Understanding risk
15 Oct 2018

Understanding risk

Published Date: 15 Oct 2018

Despite excellent efforts from its staff, the NHS currently suffers from an overly reactive stance to the management of safety (Health Foundation, 2012; Ward, 2010). Safety-critical industries place the balance differently between reactive and proactive safety management (e.g. ICAO, 2009). In essence the NHS lacks a proactive, systematic and system-wide stance on risk management (Robinson, 2012; Shebl, 2009; Ward, 2010).

This project researched how to introduce proactive risk based approaches to quality improvement and system redesign in the NHS. In conjunction with the research, a web-based toolkit (www.ssatoolkit.com) and training package was also developed for System Safety Assessment (SSA). SSA is a process for examining ‘what could go wrong’ in a healthcare system, helping to prevent problems before they occur.

The toolkit was refined and tested as part of a collaborative project funded by The Health Foundation, led from Hertfordshire Partnership University NHS Foundation Trust. The project aimed to address patient safety hazards in mental health care pathways in five project sites across the East of England. Clinical teams were trained in SSA and in human factors (HF). HF training enables a shift in staff culture to being more proactive and collaborative on patient safety. The SSA gave the staff a tool to systematically identify safety issues and to develop solutions to improve safety. This project was unique in combining both SSA and HF training in the mental health setting.   

Over 500 NHS staff, including those in the host trust CPFT, have received training on SSA, which typically receives very positive feedback.

Contribution of CLAHRC East of England

The research underpinning the development of the SSA tool was funded by CLAHRC EoE.

Although the project was only partially funded by the CLAHRCs, they played a key facilitation role in the underlying research, development of the SSA tool and staff training.

What happened next?

Evaluation showed the intervention helped NHS staff to make positive changes to clinical practice. Significant safety culture improvements were found in six out of 12 areas, using an established patient safety culture measure.

Over 500 NHS staff, including those in the host trust CPFT, have received training on SSA, which typically receives very positive feedback.

Working with partners including the Royal College of Physicians, findings have been embedded into the report Engineering Better Care. This has given the work national exposure and, under the RCP’s Quality Improvement programme, has led to continued work to spread the use of SSA within care pathways and wider organisations.