Can the NHS embrace behavioural and organisational risk?

A year ago, Mike Bell wrote about the safety culture in civil aviation which has made flying so safe.  He wrote:

"There are two principal factors involved in aviation’s success: 

• There is an independent regulator, with a clearly defined role, expert staff, accountable to parliament, and funded by those it regulates; and 
• There is a culture of openness, with timely and honest reporting of all untoward occurrences whether or not they cause harm and widespread dissemination of the lessons to be learnt. "

The UK's National Health Service ("NHS") now appears to be moving in that direction, with the Secretary of State, Jeremy Hunt, announcing "unprecedented hospital data release which aims to ensure NHS remains a world leader on safety" and a "new safety drive with ambition to save up to 6,000 lives and halve avoidable harm".

The move was been prompted by the Report of Sir Robert Francis QC into the Mid-Staffordshire Hospital Trust debacle with support from the Clinical Human Factors Group which was founded by a commercial airline pilot following the death of his wife from a clinical accident.

The aviation sector has long recognised the crucial role of reducing behavioural and organisational risks - what the industry calls "Human factors".  The industry recognises that special measures have to be taken to ensure that all mistakes, including those without adverse consequences, are reported.  Only then can they be analysed to their real root causes and lessons learned and disseminated widely.

Such a system is intrinsically fragile because it takes very little for the supply of reports of mistakes to dry up.  People will not own up to their own mistakes if they suspect they may be treated unfairly.  They will not tell a superior that they may be making a mistake unless they are confident that their honest view will not be met with disdain or aggression.  They will not report what they believe are unacceptable practices if they fear retribution or if they think no action will be taken.  Fear of litigation or prosecution may drive mistakes underground.  And if hospital manager body language gives the impression that they do not really want to learn about and from all mishaps, however minor in consequences, the system will also be undermined.

It is therefore important that Sir Robert is to chair the independent review into what further action is necessary to protect NHS workers who speak out in the public interest and help to create the kind of open culture that is needed to ensure safe care for patients.

The NHS should be congratulated in trying to move in the right direction in dealing with the behavioural and organisational risks that have bedevilled patient safety for decades.  But there remains much work to be done, and to be successful it will need a sea change in the attitudes of politicians as well as by those who run the NHS.

Anthony Fitzsimmons
Reputability LLP
London

Anthony Fitzsimmons is Chairman of Reputability LLP and, with the late Derek Atkins, author of “Rethinking Reputational Risk: How to Manage the Risks that can Ruin Your Business, Your Reputation and You”