Today the fundamentals of LfE are being showcased by the East Midlands Patient Safety Collaborative at a national patient safety event. LfE is all about studying excellence in healthcare and creating new opportunities for learning and improving resilience and staff morale. On the LfE website, there are a number of blogs and there is an update from the most recent conference where practitioners shared their learning.
Blogs are written to help us consume information in short bite seize chunks, but here is a challenge, how can we hope to understand such a complex system as healthcare and patient safety learning with the reading of a blog or two? The concepts involved in this complexity require us to have deep knowledge about; systems thinking, the model for improvement and various frameworks from implementation science to get close to that deep understanding. It takes time and a specialist focus as this blog will address.
Understanding risk management through the Swiss cheese model of a threat becoming a reality and being mitigated by the differing layers and types of defences which are "layered" behind each other is still a very liner model unlike complexity. We often imagine these protective layers to be our response to incident investigation such as; a refresh of a policy or guideline or some new training or a reference to use the SBAR communication tool. These have been seen as solutions. However, we staff in healthcare continue NOT to have confidence in these responses as a silver bullet solution to a complex issue.
One current approach for us to observe our system is ‘the framework for measuring and monitoring’, as proposed by Charles Vincent et al 2014. The interconnected nature of the healthcare system is illustrated in these 5 domains. Other frameworks to consider are; the Eurocontol Systems thinking for Safety: Ten Principles (air traffic control) and Systems Engineering Initiative for Patient Safety 2.0
In the same way, we cannot understand patient safety complexity through just one approach – the Root Cause Analysis. We need new tools to observe ourselves in the work that we do regardless of what is prescribed as ideal. Adaptations and work-arounds happen all the time to ensure the task gets done and we all stay safe. However, we simply do not have an approach that allows us to explore what is happening in these situations. This is often described as the ‘black box’, looking inside this box can only be done with the agreement of those involved. It’s different from simulation, but pretty close.
Our Patient Safety Collaborative presentation has been shared at the NHS Improvement event today (12 December) focused on organisational learning from incidents and patient safety culture.
The approaches to analysis are still in formation from within the LfE community of practitioners and it is likely that this community will keep growing if the rapid growth over the last year is anything to go by. The East Midlands PSC has adopted LfE from the West Midlands and is growing and developing practice in a range of trusts across the region. Our strategy has been to underpin this development with Appreciative Inquiry (AI). Although AI is not new to organisational development colleagues, NHS Employers have created a suite of useful resources.
Insights require teams and communities of practice in LfE to do the analysis of the emergent patterns and themes which flow out of the reports that colleagues on appreciating people around them to understand how we work together to improve safety. This needs developed thinking. Thinking requires concentration.
Leadership for learning is different to leadership for management. In complex situations, the best leader approach is to probe, to sense and then respond. Leaders allow patterns to emerge and determine which ones are desirable and will succeed. In this way, they will discern many opportunities for creativity, new models and innovations. And if we can let go and be brave, we can learn to fail fast, learn fast and fail-safe creating the right approach to learn about our complex systems and innovate our way to new knowledge.
For more information and training in this area contact