Feature
NURSING MANAGEMENTApril 2009 | Volume 16 | Number 132
One example of a specific aim is that there should
be no central line infections in a hospital by a given
date. two important points can be made about such
an aim: the work involved in achieving it is measurable
and it can be achieved within a specific time.
Nurse leaders need not wait for their colleagues
to set aims in their areas of responsibility, but
should do so themselves. Meanwhile, nurse leaders
who work in organisations without explicit patient
safety aims can ask why these have not been devised
and implemented.
Visible advocacy for patients is integral to the
standards of conduct, performance and ethics of
nurses at all levels (Nursing and Midwifery Council
2008). to instil public trust and confidence in the
profession, therefore, nurses must make the care
of patients their first concern.
Providing demonstrable leadership to encourage
executive directors to demonstrate leadership for
safety, the Patient Safety First Campaign advocates
that directors and nurse leaders at all service levels
should undertake several activities (table 1).
Leadership, according to Cook (2001), is not
merely a series of skills or tasks, but an attitude that
informs behaviour. Crucially, attitude and behaviour
can alter the cultures of the NHs and of other
healthcare providers so that patient safety becomes
the top priority of everyone concerned.
Ensuring accountability Chief executives are
accountable for clinical safety in NHs organisations,
but for them to exercise such accountability,
other hospital leaders must take responsibility for
improving safety performance.
the Patient Safety First Campaign suggests,
for example, that other board directors should take
direct leadership roles in specific interventions,
and the experiences of those who have taken part in
the Safer Patients Initiative or Leading Improvement
in Patient Safety Programme (NHs Institute for
Innovation and Improvement 2008) show that the
involvement of directors of finance can be a powerful
lever for change.
Part of the Patient Safety First Campaign's
accountability framework requires that improving
patient safety should be part of the day-to-day
work of hospitals or trusts, rather than being
delegated to separate committees that operate
outside usual performance management and
governance procedures.
For accountability to succeed, leaders at all
levels must have clear responsibilities to deliver
the required changes to achieve reductions in harm.
Nursing sisters, charge nurses and matrons,
for example, can play crucial roles in ensuring that
specific patient safety aims are met at ward or
departmental level.
this means that all nursing team members must
understand their professional accountability in
implementing safe, effective and evidence-based care,
appropriately and consistently.
Nurse leaders are vital therefore in ensuring
compliance with evidence-based treatment.
Establishing safety scorecards the prevalence of
adverse events in individual organisations vary, so
a baseline measure of progress towards achieving
specific aims that covers all organisations is needed.
to this end, the Patient Safety First Campaign suggests
that the Global trigger tool (Gtt) (Classen et al 2008)
should be used to plot levels of harm.
In using this tool, a random sample of casenotes
are reviewed each month so that adverse events
can be identified and recorded. the results are then
plotted on a time-series graph so that progress can
be monitored. For example, if the Gtt is used to
review the casenotes of 100 recent deaths, common
factors such as infection or lack of action for
deteriorating patients can be identified.
Other tools can be used with safety scorecards,
while the Hospital standardised Mortality rate
can be a helpful indicator across entire hospitals
(Jarman et al 2003).
Developing robust measuring methods is
one of the challenges of improving patient
safety. Most organisations have good systems
for measuring financial and target issues, and
should apply the same degree of attention to
measuring patient safety.
Organisations, departments or wards must also
quantify the outcomes of more specific aims, such
as the number of surgical site infections, as well as
of processes and treatments, such as the reliability
of prophylactic antibiotics that are given one hour
before surgery.
the experiences of hospitals involved in the
Safer Patients Initiative show that, when 95 per cent
of clinical processes have been implemented
correctly, progress in reducing adverse events can
be said to have been made (resar 2006).
Box 2 Six areas of focus for healthcare leaders
1. Setting explicit strategic priorities and specific aims.
2. Providing demonstrable leadership.
3. Ensuring accountability.
4. Establishing safety scorecards.
5. Monitoring progress and executing plans.
6. Improving staff knowledge and capability.

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