Sunday, 10 April 2011

Quality or Safety or both?

I attended a really useful conference yesterday on inter professional  learning. There were some useful discussions on safety and quality not being the same thing. Perhaps we are now at the point in our health care system that we need to be talking about safety a lot more and with dwindling budgets, quality a lot less? Some of the main issues are identified below.

Human Factors - that can lead to mistakes are hardly recognised within  the quality literature - people make mistakes when they are tired, lack knowledge and support or are simply expected to do too much.

Team working - people  do not always learn how to work as a team  which involves collaboration and  communication at all times. Developing team working skills can therefore prevent mistakes from happening if people feel valued, supported and listened to within a team. This includes peer support workers and carers who are all trying to achieve the same goal- recovery and wellness.

Communication - even if people do not work as part of a team but are more specialised they still need to be able to communicate vital information that can reduce risk and improve safety. Saying it is not my job is not a good reason. Nor is confidentiality but it is important to gain consent before passing on  personal information. Signs and symptoms are not personal information but simply your observations of what is/could be happening. Tools can be used here to give exact measurements or an overview e.g. SBAR 

Knowledge & Skills - it is difficult to have skills without knowledge but by grouping them together does not mean that they are both the same thing. You need knowledge  to  decide which skills you should be using so they cannot be used in isolation of each other.  For example in order to give medication you must not only know how to give it ( route/dose etc) but also why you are giving it and how it might interact with other substances.  Some skills require more complex knowledge than others but all skills require some knowledge and  understanding that you must be able to demonstrate that you are competent in. Simply attending conferences or one-off study days will not achieve this and could be unsafe in practice if you do not fully understand the consequences of what you are doing. Most professional bodies require this as a minimum to
be considered safe practice.  Educational courses also give 'credit' that you are competent by assessing you at the right level for your knowledge needs. However all professionals are responsible for their own safe practice ( not their managers) and must make it known if they feel practice is becoming unsafe. It can also be useful to identify what you need to know to make it safe. This can be done through clinical supervision or peer evaluation.

Consistency - is perhaps a quality issue that can be related to safety. If practice is different from area to area people will not get consistent care which can lead to mistakes being made.  Consistency means following the most up to date guidelines and evidence-based practice and being able to consistently demonstrate that you have done this.  This could be used to audit  and improve current practice in teams and in our own continual professional / personal development (CPD).

Some useful links for  measuring safety in  practice where 'how-to'guides may have been created

Patient Safety First
National Patient Safety Agency
Scottish Patient Safety Alliance
1000 Lives Plus -Wales
HSC Safety Forum -Northern Ireland

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