ESPO Conference 2014ESPO Conference 2014

“Patient Safety, Good Governance and Regulation”

Hugh McCaughey Chief Executive, South Eastern HSC Trust

9th May2014

Safety in Healthcare“Health care is complicated, and, even when the staff and clinicians are doing their very best (which is most of the time), errors occur and problems arise for patients that no one intends”

Don Berwick, former President & CEO of the Institute for Healthcare Improvement

Patient Safety in the UKPatient Safety in the UK

How does society view safety?How does society view safety?

• Anecdotal• No comprehensive

system of evidence• Headlines + stories• Failure+scandal

How Safe is it?

How to Measure safety?

Why did Regulators not identify?

“For hospitals, the focus on a ‘whole institution’ rating may prompt management to better performance, but quality of care for patients is delivered at more of a service level, for example in departments or specialties or wards.”

Rating providers for quality: a policy worth pursuing? A report for the Secretary of State for Health: summary March 2013, Nuffield Trust

Nuffield report on RatingsNuffield report on Ratingsa) We conclude that the overall approach to

ratings should allow complex organisations to be assessed at different levels and to promote service-specific ratings where possible;

b) We suggest that any rating should include measures of safety, effectiveness and user experience

Rating providers for quality: a policy worth pursuing? A report for the Secretary of State for Health: summary March 2013, Nuffield Trust

What are we doing in SETWhat are we doing in SETQuestions to ask clinicians/services

• How can you prove your service is safe?

• What is your teams objective?

• What is success to you + your team?

• Can you evidence you learn lessons?

• What do users think – is it valued?

• What Outcome(s) are you achieving?

Can you answer those questions?

Safety in SETSafety in SETSome Questions to ask

• your service is safe - SAFETY

• your teams objective QUALITY

• success to your team +

• What do the people think EXPERIENCE

• What are the implications if you cant?

SET Approach - SQESET Approach - SQE

Our Goal...for every service:Our Goal...for every service:

•Assure its Assure its SSAFEAFE

•Improve the Improve the QQUALITYUALITY

•Test the Test the EEXPERIENCEXPERIENCE

SQE in SETSQE in SETWhat do we want:What do we want:

•AllAll not some services not some services

•Assurance what we do is safeAssurance what we do is safe

•Outcomes + Evidence basedOutcomes + Evidence based

•A Learning + Improvement CultureA Learning + Improvement Culture

•Users at the heartUsers at the heart

““Bottom up Culture of Safety + Bottom up Culture of Safety + Improvement”Improvement”

“The standards (to be enforced by the regulator) should be a clear fundamental set of standards, driven by the interests of patients, and devised by clinicians; a “bottom up” as opposed to a “top down” system”.

Nuffield Report on Hospital Ratings

July 2013

How do we evidence safety?How do we evidence safety?

What about Culture + What about Culture + MotivationMotivation

• Evidence proves the right culture + motivated staff get better outcomes

• An organisation committed to Safety + Quality has happier staff

“A culture of learning can produce a safer and better NHS. The likelihood of such a culture thriving in the NHS depends, more than on anything else, on how you, the senior leaders, behave, speak and invest”

Don Berwick, former President & CEO of the Institute for Healthcare Improvement

Is SQE changing our Culture?Is SQE changing our Culture?SET 12/13 SET 2009 HSC 12/13 National 12

Care of Patients is my Trusts top priority

67%

up 13%

54% 59%

+8%

64%

+3%

Snr Managers are committed to a Quality service

64%

Up 12%

52% 59%

+5%

49%

+15%

YOU CAN CHANGE SAFETY CULTURE

Some Final Reflections or Some Final Reflections or ChallengesChallenges

• How well do we assess the system of Safety?

• How well do assess the Culture, Mood + Values?

• How well do we educate our public and media?

THANK YOUTHANK YOU