What is the challenge your project is going to address and how does it connect to the theme of 'How can we improve across system boundaries?​

A positive safety culture is where the environment is collaboratively crafted, created and nurtured so that everybody (individuals, teams, patients, service users, families and carers) can flourish to ensure brilliant safe care [Prof Seligman].

Never Events are serious, largely preventable patient safety incidents that should not occur if the available preventative measures have been implemented.  Grouped with serious incidents and near misses, they are a particular risk in operating theatres and are of concern within ABUHB, particularly around wrong sided anaesthetic blocks and retained foreign objects.

Learning from incidents highlights numerous factors related both to culture and processes leading to adverse events.  Many factors relate to theatres but also to the wider system.

Innovative work to build a safety culture within theatres using Human Factors Simulation, coupled with Quality Improvement, will be spread across the boundary between theatres and wards, building positive relationships and an environment to foster safe care.

What does your project aim to achieve?

Safety culture has been identified as a key theme in numerous national reports where there has been poor care or risks to patient safety.  This project aims to improve the Safety Culture across the boundary between operating theatres and wards.  Specific objectives within this will be to:

• Improve staff wellbeing
• Develop deeper relationships between theatres and ward teams
• Evaluate any changes in staff behaviour and outcomes following the Human Factors/Simulation intervention using the Kirkpatrick Model

Whilst the project will review the number of adverse incidents in theatres, these are not necessarily a good measure of how safe a system is.  There is strong evidence showing that building a safety culture and psychologically safe environments also increases adverse incident reporting.

As part of it’s measurement strategy this project will develop and use the validated SCORE Safety Culture survey to evaluate the safety culture.

How will the project be delivered?

Culture is dynamic and the context within which all our work sits.  The NHS England guide to Improving Patient Safety Culture recommends creating relational opportunities that influence social interaction when building a safety culture including:

• Space/time for teams together.
• What we talk about so teams can make sense of their work.
• How we talk and behave towards each other.

An MDT team of medical, nursing, ODP, management, psychology and quality improvement will employ:

• Human Factors workshops– employing Human Factors principles at an individual, team and system level to effect changes in behaviour, how systems work and overriding safety culture.
• Simulation Sessions – originally used as an education and training technique, Simulation has an emerging role as an improvement technique (THIS Institute).  Regular simulation/debriefing sessions held with theatre and ward teams exploring areas of high risk
• Quality Improvement – where complex problems are highlighted, teams employ quality improvement techniques to learn and improve.

How is your project going to share learning?

We would like to share the learning from this work with the wider Q Community via two interactive workshops, one face to face and another virtual.  The workshops will deliver:

• The Human Factors/Simulation experience that has been tested over the past two years within theatres.
• Knowledge using the above model to improve patient safety in theatres
• Update on the Q Exchange project – ‘Human Factors Approach to Build a Safety Culture across boundaries’

We will also develop a package of resources that will be useful for staff who want to learn more about the components of building a Safety Culture.