Reducing risk and avoidable errors
We all know that healthcare is a hugely emotive issue in Britain today. It was on the lips of many during this year’s general election, and with a 2014 report from the NHS Litigation Authority saying it could face a bill of up to £25.6 billion to cover clinical negligence claims (the annual report with the full figures will available after their AGM in July), it is clear that we need to find a way of improving the service.
How we reduce this cost, improve conditions for staff, and reduce patient risk are some of the biggest questions facing the NHS today. We believe the answer to these problems lies in better understanding human behaviour; working out why errors are made, and how we can mitigate for them in future.
Learning from other industries
On the surface, saying that the NHS needs learn from pilots and the oil and gas industry sounds ridiculous. What do nurses have in common with offshore workers? Pilots with surgeons? In reality the answer is quite a lot.
The risks imposed by fatigue (long working hours), pressure (high-risk environment), lack of communication (fear of speaking out, rushed briefings) and morale (stressful conditions) are not at all dissimilar. We know both of the aviation and the oil and gas industries inside out, and we think lessons can be transferred into the NHS in many places. Here are just two of them:
Using some lateral thinking and looking to the lessons learnt in other high-risks environments can lead to huge improvements in surgery. All staff on the flight deck are encouraged to speak openly – especially if they spot a problem – and the environment changed so that even more junior members can speak out when necessary; the same could be true in operating theatres.
Changing attitudes takes a great deal of work, but understanding how people will accept change more easily will help hugely. Need to persuade doctors to be part of longer briefings – offer them research from the British Medical Journal from 2011 that shows strong links between briefings and attitudes towards safety. Want to implement checklists for surgeons to ensure all practices have been carried out – we have surgeons write these so it is compatriots writing the lists, not a manager with no experience in the field. Surgery is inherently high-risk, and the last thing you want to do is add more stress or distraction in to the mix, but some changes really can make huge differences.
Often times the answer touted for solving healthcare problems is simply that it needs more money. But until funding is available units cannot just ignore failings. In many cases some simple, inexpensive solutions can have big results.
Pressure, lack of team work, lack of communication, stress. These are all things that NHS staff face every day, and looking at how to relieve these can lead to big improvements in service levels – and the morale of your staff. Looking at making slight improvements to the working environment (including things like lighting and equipment ergonomics), how to improve communication through briefings and knowledge transfer sessions, and how to ensure people are aware of all elements involved in their situation will make disproportionately large impacts on the risks and errors that result in negligence claims.
There is, of course, no magic cure to all of the NHS’s problems – they are too numerous and varied – but what we can do is look at ways to improve performance and mitigate for errors in a way that makes practical sense, is easy to implement and takes the people element of the NHS in to account.