Feature
NURSING MANAGEMENT April 2009 | Volume 16 | Number 1 33
Monitoring progress and executing plans
setting aims and having good intentions are necessary
starting points for improving patient safety but,
if improvements are to be delivered, these aims
must be translated into action and results.
It is helpful, therefore, for nursing leaders to
develop easy-to-use and widely agreed systems to
measure progress, and to determine how nurses
can contribute to data collection.
each clinical intervention should have
a project plan with milestones to measure progress.
reports on progress should be made regularly at
team and board levels, and leaders should scrutinise
these to help them make improvements.
Improving staff knowledge there is a network
of organisations that can help hospitals improve
patient safety. these organisations include
the Health Foundation, the NHs Institute for
Innovation and Improvement and the National
Patient safety agency, all of which are the Patient
Safety First Campaign's sponsoring organisations.
the clinical interventions proposed by the
campaign (Box 1) have been tried and tested
Table 1 Activities for visible leadership
Activity Description Explanation
Devising
safety
`walkarounds'
These involve clinical and non-clinical members of trust
boards pairing up and undertaking regular planned
tours of wards and departments, eventually covering all
parts of hospitals. For walkarounds to be effective, their
timescales, and the actions and responsibilities of their
participants, should be agreed beforehand.
During walkarounds, directors can meet staff to ask them
questions and listen to their concerns. By hearing about
staff problems first-hand in this way, directors can help to
resolve them. Similarly, nurse leaders can learn about the
challenges faced by their teams and to identify solutions
through partnerships.
Putting
safety first on
the agenda
Patient safety must be the first item on the agenda at
every trust board meeting, and about one quarter of the
meeting time should be allocated to it. To check whether
patient safety is the top priority at these meetings,
agendas and minutes can be checked. Senior staff who
have been involved in investigations of serious incidents
can listen to and reiterate the opinions of patients and
their families at these meetings. In some cases, trusts
can invite patients to give personal accounts of their
experiences at board meetings.
If reports to board meetings are personal and detailed,
they can have a great emotional effect and encourage
board members to prioritise the improvement of
patient safety.
Identifying
personal
priorities
Nurse leaders can look back over the past two months to
see how much of their time was devoted to patient safety,
and then look forward over the same period to calculate how
much time they intend to devote to the subject.
Nurse leaders have many competing priorities for their
attention and most have over-crowded diaries. They are
unlikely to improve patient safety if they do not find the
time to do so easily.
Promoting
a just and
fair culture
Promoting a culture in which patient safety is taken
seriously is a fundamental leadership responsibility.
In healthcare organisations, there are often microcultures
that are related to professional background (Ginsburg et al
2006), for example in which nurses are more likely
to report incidents than doctors (National Audit Office
2005), and the reporting of incidents must be improved
across all professional groups. While hospital directors are
responsible for promoting safety cultures, clinical nurse
leaders must define their safety expectations on each shift
they lead. They can act as visionaries, helping staff to
plan, lead, control and organise activities to deliver safe
care (Jooste 2004).
The true causes of adverse events are often hidden
beneath explanations of human error. Accidents have both
individual and organisational contexts (Reason 1997),
and apportioning blame to front line staff is rarely fair
or just, and often contradicts the notion of root-cause
analysis. Apportioning blame can also preclude structured
investigations into underlying causes and likely successful
countermeasures. It follows that organisations committed
to patient safety, and to just and fair cultures, are more
likely to discover underlying causes of adverse events
by asking repeatedly, at different levels, why they occur.
When leaders conduct safety briefings before shifts or
surgical procedures, they set the tone and requirements
for their staff both formally and informally. Where there
are no safety briefings, leaders lose opportunities to set
immediate safety agendas.
Adapted from the Patient Safety First Campaign

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