On publication today of The King’s Fund’s review of Patient Safety Collaboratives, Natasha Swinscoe, national lead for patient safety for the AHSN Network, reflects and looks forward on their achievements and learnings.
England’s 15 Academic Health Science Networks (AHSNs) have a unique dual focus: we work locally while benefitting from being part of a national network.
Each AHSN is embedded in its regional health and care community, understanding the system and patient needs on the ground. We develop projects, programmes and initiatives that reflect the diversity of our local populations and healthcare challenges.
Each AHSN is also part of the national AHSN Network, linked into a unique collaborative of expertise and experience, sharing learning, pooling intelligence, and benefitting from a pipeline of emerging and proven solutions from around the country.
Nowhere is this more clearly evidenced than in the AHSNs’ shared priority of improving patient safety, and in particular through our coordination of the 15 Patient Safety Collaboratives (PSCs).
The King’s Fund has just published the report of their rapid assessment of the PSCs. The report’s authors, Ben Collins and Deborah Fenney, consider how the AHSNs can maintain the momentum they have built up helping the NHS to become, as the Berwick review directed, “more than ever before, a system devoted to continual learning and improvement”.
As I take on the lead officer role for patient safety on behalf of all AHSNs, this report gives us a timely opportunity to both reflect and look forward. After all, we can hardly advocate quality improvement (QI) methodology and not look to learn from our own experiences.
The report gives us a number of helpful pointers for the future. We established the PSCs from a standing start and now have four years of experience under our belts, working with our regional health and care systems to deliver improvements in patient safety in a variety of different ways across the country.
During that time we have made real measurable progress that is improving the lives of patients. The system transformations we’ve spread around deteriorating patients have won awards across our network and are making a significant impact on detection of sepsis. Our work on Learning from Deaths has directly led to system changes that are being made right now. There are further examples across our work on maternal and neonatal patient safety, on emergency laparotomy and a host of other initiatives that are making patients safer.
The report provides us with interesting insight into the range of ‘personalities’ each PSC has developed in response to their local system’s needs and priorities, showing we are all slightly different. It can take time for initiatives developed at a local level to spread and achieve national impact, but local insight is vital, and only comes from extensive experience of supporting improvement in a region. Of course, we do need to standardise where it makes sense to do so, but equally we must allow people the local scope to innovate flexibly where it makes sense to do that too.
Working at local level and responding to local needs also allows us to build relationships and build trust. It’s these resilient relationships that underpin our work. We are working in a changing landscape with changing needs, operating as trusted partners. As the report states, “the most successful leaders of collaboratives also have strong personal relationships and experience of working within their local health systems. They bring a detailed knowledge of the personalities, the history and the dynamics of the local system which helps them to decide how best to engage with local teams”.
Leadership and culture are crucial. Effecting lasting, significant change to the way people think about, and work in relation to, safety is a big ask. Strong leaders with real QI understanding need to be retained and sustained. It’s not easy. As Chris Ham, Don Berwick and Jennifer Dixon have argued, it is crucial for “leaders at all levels to hold their nerve. As difficult as a quality improvement strategy is, and as long as it may take to harvest the needed changes at full scale, we simply do not see a more promising alternative”. (Ham et al, 2016).
We look forward to the results of the recent NHS Patient Safety Strategy consultation, and hope that a balance of greater clarity of goals at a national level will be aligned with continued local freedom in deciding how to implement them. As a network of AHSNs we are keen to continue nurturing and developing what now feel like some very fertile local QI ecosystems. We will also continue to learn from each other, understand each other’s successes and failures, and ensure we are greater than the sum of our parts.
Natasha Swinscoe is managing director of the West of England AHSN and national lead for patient safety for the AHSN Network. Follow them on Twitter @SwinscoeTasha, @WEAHSN, @AHSNNetwork