productivity and targets, which can conflict with processes designed to ensure safety.


d) Not seeing NatSSIPs as a priority. e) Lack of internal expertise as well as understanding of which areas / procedures qualify as an invasive procedure.


It will be up to each steering group to ensure that NatSSIPs 2 do not suffer the same inertia although it is also recognised that there is huge pressure at this time due to staff vacancies and the backlog following COVID-19.


Organisational standards In summary, the NatSSiPs 2 organisational standards are the following, and it would be difficult to argue against any of them. Under each of the stated principles, there are a raft of standards, written in easy-to- understand language, which is referenced. The organisational standards consist of three broad sections which are: people, processes and performance, and tie in with the NHS patient safety strategy categories of: insight, involvement and improvement. The standards highlight that there is less


Organisational Standardise


Safety behaviours, processes, policies, insight, involvement and performance measures across organisations and specialties.


Harmonise Educate


Across groups of hospitals. Across IT systems.


Commit to safety education, human factors expertise and systems thinking. Create a safety infrastructure, leadership understanding and training in cultural change.


Table 1. 16 www.clinicalservicesjournal.com I March 2023


The standards (dubbed NatSSiPs 2) are intended to enable safe, reliable, and efficient care to every patient having an invasive procedure. They state most emphatically that they are designed to make every patient safe rather than a tick box exercise to help prevent Never Events.


focus on local standards generation (as indicated by NatSSIPs 1) and more on the quality improvement and implementation strategy required to deliver and sustain the standards, in a meaningful way. 1. Patients should be involved in the safety pathway. Full information should be provided, and safety processes explained. Patients should understand the value of the checks and be encouraged to speak up/check if they have concerns. Patients having an invasive procedure may feel anxious, overwhelmed or not understand medical terms.


2. Every Trust/Healthcare Board must have an adequately resourced leadership team to deliver the NatSSIPs.


3. Every Trust and service must have sufficiently skilled and knowledgeable teams to deliver invasive care safely.


4. Teams need to be trained in safety behaviours and practices. This needs to be supported via specialty bodies/examinations and regional integrated systems.


5. Proportionate checks for procedural safety are performed, recorded and reviewed regularly alongside governance, cultural aspects and IT integration.


6. Scheduling should include time for planning and supports safe and efficient practice.


7. Staff should receive an appropriate induction covering local NatSSIPs processes before


Sequential


Expected behaviour, safety standards, checklists and format across invasive specialties.


Reduce variation across specialties.


Teach and train in team behaviours, human factors, systems thinking learning / co-production with patients.


All of the above are essential areas to ensure that safe care can be given. However, when there are such high vacancy rates, if these cannot be met, is it justified to cancel surgery? These are the difficult decisions which face hospital staff and theatre managers every day. NatSSIPs say that there should be a clear


procedure, risk assessment and escalation for when invasive procedures do not take place or


working in these clinical areas.


8. Insight regarding NatSSIPs performance and risk should be tracked, acted upon and fed back to teams in invasive areas.


As an example of the detail within each standard, take ‘invasive area staffing and resources’, standard 3. We know this is an area where there are acute shortages, at present, so the standard is particularly pertinent to safe care. The standard states that safety in invasive procedures relies upon: l Having sufficient numbers of permanent staff vs agency staff.


l Appropriately trained and competent staff (trained in specialty safety aspects).


l Appropriate skill mix, and ratios of staff with relevant primary or postgraduate qualification (qualified in specialty).


l Sufficiently rested staff who can take planned breaks during their shifts.


l Appropriate resources to plan for and perform the planned procedure.


l List planning and scheduling that includes adequate preparation time.


l Flow in and out of the invasive procedures (e.g. ward beds, critical care facilities).


l A supportive culture and civil behaviour. Staff able to report safety concerns or exception reporting without fear of reprisal.


l An understanding of how to support staff with building resilience, wellness and avoiding burnout.


l An understanding of the safety differences and risks between elective vs emergency patients.


l Mechanisms, such as team briefs that can be used to share concerns with staff and build trust.


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