Pat O'Connor
Risk Management and Patient Safety
NHS Tayside, Scotland
"It’s much easier to actually apply quality improvement in Scotland, because you only have 15 areas to cover." (1:24)
My name is Pat O’Connor. I’m head of Risk Management and Patient Safety at NHS Tayside in Scotland. There are 15 health regions and we’re one of them. It’s much easier to actually apply quality improvement in Scotland, because you only have 15 areas to cover. Primary care, acute services, and commissioning are all part of the one organization.
As part of Safer Patients Initiative, we had to bid against 52 other organizations to apply for this money for quality improvement projects. So we have five teams of people: leadership team, medicine management team, perioperative care, critical care, and general ward team. We’re now starting to apply that into every single structure of the organization. It’s a wonderful opportunity for myself and the teams, and from a trustee side, it’s brought the whole organization together, because we work for the NHS, and care is free at the point of delivery, there is always a change within our budget because you don’t know how many patients will turn up, and every single one of them has to receive care regardless of how much money is in the budget. So this has given us an opportunity to take some time out and people away from the bedside so that they can think about how to apply these ideas in practice.
"I became quite the pain to my colleagues, seeing that we don’t need to continue to do all of these things, and our activities were very wasteful." (1:28)
I’ve always worked in health care. I was a midwife for 20 years. I’ve done occupational health nursing, I’ve worked in ICU. I think the moment for me wasn’t so much the "quality bug"; it was a personal moment for me when I went to an advanced midwifery course in Edinburgh. Edinburgh University is one of the oldest in Scotland, and they had a massive library filled with information, some of that from 1750, so there were lots and lots of books there. That was the tipping point for me, because I thought all of these people have taken all of this the time to write about the medical practice and I haven’t taken the time to read it. So that was really the tipping point, and then through practice development and midwifery that’s when I focused on quality improvement.
There was a huge drive in the UK for teen midwifery where midwives worked in teams to give very personalized care to the patient, so you were making patient promises to say one of these three people will deliver this baby and that’s the first quality improvement project I worked on. Very successful. There were a number of other initiatives that we took where I started to question why we did things we’ve always done, and probably became quite the pain to my colleagues seeing that we don’t need to continue to do all of these things, and our activities were very wasteful, and actually took away from the laboring women, and stopped doing them, and it was pretty easy to do.
"It’s not just patients, it’s actually members of the public who bring a lot of information from the community into the hospital, and they can also take parts of our Safer Patients Initiative out into the community." (1:14)
We have mandatory systems to make sure that in every single committee in our organization there are representatives from the patient and public, and not only do these representatives need to attend, you need to actively demonstrate that they are contributing to the agenda. I think that is not something that my colleagues here in the States were familiar with at all. They are finding that very challenging, and yet that is something that’s been pretty easy to do in the UK, but maybe it’s because you have that mandatory principle behind it, to say you’ll do this. It’s a very rewarding experience because it’s not just patients; it’s actually members of the public, who may not be using the health care systems. They bring a lot of information from the community into the hospital, and they can also take parts of our Safer Patients Initiative out into the community. So, they can take the message out about hand washing, take the message out about communication, and actually find out about what the patient sees, from a patient safety perspective, in the community. They go to community health centers, they go to shopping malls and take the message out for us as volunteers. That’s another great resource for our organization and our quality improvement work.
"One of the things we don’t do well in the UK is use patient stories; it’s maybe just the culture of the country." (1:10)
One of the things we don’t do well in the UK is use patient stories. That seems very effective here in the United States. I don’t know why, because there is not the pressure of litigation in the UK, it’s maybe just the culture of the country, that we don’t feel comfortable actually standing up there and telling the patient story or the patients wouldn’t welcome that. I don’t know but it’s something that we need to explore because it’s a very powerful, impactful way of actually getting that message of patient safety across, and it’s something we intend to take forward in NHS Tayside. As far as litigation goes, we have a central point in Scotland for litigation against the health service, and all cases are defended by the central legal office. There are strict procedures and deadlines, to respond to a patient who wants to formally complain, and there’s a lot of negotiation with the patient before it actually becomes a formal complaint. It’s just I don’t think we talk about it enough publicly. How can we start to work in a different way? How can we sit down with the patients and their families and actually look at what errors have happened long before it gets to some kind of litigation track?
"The leadership of the organization needs to feed this message to their employees every day: This is the right thing to do." (0:44)
It’s not beyond everyone to apply the principles of quality improvement to the work. I think you can teach people to do that. I’m sure I can teach other people to do that. You need to look at a range of role models in your professional life and choose the best elements of everyone and say, “I want that,” put them all together and say, “That’s the person I want to be. That’s how I’m going to apply the things I believe in to the quality improvement work.”
The leadership of the organization needs to feed this message to their employees every day: This is the right thing to do. It is hard, this is a difficult journey, it’s never going to end. So, I’ve always said there’s a goal line of December 2006. That’s not the finish. That’s the beginning of the next step.
01/17/2006
