World Patient Safety Day 2021: Reflections from Andrea McGuinness

We see, hear, and talk about safety being “everybody’s business” and “safety starts with me”, but what does that actually mean?

Do you know anyone who goes into any situation in health and care services deliberately looking to create unsafe conditions?  I don’t.

Why then do we still revert to finding a single person, a single sole cause for harm and errors that happen?

Einstein allegedly said (although this has never been found to be directly quotable to him!) “the definition of insanity is doing the same thing over and over and expecting different results”.

Whether Einstein said it or not it helps to stop and think about why we aren’t seeing the results, changes, improvements that we want to see.  It also takes confidence, courage and commitment to break the cycle of or patterns that we are so familiar with.  Even when we don’t like the pattern, we follow it because breaking a habit and forming a new one is hard, really hard.

According to a 2009 study published in the European Journal of Social Psychology, it takes 18 to 254 days for a person to form a new habit. The study also concluded that, on average, it takes 66 days for a new behaviour to become automatic. (European Journal of Social Psychology Eur. J. Soc. Psychol. 40, 998–1009 (2010).

This same study talks about the impact of rewards and recognition as factors supporting the acquisition of new habits.  They didn’t use a reward for their study and found participants still achieved levels of success in developing a new habit.  Possibly when individuals self select a habit to change their intrinsic motivation is all it needs.  Why am writing about all this?  It’s because I am interested in understanding more and finding out form others what are the new ways of approaching safety improvement.  I have written previously about the non-technical knowledge, skills and understanding that Aqua has been investing and sharing in how we approach safety improvement because all the tools and methods and techniques in the world won’t work if we didn’t recognise the role that people, values, beliefs, confidence, and culture play in making change happen.

“Culture eats strategy for breakfast” is a famous quote from management consultant and writer Peter Drucker. It is a phrase I have seen throughout my working life and yet it didn’t initially land with me in a way that I really understood.  I don’t think he was implying strategies aren’t needed or useful but he was saying the people in any organisation and their behaviours and values will obstruct or accelerate any strategy.

So many safety improvement initiatives rely and focus on the strategy, the ambitions and the performance metrics that will demonstrate success and yet they fail to fully involve and be guided by those who are most impacted by these plans, service users and staff who will have to make and deal with the reality of how a paper document converts into a working practice.

What can we do differently, what new habits can we form?  We can work together to understand what the issues are, what matters most to people and what ideas they have to improve things, services, buildings…the list is endless.  It isn’t improved by plans written in offices it is improved by shared decisions, shared plans and mutual respect for our exquisite unique, detailed, relevant and credible experience of the world we know and exist in.

Back to Einstein (or not!) and the creation of new habits (or not!). What one thing can everyone of us do to ensure “safety starts with me”?  We can practice a new habit between 18-254 days whereby we listen to our service users, our colleagues and our teams, I mean really listen. Don’t listen with an answer ready to respond, don’t listen with a defensive retort, don’t listen to feel judged or to judge; listen to hear, to understand, to welcome the words of wisdom and insight from someone else; to realise how hard it might be for someone to find the time and the bravery to speak to us; to thank them for finding the courage to talk and to set no promises other than to say “I heard you”.

Once this becomes our new habit we can move to our next habit, involving everyone in the changes needed, doing with not to, talking with not at, reflecting together not on behalf of.

My challenge to us all is to start to create the culture we value and to demonstrate this by example and practice, to share our successes, failures and the learning we have gained. It will be interesting to hear what you think, what you have tried and what you have achieved over the next months.  If you take up the challenge, please let me know how it is going. If anyone is interested I will let you know how I am doing too .