Hearing the patient voice - a pre-Conference blog

As we look forward to our imminent annual patient safety conference, held in partnership with the CQC and kindly supported by Bevan Brittan, our director of regulation (and nurse of 30 years) Dawn Hodgkins, talks about why the theme of the conference is so vital.

I am delighted to be writing this column just ahead of our annual patient safety conference.

This year there will be a particular focus on how we really hear the patient voice, to deliver the very best services in terms of safety and quality, and I have to say, I am really excited by the programme.

The quality of speakers is outstanding and I’m so looking forward to hearing from them, and I’m also really delighted that once again the event has been so popular and we have such a great turnout from senior clinical leaders from across the sector and the wider system.

Deeper engagement
I believe that patient involvement is essential to improving patient safety. Patients and their loved ones are the experts on their own experiences, and they can provide valuable insights into how to improve the safety of care. When we listen to patients, we can learn from their experiences and make changes that will help to prevent harm.

There are many ways to involve patients in safety and quality. One way, on a superficial level, is to simply ask patients for their feedback. This can be done through surveys, interviews, or focus groups. It’s all good, useful information, but I think we need to be more ambitious to ensure that we aren’t just paying lip service or ticking a box.

This means a deeper and more systemic involved of patients – not just after the fact, or ‘how did we do?’ But actually engaging and involving patients or patient representatives far more fully in how we run our services – that’s about having a role in decision-making. This could involve patients serving on hospital committees or working with clinicians to develop new safety initiatives.

Involving patients in safety and quality is not always easy. It can be time-consuming and challenging to get patients involved. However, the benefits of patient involvement are clear. When we listen to patients, we can learn from their experiences and make changes that will help to prevent harm. If we truly have patient care at the heart of what we do, we should be prepared to hear them, and take the time we need.

When things go wrong
It’s not always easy to think about it, but things do go wrong in healthcare. When they do, it is important to recognise and learn from our mistakes and make changes to prevent them from happening again.

One of the biggest challenges we face is admitting when things have gone wrong. As clinicians (as a nurse of more than 30 years, I still think of myself this way, although I just drive a desk now!) I know how difficult it can be to admit that we have made a mistake.

We may feel embarrassed or ashamed, or we may worry about the consequences. However, admitting when we have made a mistake is the first step to learning from it and preventing it from happening again.

Another challenge we face is communicating with patients and their families when things go wrong. It can be difficult to knowhow to start the conversation. We want to be honest and transparent, but we also want to be sensitive to the feelings of patients and their families. Patients and their families can be going through a very difficult time, and we need to be there to support them.

I think we all need to ask ourselves why we’re not always able to say sorry, in a meaningful way.

Not that ‘Sorry you feel upset’ apology we see from politicians (years ago I used to run a complaints team in the NHS so I’ve seen lots of those kinds of letters!), but a genuine recognition that we’re sorry, and we want to make things better. We want to learn and make sure that the same mistake doesn’t happen again.

I think we are even more guarded about this in the independent sector. I think there’s sometimes a nervousness and the fear that any death or harm in the sector becomes front page news, so the fear about reputational damage – of a consultant, or a hospital, or a company – is real and I think it’s holding us back.

On the same side?
In recent years, there have been a number of high-profile examples where patient safety was desperately lacking – cases like Morecambe Bay, East Kent, Nottingham, Ian Paterson.

They’re all different obviously, but one thing ties them all together, which is that the tragic and often hard-to-hear truths we now know have only come to light as a result of sustained, prolonged, painful and tireless campaigning from patients, victims, their families and loved ones – it’s them who are having to bang the drum.

These are people who are saying to us: ‘This doesn’t feel right, it doesn’t seem right – please investigate.’ And often we’re talking about people, like James Titcombe (James is patient safety campaigner who I am so pleased will be addressing the conference) who have been bereaved – who’ve suffered an appalling loss.

And above and beyond that loss, they have to campaign – to ask, and ask, to beg, to demand for someone to investigate, to explore, to ask difficult questions. It’s blatantly clear that we’re not really hearing their voices, certainly not early enough, and in many of these cases – and I suspect elsewhere – are we really even on the same side?

I think it’s a lot about culture – it’s about feeling confident, safe, secure as colleagues and within teams – to seek out feedback. To ask ourselves was that as good as it can possibly be? How can we improve? Can we set our standards even higher?

Wouldn’t it be amazing if it was the organisations – the trusts, the hospitals and healthcare organisations, the health care professionals’ groups – really driving that process – having a real commitment to finding the answers, where things aren’t what they should be – and fixing them.

Wouldn’t it be great if the patient groups didn’t feel isolated, or feeling like they are at war with healthcare professionals, providers and sometimes regulators?

I believe that real progress in patient safety can only be achieved if we are all on the same page. Patients, clinicians, organisations, regulators – we all have a role to play and we have to do better.

So, where next?

Well, to the conference, obviously! I’m really hoping that through this event, we are going to come out with some really clear thoughts to inform our work over the next year.

Obviously I want people to be inspired and, I hope that from this, we can get some clear takeaways, priorities or tangible objectives – concrete things that we can develop and work on, and so next year, when we come back together, we can really see progress.

For example around how we really embed Patient Safety Partners into the system. Patient Safety Partners (PSPs) are people who have experienced care, sometimes harm, or near misses in healthcare. They volunteer their time to share their experiences with others, and to help improve patient safety. PSPs can play a vital role in improving patient safety. They can provide valuable insights into how we can better listen to the patient voice and help to prevent harm, and they can help to raise awareness of patient safety issues.

It’d be great to be back here in a year and have lots of our members – whether that’s acute care, community care, from diagnostics – able to say we’ve brought them in, we’re involving patients and families more. But, let’s see what ideas and energy we get from conference and I’ll report back!