How could the ‘Measurement and Monitoring of Safety’ framework go viral?


Since 2013 Haelo has worked with leaders to explore how we can use the framework to improve safety across whole systems. Abigail Harrison, Director of Innovation blogs her belief that the ‘Measurement and Monitoring of Safety’ framework has something significant to offer us to improve safety.

Here are some of the things I learnt along the way, including how the Measurement and Monitoring of Safety Framework can have the greatest impact and how we might spread it at scale. Recently I presented at a sharing event held by The Health Foundation and considered ‘how the Framework could go viral’ drawing on learning from Rogers’ ‘Diffusion of Innovations’ theory, social movement theory, and how film can be used for engaging at scale. My presentation can be found here

If I’m honest, in the work we’ve done with the Measurement and Monitoring of Safety Framework we’ve seen mixed results. Some individuals and teams have found it interesting but have struggled to use it to specifically drive change. Some have found it difficult to demonstrate improved safety outcomes linked to the framework. But we’ve also worked with hospital boards, CCG governing bodies, teams and individuals from across health and social care that have used it to redesign pathways, to underpin improvement programmes, to improve their use of data and as a method of self-assessing the maturity of their organisation or system with regards to safety.

Is this primarily a change in mind-set?

Certainly for many individuals or organisations there will be new ideas in the framework – for example, considering different approaches to unearthing and responding to safety issues in real time.

I have seen with many that although the framework hasn’t necessarily brought around different interventions or actions it has more so enabled a radically different way of thinking about safety, safety behaviours and safety data.

For me, the framework expands our view of safety and helps us to bring together the safety information we already have to ask different questions. It broadens our view beyond looking in the rear view mirror (a long held habit in healthcare) by asking us to consider reliability, real time safety and how we use data for prediction and prevention. Most importantly, it prompts us to integrate all of this information to create a continuously learning system. It encourages us to ask different questions and to move from seeking assurance to developing a curiosity about safety, developing an approach based on enquiry.

The Safer Salford dashboard is a great example of this. It brings together a mix of system-wide safety indicators including measures of past harm and reliability. Its data display stimulates questions and investigation and the dashboard enables prediction through understanding multiple data together. It was inspired by the domains of the framework and complemented with measures that were already available, it encourages us to think differently about them, developing an enquiring approach.

So if this is a change in mind-set – how could we spread it?

Whilst working with the Measurement and Monitoring of Safety Framework we have been considering what we can learn from the theories of Diffusion of Innovations and social movement and how we might use the rise in digital media to help engage people?

Everett. M. Rogers

Everett Rogers’ Diffusion of Innovation

You’ll be familiar I’m sure with the innovation curve and currently we’re probably seeing the framework used by our innovators and early adopters. We can’t underestimate the challenge of moving to the next stage of this being picked up and spreading to the early majority. There are two key things Rogers outlines that I think we should consider:

  1. How to use interpersonal networks to spread innovations quickly and the different attributes of innovations that succeed in spreading. Features such as relative advantage, compatibility, complexity, trialability and observability are known to impact the scale at which innovations spread.
  2. In Rogers’ latest edition, he talks about some of the technical innovations that have radically changed what we know about the speed at which innovations can spread. Since the invention of the World Wide Web in 1990, which connected 20 million computers in five years, we have seen multiple Internet based innovations spread at an incredibly rapid rate. Online platforms like Hotmail and Facebook and technologies like the mobile phone have absolutely smashed the usual time for innovations to spread.

Social Movements

We have also considered what we can learn from social movements. Understanding how to spread change from the ground up at scale is something that is increasingly being considered as important in health and healthcare and indeed it has been said that the NHS itself could be considered a social movement (The Five Year Forward View).

Helen Bevan and her team have done much work to use social movement theory to enable change including NHS Change Day and the NHS has now launched the Health as a Social Movement’ programme . Nesta have recently published a report which shared key learning on this subject.

The key things I take from what we know about social movements are the importance of a sense of shared purpose that people connect to because it is draws on their intrinsic motivations and not because it is something they are told to do and the way that informal networks are used to connect people – something that Rogers also talks about.

Digital Media

Finally, we have considered in our work what we can learn from the rise in digital media – in particular how we can use film to communicate at scale. There are lots of impressive statistics that demonstrate how film is starting to dominate how we communicate.

  • Over 8 billion videos or 100 million hours of videos are watched on Facebook every day (TechCrunch, 2016; TechCrunch, 2016).
  • 10 billion videos are watched on Snapchat every day (Bloomberg, 2016).
  • Video views on Twitter grew 220 times from December 2014 to December 2015 (Twitter, 2015).
  • More than 500 million hours of videos are watched on YouTube every day (Business Insider, 2016).

What are we doing in health and healthcare to really take advantage of this, given that YouTube is blocked to staff by many public sector organisations? If we take a look at some of the most popular films on YouTube there are some clear themes that start to emerge. They are funny, they draw on our inquisitive nature, we can relate to them and they are emotive. If you click through the talk I gave on this topic you can watch some of the films I chose to demonstrate this. There are clear overlaps here with some of the learning from Rogers and social movement theory. Films are quick, simple and accessible; they can be easily shared and discussed through interpersonal networks with friends and colleagues. They draw on people’s personal motivations and make use of our inquisitiveness and empathy for others. Many of the most popular films are low tech and homemade so a viral film can be made from the ground with no power or influence required.

So what have we done with this learning to spread the framework?

We have taken our learning from Rogers, social movement and the rise of the internet and film to do three things: simplify the message, make it fun and connect to people’s intrinsic motivations.

  1. Simplifying the message We started by stripping the framework down to the most simple and engaging explanation. We found that most people we worked with connected with the idea of shifting from looking in the rear view mirror and the concept of lagging and leading measures and so we started to talk about the ‘Past, Present and Future’ as a way of explaining how the framework can help us. This was easier to remember than the 5 domains and enabled people to explain the framework to others
  2. Making it fun We enabled people to build partnerships and engage with the framework through being creative and having fun. You can see an example of this in our best bits film from a programme we ran with board members across Greater Manchester
  3. Drawing on people’s intrinsic motivations We tried to engage with people personally through telling stories and drawing on their natural inquisitiveness. Most importantly we enabled people to develop a sense of shared purpose, connecting the framework to their shared ambitions for safety for their health economies.

There is much more we could do but I hope that some of our learning gets you thinking about how you might spread the framework to help improve safety, We know that one of the most powerful methods of spread is through social connections so I want you to think about how you could communicate your learning about the framework to someone you know after reading this. And maybe if we all share our learning in a fun, engaging way that connects to people personally…..just maybe we can start to help the ‘Measurement and Monitoring of Safety’ framework go viral!

Works Cited

Cisco. (2017). Cisco Visual Networking Index: Forecast and Methodology, 2016–2021. Cisco.

Del Castillo, J., Khan, H., Nicholas, L., & Finnis, A. (2016). Health as a Social Movement. London: Nesta.

NHS England, P. H. (2014). Five Year Forward View. London: NHS England.

Vincent, C., Burnett, S., & Carthey, J. (2013). The measurement and monitoring of safety. London: The Health Foundation.

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