Safer Patients Inititative: The Journey to Safety

Project summary

This study aims to capture the lessons learnt for UK healthcare from the experiences of organisations participating in the Safer Patients Initiative (SPI). Our overall aim is to understand how whole healthcare organisations can make significant and sustainable improvements in the quality and safety of care delivered to patients, through development of their capability for process improvement and other internal changes and cultural factors.

The Safer Patients Initiative (SPI) was set up by the Health Foundation in collaboration with the US Institute for Healthcare Improvement (IHI) to improve safety on an organisation wide basis. The programme is in place in 24 healthcare organisations across the UK and aims to improve safety through the application of Continuous Quality Improvement methods and the introduction of specific clinical change packages.

Many countries are carrying out large scale quality improvement programmes involving complex, long-term interventions that involve multiple system changes and which are expected to impact at a cultural/organisational as well as operational level. We have, through the work of IHI and others, some understanding of how to tackle problems on this scale. However, many questions remain and there is a considerable amount of conceptual, research and practical work needed if we are to gain a solid understanding of the steps that need to be taken to develop safer healthcare organisations.

The SPI programme represents a unique opportunity to understanding the capability for effective quality and safety improvement and how it can be developed. The research design we describe below was developed to understand this ‘journey to safety’ or how whole healthcare organisations can make significant and sustainable improvements in the quality and safety of care delivered to patients across all clinical areas.

Aim

Our principle aim is to investigate change in the organisation’s capability for care service improvement as a result of participating in the SPI programme.

We have divided this work into three fundamental research themes, each representing a series of important questions for the impact of SPI and broader spread of the benefits of potential future programmes throughout UK health services.

The themes are:

Organisational readiness for SPI
Variability in response to SPI
SPI impact and process

Method

In order to conduct a full investigation based upon our research themes, we are using a mixed methods approach. This will include site visits, interviews, qualitative analysis of varied sources, questionnaire measures and analysis of time series data relating to care processes.

The survey will be distributed to the professionals involved in implementing and running the SPI programme within each of the organisations. It comprises a series of quantitative rating scales with items designed to assess the impact of SPI upon various human and organisational dimensions of care service quality and safety. Additionally, the measures are designed to assess aspects of organisational readiness and sustainability of the benefits of the SPI programme.

Semi-structured interviews with key SPI personnel will be undertaken during site visits at each organisation. We will repeat the process at the end of the SPI programme to assess change and understand development over time.

PLEASE NOTE: CPSSQ undetook two projects based upon SPI, in collaboration with The Health Foundation and external partners. Information on the other CPSSQ SPI project can be found here

Project team

Project outputs

Peer Reviewed Papers

Parand A, Benn J, Burnett S, Pinto A, Vincent C. (2012) Strategies for sustaining a quality improvement collaborative and its patient safety gains, (in press) International Journal of Quality in Health Care.
Benn J, Burnett S, Parand A, Pinto A,Vincent C. (2012) Factors predicting change in hospital safety climate and capability in a multi-site patient safety collaborative: A longitudinal survey study, (in press) BMJ Quality & Safety
Atef Shebl N, Franklin BD, Barber N, Burnett S, Parand A. ‘Failure Mode Effect Analysis (FMEA): The views of UK hospital staff, The Journal of Health Services Research & Policy. Pubmed
Pinto, A., Benn, J., Burnett, S., Parand, A. & Vincent, C. (Feb 2011) Predictors of the perceived impact of a patient safety collaborative: An exploratory regression analysis. International Journal for Quality in Healthcare. Pubmed
Parand A; Burnett S; Benn J; Pinto A; Iskander S; Vincent C. (24 Aug 2010). The disparity of frontline clinical staff and managers' perceptions of a quality and patient safety initiative. J Eval Clin Pract. Pubmed
Parand A; Burnett S; Benn J; Iskander S; Pinto A; Vincent C. (Oct 2010). Medical engagement in organisation-wide safety and quality-improvement programmes: experience in the UK Safer Patients Initiative. Qual Saf Health Care. 19:e44. Pubmed
Burnett S; Parand A; Benn J; Pinto A; Iskander S; Vincent C. Spurgeon PP (ed). (2010). Learning about leadership from Patient Safety WalkRoundsTM. The International Journal of Clinical Leadership. 16:185-192. Link
Pinto A; Burnett S; Benn J; Brett S; Parand A; Iskander S; Vincent C. (Feb 2010). Improving reliability of clinical care practices for ventilated patients in the context of a patient safety improvement initiative. J Eval Clin Pract. 17:180-187. Pubmed
Benn J; Burnett S; Parand A; Pinto A; Iskander S; Vincent C. (Dec 2009). Studying large-scale programmes to improve patient safety in whole care systems: challenges for research. Soc Sci Med. 69:1767-1776. Pubmed
Burnett S; Benn J; Pinto A; Parand A; Iskander S; Vincent C. (Aug 2010). Organisational readiness: exploring the preconditions for success in organisation-wide patient safety improvement programmes. Qual Saf Health Care. 19:313-317. Pubmed
Benn J; Burnett S; Parand A; Pinto A; Iskander S; Vincent C. (Jun 2009). Perceptions of the impact of a large-scale collaborative improvement programme: experience in the UK Safer Patients Initiative. J EVAL CLIN PRACT. 15:524-540. Pubmed

Other publications

Burnett, S. Organisational readiness: why organisations respond differently to safety improvement programmes (February 2010) Healthcare Risk Report.
Iskander, S., Vats, A., Burnett, S. Benn, J., Parand, A., Pinto, A., Vincent, C. Surgical safety briefings: the challenges of implementation (December 2009) Healthcare Risk Report
Burnett, S. Improving patient safety: learning from the Safer Patients Initiative (November 2009) Healthcare Risk Report.

Conference papers

Benn J, Parand A, Dixon-Woods M. Studying the social and organisational effects of patient safety improvement programmes: Understanding contextual factors and local programme implementation. Presentation at Making health care safer: learning from social and organisational research (June 2011, St Andrews, Scotland)
Parand, A., Burnett, S., Benn, J., Pinto, A., Iskander, S., Vincent, C. (2010) Achieving Patient Safety Improvement through Multi-Professional Collaboration within Quality Interventions, International Society for Quality in Health Care, Oct 2010, Paris, France.
Parand, A., Burnett, S., Benn, J., Pinto, A., Iskander, S., Vincent, C. (2010) Barriers and strategies to sustainability of a patient and quality collaborative: A qualitative study, International Society for Quality in Health Care, Oct 2010, Paris, France.
Pinto, A., Benn, J., Burnett, S., Parand, A., Iskander, S., & Vincent, C. (oral presentation) Predictors of staff perceptions of the impact of a large scale quality improvement initiative: the Safer Patients Initiative-2nd phase. International Forum on Quality and Safety in Health Care, Nice, April 2010.
Burnett, S., Benn, J., Pinto, A., Parand, A., Iskander, S., Vincent, C. (2009) Organisational Readiness: Exploring the preconditions for success in organisation-wide patient safety improvement programmes. Poster presentation at Patient Safety Congress, Birmingham, UK, Apr 2009.UK.
Benn, J., Burnett, S., Parand, A., Pinto, A., Iskander, S. & Vincent, C. (2009) Perceptions of the impact of a large-scale collaborative improvement programme: Experience in the UK Safer Patients Initiative. Poster presentation at Patient Safety Congress, Birmingham, UK, Apr 2009.
Parand, A., Burnett, S., Benn, J., Pinto, A., Iskander, S., Vincent, C. (2009) Designing Quality and Safety Initiatives for Optimal Medical Engagement, 26th International Conference, Oral presentation at The International Society for Quality in Healthcare, Dublin, UK.
Parand, A., Burnett, S., Benn, J., Pinto, A., Iskander, S., Vincent, C. (2009) Engaging Doctors in Quality and Safety Improvement. Poster presentation at Patient Safety Congress, Birmingham, UK, Apr 2009.
Benn, J., Burnett, S., Iskander, S., Parand, A., Pinto, A., & Vincent, C. (2009). Experience in the UK Safer Patients Initiative: Understanding improvement at the organisational level. Poster presented at the International Forum for Quality and Safety in Health Care, Berlin, Mar 2009.
Benn, J., Burnett, S., Iskander, S., Parand, A., Pinto, A., & Vincent, C. (2008). Experience in the Safer Patients Initiative: A complex intervention for quality improvement at the micro and macro systems levels. Paper presented at the International Conference on Healthcare Systems Ergonomics and Patient Safety (HEPS) June 25-27th 2008, Strasbourg.
Pinto, A., Burnett S., Benn J., Brett S., Parand, A., Iskander, S., and Vincent, C. Implementation of a ventilator bundle as part of the “Safer Patients Initiative”: a qualitative case study. Poster presented at the International Society for Quality in Healthcare Conference. October 2009. Dublin.