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Safety Culture Conversations Across Boundaries

We plan to use safety culture cards with all our teams across acute, community and social care to provide a common language and basis to build quality improvement projects across bourndaries.

Read comments 7
  • Proposal
  • 2019

What is the challenge your project is going to address and how does it connect to your chosen theme?

In working across an integrated care system a wide range of people, staff and patients, from multiple different disciplines and professional backgrounds are going to be coming together and need to build relationships and a common language in order to improve the safety and quality of care that we provide.  Safety as a key part of care provision crosses all boundaries of the health and care system and as such can provide a sound starting point for conversations.

The Kings Fund report “A year of integrated care systems”, Sept 2018, recognises the need importance of “investing in collaborative relationships” and need to “draw on skills and leadership of front-line staff”. IHI white paper on “Safe Reliable, and Effective Care” 2017, also recognises importance of “developing shared understanding” and “genuine agreement on matters of importance to team” as parts of “teamwork and communication” and “negotiation”  within the culture required to support a learning organisation.

What does your project aim to achieve?

The aim of the project is to bring health and social-care teams together, and to involve patients to develop a common language and purpose around safety. Our intention is that this will provide a basis of moving forwards to understand how we can work together to improve safety and quality of care in  pathways and working across historical boundaries.

We recognise that the evolution of a new organisation and integrated care system represents a significant opportunity, alongside the challenge of changes in teams and relationships.  We would like to use the safety conversations to stimulate ideas for quality improvement for care of patients across the integrated care system.

Measures of success;

1. Use an evaluation of Safety Culture Conversations which we will develop alongside our colleagues from NHS Education Scotland, whose cards we would use

2. Use quarterly staff pulse survey to sense check staff perception

3. Triangulate with a question included in patient face to face questionnaire

How will the project be delivered?

Having already linked with colleagues from NHS Education Scotland, we plan to use the Safety Culture Conversation cards that they have already developed.  We will liaise with those experienced in use of cards to enable us to develop a model for delivery of the  to  both within and across health, acute and community, and social care in North Cumbria. Safety Culture Cards have been used by NHS Scotland to initiate conversations.

If funding supports, we would recruit to a seconded role for leading delivery and identify “champions” for conversations, initially from our local Q community, clinicians and staff with an express interest in patient safety with a view to spreading the initiative and encouraging staff to utilise these conversations at any team meetings, and as part meetings where groups from different parts of the Integrated Health Care System are coming together to work.

Our patient experience team will help us to ensure that patients are also involved as the project evolves

What and how is your project going to share learning throughout?

North Cumbria is privileged to be one of the new Integrated Health Care Systems. This project has the opportunity to look at ways of bringing together health and social care teams to work not just across, but without, organisational boundaries.

We are proud to have support from colleagues in NHS Education Scotland to add breadth to the project, and facilitate a wider evaluation of the benefits and limitations of the Safety Culture Conversation Cards beyond Cumbria.

We will share learning across our Integrated Care System, with the Q community. This can be via regular updates initially on progress of implementation and numbers of teams/meetings at which these conversations are used, recognising need for formal evaluation in addition. As the first year of implementation, and assessment, are completed we would share learning by postera or presentation regionally at our AHSN or national meeting.

An increase in cross-boundary QI projects registered will be an indirect measure of success.

How you can contribute

  • Ideas for any objective measurement tools
  • Thoughts, suggestions or advice on improving our approach.
  • Thoughts and advice from others who have tried any similar initiative.
  • If other organisations wish to participate in trial of safety culture conversations across boundaries and evaluation, which NHS Education Scotland have agreed to help co-ordinate, we would love to hear from you.

Plan timeline

19 Sep 2019 RunSafety Culture Conversations organisation Safety Summit
30 Sep 2019 Run Safety Conversation session Trust Board
30 Oct 2019 Develop Evaluation with NHS Education Scotland
30 Oct 2019 Have role description ready to advertise for seconded lead
30 Oct 2019 Identify teams to pilot conversations
20 Nov 2019 identify multi-disciplinary, multi-professional "champions"
31 Jan 2020 share initial feedback from conversations Q
30 Sep 2020 Complete evaluations (having worked with continuous cycles)


  1. Thanks Ruth, great idea and delighted to support you with this endeavour - we'd be particularly keen to do some basic evaluation to get feedback on the overall utility of the approach.  best wishes, Paul

    1. Thanks Paul, it would be brilliant to have the opportunity to learn from your teams experiences with using the cards and to collaborate on evaluation. Ruth

  2. Absolutely love this idea, sharing common terms and language is such a big step in getting people to embrace a new project / idea / method of work.

    Would you base this closely on the Scottish model and piggyback from their campaigns?

    1. Thanks Kathleen,

      Absolutely planning to use Scottish model and develop from it, we are getting in contact with team in Scotland to try and work together and learn from their experiences. We would also be keen to hear from others with experience of using the cards.

  3. Guest

    Rachel Fleming 3 years, 1 month ago

    This sounds a really interesting idea and plan. In CLIC we use a framework called Relational Coordination (RC) which can help to frame conversations too. It is an evidence based model of 7 elements that contribute to safer and more coordinated care. I agree time to build trust  and hold the conversations is important but where time is short having focus on evidence based elements may help. I am really happy to go through this in detail with you if it might help. You can also measure RC using a survey tool too, which when you are dealing with "softer" elements of communication and relationships is useful too.

  4. Thanks or your input Jo, I would agree with your thoughts about differing approaches, and I think that one of the challenges is to ensure that conversations about safety focus on a positive basis for learning and celebration of successes rather than the more negative focus that can come from the acute sectors more data driven approach.

    one of the challenges for us is going to be how we get a range of "champions" to lead these conversations across the health care system, and ideally be able to encourage more cross-linking between staff groups.  I do think that whilst there is some opportunity for "leaders" of acute/primary and social care to meet, this is much more of challenge for wider staff and yet I believe that we need to try and create more opportunities, and would hope that promoting safety culture conversations may be one way.  If we can achieve a measurable increase in QI initiatives that work across sectors, stimulated by safety culture conversations, that would be fantastic!

  5. An interesting idea and way to get a shared understanding of safety across a system - the thing that we have learnt the most from work locally is the importance of creating a space for these "cross-boundary" conversations to take place. We need to do this at scale locally, so would be very interested to hear more about your idea and whether this provides a vehicle for these discussions to happen, and what actions are stimulated as a result (v. hard to measure!!).

    Something that is really important is in challenging assumptions and valuing different approaches (e.g. community / social care is much more equipped using "softer" intelligence to inform of safety, whereas acute settings very much more reliant on data reflecting on harm).

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