To mark World Patient Safety Day, our Chief Executive, Robbie Pearson, reflects on Scotland’s patient safety journey and looks ahead to a more holistic approach to safety in the future.

With the celebrations to mark 72 years of the NHS, I was reflecting that it is now 10 years since the Scottish Government published the Healthcare Quality Strategy. While we don’t mark anniversaries of documents as we do major events like the birth of the NHS, this publication was a critical step in NHS Scotland’s improvement journey. The Strategy is centred on three linked ambitions of safe, effective and person-centred care, and, with that simple and clear ethos, it has withstood the test of time. 

Safety – as one of those ambitions – is also only one dimension of quality, but I am very conscious that it is at the heart of the work of Healthcare Improvement Scotland. 

One major element of Healthcare Improvement Scotland’s work is the Scottish Patient Safety Programme (SPSP) which was formally launched in 2008. In the very early days of SPSP, a small handful of committed individuals had a determined fight on their hands to plant its roots and to nurture its growth, in the face of other competing improvement initiatives, sceptics and some vocal opponents. In building on small early wins, SPSP has grown to be a success which reflects the dogged determination and enthusiasm of the many who have worked hard to implement improvements in frontline care, in order to reduce harm and mortality. 

The results have been impressive:

  • Hospital Standard Mortality Ratio (HMSR)reduction 14%
  • Cardiac arrest rate reduction 29%
  • Pressure ulcer reduction 26%
  • Neonatal mortality reduction 15%
  • Paediatric Ventilator Associated Pneumonia (VAP) reduction 86%
  • Stillbirth reduction 24%

There isn’t one answer to safety though, nor is SPSP the only aspect of Healthcare Improvement Scotland’s contribution to achieving the ambition of a safer NHS. 

Whether it be in tackling variation in the use of medicines, the monitoring and tools to support safe staffing, learning from adverse events, the development of guidance for the diagnosis and treatment of major priorities such as cancer and heart disease or in the external assurance of hospital care, we are focused, as an organisation, on supporting the wider implementation of good practice and reducing avoidable harms.

In so much as the Healthcare Quality Strategy emphasised the different dimensions to quality, we need to recognise that there are also different ways to support the creation of a safer system of care. 

We already know that evidence-based clinical interventions in wards delivered consistently improve safety, but so does the right leadership, working environment and organisational culture. Indeed, I would argue the provision of safe care, also fundamentally depends on a safe and supported health and social care workforce. This echoes the priority set out in the World Health Organisation’s ambition to ensure we prioritise the safety and well-being of all those staff working in the health and social care system.

It has been a long journey since the early days of SPSP. We have though, over that time, gained a better understanding of the many dimensions that contribute to safer care.  Healthcare Improvement Scotland is taking that into account in redesigning our approach to safety for the next ten years – which holds and builds on the gains of SPSP – but brings together in a more cohesive and connected way our approach to improving safety. 

‘Safety’ cannot be seen as only relevant for specific moments of care, whether it be the safe use of equipment, avoiding a fall, pre-operative checklists and so on. The reality is that this aspect is highly relevant but also insufficient. We must keep a focus on safety at the point of care for our clinical and care staff as well as our aspirations for safer systems.

In future, we will see a more holistic approach to safety. We will rapidly review the evidence for safety in key priority areas and ensure that there is both the national support and external assurance in making care safer from the frontline to the very top of the organisation. 

Today of course is WHO World Patient Safety Day. As mentioned earlier, this year’s theme attempts to raise awareness of the personal safety risks health care workers face around the world. Such risks have been highlighted this year by COVID-19 but sadly these risks are a more common reality for some in the most deprived parts of the world. 

Scotland’s healthcare workers are part of a system that by global standards is generally very safe. However this level of safety has been achieved by constant vigilance and hard work. Our collective efforts to keep health care workers safe are themselves a vital component of patient safety. Today provides an opportunity to focus on Scotland’s success as well as better understand and learn from the global issues in continuing to make all aspects of care safer in future.

Beyond today, our improvement journey must continue, supported by the same commitment, determination and enthusiasm with which it began.

Looking back we can see the positive impacts resulting from the Healthcare Quality Strategy that was set out a decade ago. Looking forward, even with the deep challenges we continue to face in managing COVID-19, we must hold on to these ambitions and ensure they remain at the heart of what do in the coming weeks, months and years.

Robbie Pearson is Chief Executive of Healthcare Improvement Scotland

More information

Read more about our contribution to World Patient Safety Day 2020.