Quality clinical leadership for improving patient safety with patients, carers and staff centre stage.
Safety in healthcare is an international concern with impact on quality of care (Hollnagel, et al, 2015). A Regional Patient Safety Collaborative, one of 15 nationally set up to place patients, carers and staff at the heart of quality improvements in patient safety, supported four large acute National Health Service hospital providers with a model to help facilitators use safety and quality improvement tools with frontline teams and to be mutually supported through action learning.
The evaluation used realist evaluation (Pawson & Tilley, 2004). Its aim was to understand what works for whom and why, when: working with frontline teams in large acute hospitals to embed a safety culture, and grow leadership and quality improvement capability. Specifically, to identify which strategies are effective in supporting front line teams to sustain bottom up change and quality improvement driven by the needs of patients and practitioners. The study drew on ethnographic principles across study sites using descriptive case study design. Mixed methods of critical observation of frontline practice, stakeholder evaluation, emotional touch points, self-assessment; qualitative 360 degree feedback; and the Teamwork Safety Climate Survey tool (Sexton et al 2006) were used to facilitate the development of a rich picture for each team and each context so as to answer the evaluation questions. In tandem, interrogation of the literature to distil relationships between context, mechanisms and outcomes generating hypotheses at individual, team and organisational level factors for safety culture.
Key findings identified an interdependence between quality clinical leadership within frontline teams, safety culture, safety behaviours and teamwork echoed in microcosm through safety huddles; the skills and attributes of facilitators; and the impact of organisations on microsystems. The interdependence between patient safety and person centeredness was also identified as was the need for organisational strategies for supporting clinical leaders and frontline teams.