How can a hospital improve patient safety?

Peter Murphy, Assistant Director of Nursing for Quality, says:

"Much of my work is around ensuring that the corporate strategy actually is delivered operationally, at shop-floor level. And our corporate strategy is to save 1,000 lives and to reduce harm by 50%. We've continued to try and drive quality, and try to improve the care that we have delivered, but often the way in which we have done that in practice is when we get a big group together to start to think about, well, ok, what's current best practice and how do we adopt that into the organisation.

And groups of people would write policies around this and then try to articulate that across an organisation to ensure that it is adopted. This is actually radically quite different from that. One of the mantras that we've got is 'What can you actually do today to affect care?'. One of the other slogans that we use is around 'Don't seek permission to change'. As long as what you are doing is safe, you've got permission from the executive board to actually go away and do it. And in many instances, we are now starting to work with patients to actually shape some of that work, so that's a very important aspect."

David Dalton, Chief Executive, Salford Royal NHS Foundation Trust, says:

"Patients rapidly deteriorated and we needed to find ways of preventing that. Staff on a number of wards spoke about this and one of them had an idea that instead of being dependent upon the equipment to take physiological measurements, blood pressure, those sort of things, they would do it manually. The old approach was to put a cuff around the patient, press the button, leave the room and come back, take the measure, record it. And now we do something very different, we are back to nurses at the bedside, doing these measurements themselves. And it's not that the equipment was at fault.

But what we're finding is that nursing staff are actually engaging with the patient, they are observing things, they're talking to the patient, they're spotting signs of deterioration they otherwise wouldn't have seen. And you may think, well, so what? Well, the so what is that cardiac arrest calls outside our ITU in this hospital have now reduced by 70% and, in part, that's because staff have got these ideas and they are keen to put them into practice to see whether they work and they are working here."

Fiona Gratrix, Corporate Matron, says:

"My role specifically is to audit the wards, every ward within the trust, using the Nursing Assessment and Accreditation System, known locally as the NAAS. That document looks at the quality of nursing care on the ward. A large proportion of the document is around patient safety. There are thirteen standards in total within the document and two of those relate specifically to safety - patient safety and environmental safety. But throughout the document, there is a theme of safety and staff awareness. With the NAAS being introduced, it's a more cohesive approach to looking at the quality of nursing care that we give our patients at Salford Royal. And also the safety issue is very much in the forefront of staff's minds as they have to achieve green on the NAAS document.

Obviously, staff are more aware of safety aspects, making sure that the risk assessments are done and looking at patient safety; we've got collaborative workings with the Quality Improvement Directorate. The next stage as far as I'm concerned with the NAAS, is that all wards have been audited, all wards are to achieve green. We're looking at SCAPE wards next, which is Safe, Clean and Personal Everytime. The tagline of the hospital is Safe, Clean and Personal so we want our patients to be nursed safe, clean and personally every time that they have an inpatient stay."

Peter Murphy says:

"Our trust has actually developed a three year quality improvement strategy. What I know is that our Trust will not stop with this. This will become a lifelong improvement organisation where it seeks to continually improve itself day in and day out. And much of the work that we are going to try and start to look at it is how is it that we change the face and culture of the way that we deliver healthcare services. How is it that we define what is unacceptable and actually articulate that as a healthcare provider so that we develop things such as 'never events', things that don't happen in our hospital anymore and if they do, we need to completely understand what the cause of that was to ensure that it can never happen again to our patients."