Review: Making Safety Visible LS2

Content

Making Safety Visible Learning Session 2 took place on 6 May 2015 at The Village Hotel, Bury. Over 160 delegates from more than 20 organisations attended the learning session. Access all the presentations and films from the event, view the Storify curating the social media activity from Making Safety Visible and see if you are featured in the Making Safety Visible photo gallery.

Sarah Garrett, Consultant in Innovation and Improvement, opened the day by outlining the agenda for the learning session and running through general housekeeping issues.

Abigail Harrison, Associate Director, Measurement and Innovation, Haelo, opened the event by recapping over the work the programme had done together in the first action period. Abigail then premiered the Learning Session 1 film, which had a great reception.

Prof Maxine Power, Director of Innovation and Improvement, Salford Royal NHS Foundation Trust, took to the stage to discuss safety today and what boards can do differently. Maxine emphasised that it isn’t just process or outcome measures, they have to be combined.

Maxine stated that “measures shouldn’t just sit on a dashboard, they should be living, breathing things.” She also said that the “right care, right person, right place” scenario is crucial to safety.

Another of Maxine’s key points was to progress technologies aggressively and use them to their full potential citing smartphone apps and the Patient Safety Briefing as simple tech ideas that can lead to improvement.

Maxine also introduced Brenda for her first appearance of the day via film. Brenda is an example of a patient that programmes like Making Safety Visible are trying to improve things for.

Technology and safety: Opportunities and barriers

Next to present was Jim Easton, Managing Director of Healthcare, Care UK, who began by telling the audience he believes that the widespread activity of technology at scale will “unlock quality and value together while driving safety improvements”. He went on to emphasise that technology is key as it does “boring, monitoring tasks” better than humans, moves work to users in a way they accept and can break geography and time issues.

Jim was strong in his belief that the NHS can’t staff its way out of the current cost and demographic pressures and needs to embrace technological innovations as most people have more computing power in their pockets than whole offices did ten years ago. He gave four examples that Care UK are currently using or testing:

  • Pocket Physio
    • A smartphone app that gives care instructions to patients
  • “Superpractice”
    • Automated booking system with options for Web GP consultations
  • Remote monitoring of older/frail patients
    • Using adhesive devices would allow monitoring of patients from remote locations
  • Black box surgery
    • Use similar tech to aeroplanes that would monitor all surgery activity

The powerful statements and issues raised by Jim led to highly energised table discussions with questions being asked about whether the examples would work in their organisations and how they could be implemented.

Next up was Dr Carl Macrae who presented on sensitivity to operations which he described as “maintaining an integrated picture of operational reality in the moment” and “responding promptly to unexpected disruptions, stressors and events.”

Carl gave examples from the aviation industry and also the NHS, with ‘Onion’ being held up as a great way of working. There was debate around sensitivity to operations and what it looked like in healthcare.

Kate Cheema, Specialist Information Analyst at Quality Observatory, followed Carl by presenting on real time data and what can be done by using it in healthcare. Discussions followed about if organisations were in a position to think about sharing real time data and if their systems are ready for real time sharing.

The final part of this section was on reliability in healthcare and was led by Carl. He asked the delegates to discuss what the key measures of reliability are in their systems and how they could build near-real time awareness of reliability.

Safety dispatches

It was then time for the teams to share some of their experiences with the audience. Dr Jeremy Tankel, a Salford GP, gave a presentation on how he and his team had used PDSA cycles to change the access system at their practice. Their brilliant work had used simple technology and methods to cut waiting times and improve the patient experience massively.

Wrightington, Wigan and Leigh and The Christie were next to present, explaining the work they had done since Learning Session 1 around lung cancer patients. The project aims to provide the safest cancer pathways from first symptom to treatment and survival and is well underway.

Central Manchester were the final team and presented on their quality reviews. The reviews are an inclusive process for all staff, stakeholders and patients. The reviews are cyclical learning peer review processes rather than inspections with a pass or fail and determine whether care is safe and effective.

Knowledge exchange

Sir David Dalton, Chief Executive of Salford Royal NHS Foundation Trust, opened the afternoon session before the teams broke out into their chosen knowledge exchange session. There were chances for the delegates to choose two sessions from a selection of six topics including culture, operations and activating patients.

The teams were given an outline of what is coming up in Making Safety Visible including the next action period, Learning Session 3 and the celebration summit, before being given time to work on their plans for their work related to the programme.

Learning from other industries

Learning Session 1 was concluded by a ‘Camp Haelo’ themed panel debate on how healthcare can learn from other industries. The Non-Executive Directors on the panel had experience from industries including aviation, railway, finance and automotive. The panel members chose colleagues who had to set up ‘Camp Haelo’!

The debate brought up many ways that healthcare can learn from other industries including the need to understand that it isn’t just about the ‘obvious’ safety issues, everything has a safety implication.

Gillian Easson then closed the day with a pertinent message, telling everyone to “resist those who say that improvement is not possible.”

Making Safety Visible Learning Session 3 takes place on 29-30 July 2015.

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