Comment: Identifying and preventing risks would support Berwick’s goals for the NHS

Published: 29-Aug-2013

Mary Clarke of Cognisco on why risk assessment is vital to ensuring patient safety

In this article MARY CLARKE, chief executive of Cognisco, suggests that Professor Berwick’s goals for the NHS could be supported by the introduction of ‘people’ risk assessments that would identify and address risks before they compromise patient safety

Improving patient care and eliminating the risk of serious case incidents or deaths is a priority for every NHS trust

Earlier this month Professor Don Berwick, a renowned international expert in patient safety, delivered his assessment on the state of NHS, outlining four key recommendations to make the NHS the ‘global leader’ in patient safety.

The former adviser to President Obama Berwick was asked by the Prime Minister to conduct the review following publication of the Francis Report and the scandals at Mid Staffordshire NHS Foundation Trust. Berwick’s four key findings are:

  • The quality of patient care, especially patient safety, should be paramount
  • Patients and carers must be empowered, engaged and heard
  • Staff should be supported to develop themselves and improve what they do
  • There should be complete transparency of data to improve care

Putting the quality of patient care first and ensuring patient safety may sound obvious, but it is a complex area that is difficult to measure. How do NHS managers accurately measure the quality of patient care without observing every interaction between patients and staff? More importantly, can they identify poor quality care and address any problems before they compromise patient safety?

One practical way for NHS organisations to measure how their staff will actually perform, their attitude and behaviour towards patients and their likely decision making, is by introducing an assessment methodology that uses situational judgment questions to measure a combination of staff competence and confidence.

Only with a systematic approach to identifying risks will the NHS ensure patient safety is put first

These ‘intelligent’ assessments don’t just measure people’s knowledge, they reveal how that knowledge will be applied in work situations and how confident they are that the way they are working is correct and appropriate. The results of such assessments produce the kind of accurate and transparent data needed by NHS managers to improve patient care because they highlight critical skills and knowledge gaps and potential risk areas which, if remain unaddressed, could put a patient’s life at risk. Such insight also enables managers to provide targeted training interventions for staff to improve their specific skills and knowledge in areas where it is needed most.

For the past three years we have worked with a leading NHS trust and introduced these kind of assessments to help eliminate the risks of serious case incidents and deaths in obstetrics. Last year, the NHS paid £400m in obstetrics damages. Improving patient care and eliminating the risk of serious case incidents or deaths is a priority for every NHS trust and our project has achieved major progress in these areas.

We have shown how significant improvements can be obtained by measuring and correlating employees’ confidence with competence and then adapting existing interactions such as ‘skills and drills’ training to focus on the area of greatest need/risk, particularly where it relates to the behaviour of staff. The programme has improved the performance of clinical teams when handling emergency situations, it has also benefitted patient care and, since it was initiated, there has been a reduction in serious incidents.

Berwick recommends that the NHS adopts a ‘culture of learning’ and that staff should be developed and improve what they do. Again through the use of assessments, NHS staff at all levels can improve their competence and confidence and importantly, take control of their personal development. Using regular assessments, competency standards can also be monitored so any potential risks to patients are identified and addressed with targeted interventions.

Berwick concedes that mistakes happen in every job and that only the ‘most reckless’ individuals will be punished. However, why wait until any mistakes happen if there is a practical way of preventing them? Berwick has laid out some very astute and sensible recommendations, however, he has failed to discuss prevention and the need to identify and address the root causes of problems. Only with a systematic approach to identifying risks will the NHS ensure patient safety is put first.

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