When I reflect upon the last six years, I cannot believe the progress which Scotland has made in fighting Sepsis. Back in 2011, the Scottish Patient Safety Fellows were tasked with a challenge: How could we make patient care safer and contribute further to the reductions in Hospital Standardised Mortality Ratio? I believed the answer was simple: tackle Sepsis. And that’s exactly what we set out to do.
Leadership support was essential to making Sepsis a priority for the NHS. Derek Feeley, the then Chief Executive of NHS Scotland, was fully supportive of our ambition and thanks to both him and Nicola Sturgeon in her role as Cabinet Secretary for Health and Wellbeing, Scotland became the first country in the world to sign up to the World Sepsis Day declaration and demonstrate our commitment to tackling Sepsis at a national level. An additional key development was the establishment of The Scottish Patient Safety Programme, a key national initiative that I was proud to spearhead as Clinical Lead for the Acute Adult programme.
Frontline clinicians from every specialty had seen people die from Sepsis and we were all too aware that Sepsis was an indiscriminate killer, affecting people of any age, background, colour or social status. It killed 37,000 people a year in the UK. As a result, everyone was passionate about fighting Sepsis and a social movement was born. Six years later, the success of our national Sepsis campaign – namely a sustained 21% reduction in Sepsis mortality – has been due to a variety of factors.
But there was one key factor and that was clinician engagement. When our campaign started, we were all learning to start putting the patient at the heart of the care they received, but the Sepsis campaign was the first time we’d asked our frontline healthcare professionals about what matters to them, or as I like to phrase it: what keeps you up at night?
I learned to talk less and listen more. The doctors and nurses knew what the challenges were in tackling Sepsis, but more importantly they also had an idea about what were the solutions. A community of practice consisting of people with a same common purpose was established. The community met twice a year in person, and monthly though WebEx, where they shared their learning and offered ideas to test. Over the next four years, we saw different NHS boards develop pilot sites of high reliability in the recognition and response to Sepsis.
An unintended consequence of our national campaign to fight Sepsis was the importance of the early recognition of the deteriorating patient. This has led to the development of our Deteriorating Patient workstream within the Scottish Patient Safety Programme, which has had a focus on what we call the 4 R’s of patient deterioration, namely Recognition, Rescue, Review and Referral.
As I prepare to step down from my position as Clinical Lead for the Scottish Patient Safety Programme’s Sepsis work, I feel indebted to the hard work of all NHS Scotland staff, from primary care and the Scottish Ambulance Service to the acute care hospitals, every single month fewer people are dying from Sepsis.
The Scottish Patient Safety Programme has now been running for nine years and as a result it has provided a framework and road map for our Sepsis journey. Our learning to date has guided healthcare professionals further on how to make change happen safely in a complex environment, as well as the importance of reliable design in healthcare. We wanted to make it easier for our doctors and nurses to provide the right care for our patients with Sepsis, but, more importantly, to make it difficult to do the wrong thing.
For all this achievement, Sepsis is a relentless disease and we need to maintain our constancy of purpose and build on our gains to provide care that is truly safe, effective and person-centred. I believe that by continuing to listen, to the patient and to the ideas and issues of healthcare professionals, we’ll be able to continue winning the fight and save more lives.