“This course will change your life,” said the loud, American, IHI woman at the front of the class.
“I doubt that very much,” thought the cynical, English, NHS woman on table 3.
So began the seven- day marathon that is the Institute of Healthcare Improvement (IHI) Patient Safety Executive Course, on 5 September 2013 in Cambridge, Massachusetts. This was followed by a one-day visit to the North Shore Long Island Jewish Health System (LIJ). My companion on this journey of self-discovery was Sarah Armstrong-Klein, my deputy in the patient safety team at NHS Improving Quality.
So IHI teach you a lot of theory about safety and improvement – some of which you ‘know’ already, some of which is new. And then they begin to piece it all together and slowly, gradually through the jet-lag, you begin to get it – get what you knew all along, get what Don Berwick reported – that the thing that keeps patients safe, is the thing that all high performing, high quality organisations have – one phrase, a million meanings – a learning culture.
And then you realise that this ‘learning culture’ thing isn’t something soft, or American, or some latest fad from a new management book, but something deep and hard wired, and scientific and even measurable. Then as the days pass you realise that although you knew that all along – somehow… somehow… you can see it more clearly now. But this knowing has nothing to do with knowledge. I have read books, attended lectures, ‘learned’ about this stuff for years – what it really has to do with is yourself and how you see the world. And I have been so blind. Culture is local, so local in fact that it is about individual behaviour (and the behaviour of individuals).
The IHI’s framework for patient safety has nine components – Leadership, Teamwork, Communication, Psychological Safety, Continuous Learning, Transparency, Improvement and Measurement, Reliable Care and Accountability. If we are to truly transform the NHS we need to address all these equally and not be blinded by the thinking that Measurement and Accountability are the dominant pieces. Easy to say maybe – another list maybe – but one that has hidden depth and one that is very, very hard to follow in the light of the safety disasters we have had. Our need to ‘assure’ is overwhelming, and there is a place for that important work. But real safety assurance and improvement? Guess what – it happens when leaders lead bravely, teams talk to each other, work is a safe, transparent, supportive, learning place to be, we know how well we are doing and we understand our personal responsibility and accountability.
But it’s all theory, right? Well not actually. As you travel the Long Island railroad from Penn Station to New Hyde Park, the iconic Manhattan skyline becomes small and you reach the North Shore where something extraordinary happens. The LIJ Health System serves 4 million New Yorkers on 16 hospital sites with 43,000 employees – and they get it. Their Centre for Learning and Innovation (I know many people have them) is truly inspiring. Why? Because they just do what they teach. The learning itself is amazing. The Patient Safety Institute uses high tech simulation to help clinical teams learn how to work together, they have two-way mirrors like a NYPD interview suite – I will write more of that another time. But it’s the CULTURE that takes your breath away. Run by a former ER nurse who takes no prisoners and reports directly to the CEO they demonstrate what happens when you focus relentlessly on helping employees learn – continuously. Staff want to learn, they want to improve, they come to work to do the best they can for patients, they want to be part of a high functioning team, they want to eliminate errors and keep people safe. We need to find a way to better support staff to do that on this side of the Pond.
And so I ask myself what can I do? I can try to model the behaviour I have recently seen in my own work – lead with courage, improve team working (communication, transparency, psychological safety), measure our improvement, stand up and speak out for a just culture and above all learn from everything we do. Sound familiar?
Maybe a course can change your life!
Head of Programmes – Patient Safety. NHS Improving Quality
Follow Julie on Twitter: @Weatherbore