How can you tell which hospitals are safest?

In the latest edition of Dr Foster's Hospital Guide, James Reason - Emeritus Professor of Psychology at the University of Manchester - shares his top tips to help us identify hospitals that put patient safety at the top of the agenda. We have also included some of the main findings from the Hospital Guide questionnaire to highlight Professor Reason's tips.

1. A safe hospital is a 'high reliability organisation'.

To be 'high reliability', hospitals should be aware of safety at the highest level and raise patient safety wherever possible throughout the organisation
Hospitals should discuss clinical outcomes and patient safety at least monthly at board level

Did you know?

Nine per cent of hospitals still do not discuss clinical outcomes and 10 per cent do not have patient safety as a constant item on their board agenda ⁽¹⁾.

2. A safe hospital sees patient safety incidents as related to issues with systems rather than with people.

Hospitals clearly should be investigating the factors contributing to incidents and therefore finding out which system changes will prevent them happening again
Investigations should be carried out to find these contributing factors, particularly when there is severe harm, death and/or cardiac arrest. Otherwise, hospitals will not know which systems need to be changed

Did you know?

Twelve per cent of hospitals carried out fewer than 10 investigations of root cause analysis (RCA) in one year and 39 per cent of hospitals failed to carry these out on all deaths or cases of severe harm that occurred ⁽¹⁾.

3. A safe hospital uses the systems approach to anticipate the worst and equip itself to deal with safety at all levels of the organisation.

Hospitals should put systems in place that anticipate problems and suggest actions
Regular observations and 'track and trigger' systems should be in place for acute patients, with plans for action when parameters cause concern

Did you know?

Thirty-six per cent of hospitals do not have a 'track and trigger' system in place for monitoring all acute patients and 14 per cent fail to audit all cardiac arrests on the wards ⁽¹⁾.

4. A safe hospital has a strong culture of reporting patient safety incidents.

High numbers of reports are good, and show a willingness among staff to share concerns
Hospitals should be reporting patient safety incidents and sharing concerns within their organisation in a timely manner

Did you know?

Although 98 per cent of trusts now provide incident reports to the NPSA - an increase of three per cent on the previous period - some of these still do not report consistently ⁽¹⁾.

5. A safe hospital is ready to act to make changes that improve safety.

Hospitals should be sharing data such as in this report with commissioners and the public, as well as showing that they are acting or are ready to act
Commissioners should be driving change and regularly discussing how this will take place

Did you know?

Between five and 17 per cent of hospitals say they do not discuss safety with commissioners ⁽¹⁾.

6. A safe hospital will see external advice and support on potential safety issues as useful.

Hospitals should be responsive to external support and guidance
The NHS benefits from having a national body (National Patient Safety Agency, NPSA) that gives it support and recommends actions based on its own data on incidents occurring
Hospitals should act on advice from the NPSA on emerging patient safety issues, and have methods for ensuring that this action takes place

Did you know?

Twelve per cent of hospitals said it would still take longer than six months from now to implement the Rapid Response Reports issued by the NPSA in 2008/09 ⁽¹⁾.

References

Hospital Guide 2009 | Expert view: How can you tell which hospitals are the safest? (p 12) | James Reason, Emeritus Professor of Psychology, University of Manchester