Following the recent publication of the Hewitt review we asked one of our Special Advisors, Professor Ted Baker, why, despite not featuring prominently in the review, patient safety should be a priority for systems.
Ted has had a long career in clinical and academic medicine, then in healthcare regulation and safety investigations. He has spoken out publicly before about the need for a new approach to patient safety, built on a radically different safety culture.
There will be a warm welcome for the Hewitt review from across the whole healthcare system. It is wide ranging and ambitious, and its recommendations reflect the growing consensus on the future for the new integrated care systems, which can be summed up as local autonomy with effective but enabling accountability. As the review says, this cannot be delivered by just a change of structures, there must also be a major change in behaviours and culture. System thinking and collaboration will be key, together with a focus on the needs of the local population, on health inequalities and on prevention of ill health.
At a recent Aqua Round Table made up of system leaders and safety experts, we considered how systems should tackle patient safety. While this is not prominent in the review, it is of course a fundamental part of quality, health inequalities and indeed the prevention of ill health. The Round Table identified several additional reasons why patient safety should be a priority for systems. First and foremost, it must be recognised that safety is a property of the whole system, not individual parts of the system. Safety risks in one part of a system-wide pathway are often manifestations of problems elsewhere in the system. They cannot be addressed by an individual service and must be managed consistently at system level. This understanding is an essential starting point for all the newly established systems.
Creating an environment which supports the provision of safe care is also key in engaging and motivating the workforce and in delivering efficient and economical care. The OECD estimates that 13-15% of healthcare costs are due to avoidable harm. Not attending to safety leads to poorer outcomes for patients, and more expensive care. This is why systems must not delegate safety to individual providers or confine management of it to sub-committees. It must be mainstream business, considered as central to every management decision. It must be built into the development of new models of care and must be central to systems’ plans to address inequalities in health outcomes in their local populations. It must involve patients and the local population. Understanding their experience of care and their priorities for safety are crucial for success. For too long we have regarded patients as passive recipients of safe care, rather than vital partners in ensuring safety. The population focus of integrated care systems that Hewitt advocates is a chance to change this for good.
System leaders have an unrivalled opportunity to drive improvements and to address the problems in care that now seem so intractable. Innovation and experimentation will be crucial. Nowhere will this be more important than in building a positive safety culture, ensuring strong and effective ways to manage patient safety across the system. The panel of experts convened for the Round Table worked to pull together seven safety themes for systems to consider:
Model of Care
As the review makes clear, Integrated Care Systems have a formidable agenda. Focusing on patient safety is an important part of this, done well it will help systems deliver the ambitious programme of improvement that the review lays out.
To read more about the Aqua Round Table’s assessment of safety at a system level, click here.
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