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We got the price for patient safety wrong!

The Patient Safety Congress is only two weeks away: Researchers, mangers and clinicians will descend into Manchester on the 9th and 10th of July to discuss safer healthcare. It is a key event to learn new knowledge and share ideas.

The hospital should be a safe place. And in many respects it is. For people with life-saving diseases that require urgent support of heart, lung, kidney the hospital is the right place. But given the complexity of modern healthcare and the strains that staff are under errors are common. Internationally between five and 15% of patients will suffer a complication that requires extra treatment or that leads to death. More often than not events that lead to catastrophic deterioration started with subtle signs that have been overlooked. A Rapid Response System consists of two parts: a monitoring system that picks up signs of deterioration such as a drop in blood pressure or a fever by looking for them systematically. And a response system that in the UK consists usually of nurses with intensive care training who will review patients that have been picked up by the monitoring system.

These type of services cost money. Is it money well spent? Probably, but there is very little data to suggest how much money a hospital would have to spend to say, prevent one complication or a single avoidable death.

Hospitals are keen to be seen to do their bit in preventing harm. Most of this prevention at organisational level results in policies. And it seams that every policy results in yet another piece of paper for doctors and particularly nurses to fill in. Safety in A4 bits. While the paper is cheap the time needed to fill it out costs real money. Documentation takes up 25% of the time that nurses and doctors are at work. This is seriously expensive There is a lot of evidence that many of the ways in which we try to improve the safety of patients in hospital does not work. There are suggestions that complicating processes might in fact stop staff to use their initiative to find safer way to deliver care.

Safety works best if those who work in a system are able to lead. There is a suggestion that safety works best if the systems are carried by those who have to work in them. As Jeffrey Braithwaite eloquently described in his recent article in the British Medical Journal (please find attached his podcast): Policy and guidelines have had extremely limited reach to change behaviour in healthcare. Training that focusses just on safety and not on ‘how we get the job done’ has low impact.

On the other hand side we know that low-fidelity simulation in a given clinical area can profoundly change the way teams feel about safety. Tim Draycott has shown this with his PROMPT course. Everybody in his team trains every year. On their unit. His unit in Bristol has now got one of the lowest complications rates for pregnant women world-wide. This certainly applies to healthcare professionals.

Patients could lead on safety. What could their contribution be? Whenever healthcare professionals become patients (or one of our friends and relatives are admitted) we find lots of things that we can improve in hospital safety. And there is a lot of healthcare professionals (and we all have family and friends). So maybe this is not so far fetched.

Training might help to improve safety: The Patient Safety Congress and the recent International Forum that is run by the Institute for Healthcare Improvement are examples of large educational events. World specialists come to share their learning and the latest developments.

The cost of these events are considerable: between £300 and £600 for a single day, or £1500 for one of the three day events. Who is able to afford to go? Only a fraction of those who might benefit from the education. So we rely on senior representatives to absorb and then spread the information many layers down the hierarchy.

Patients could be part of training. Given that this is about patient safety: are there patients? Not a lot! The amazing Josephine Okloo is one of the opening speakers at this years Patient Safety Congress. Josephine lost her daughter through medical error. She is an outspoken advocate for patients and is undertaking research for the HealthFoundation.  Alison Phillips is a patient speaker for the associated meeting of the International Society of Rapid Response Systems. But without backing from a large organisation the entry fees become prohibitive for many clinicians, patients or others who care about patient safety.

The price of training needs to come down. We could learn from areas outside medicine. So what if we would have events that run like the Hay Festival? If you have not had a chance to go – I can highly recommend it. Hay is a literature festival in …. Hay in Powys in Mid-Wales. It has no station, no large road, no airport but one of the largest literature festivals in the UK with 250.000 people typically attending over a two week period. Literature buffs and Journalists are around in fair numbers, but it is a place for everybody who enjoys a book. The Hay festival started in a primary school on a shoe string – but now brings Nobel Price winners and award winning writers to large tents in fields around the village in a format that is affordable to almost everybody (who can make the way to Mid-Wales).

How could we translate this type of format into something that would help to spread knowledge about safety and be accessible to healthcare professionals and patients alike.

Who would help organising a patient safety festival that is cheap enough so that everyone who needs to learn can come?

How would we know that better processes & training are value for money?

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