Denys Court - Getting to Safe: Resilience Strategies for Healthcare Teams

Why This Book?

This is a book about people. It is a book which looks at the ways in which people involved in healthcare can keep people they are caring for, and thereby themselves, safe. For patient safety to flourish, those who provide safe care must also be flourishing. It is people, working in mutually supportive professional relationships, and who are supported by safe systems, who are best enabled to provide safe care. My goal is to enable reflection on how you may achieve that shared safety.

If I were to ask you right now about safety in your healthcare workplace, what would immediately spring to your mind? It would probably depend on your most recent experiences. It could be that you had a colleague who stepped in and supported you when you were overworked and made you feel safe and cared about that you felt safe. Or was it that you spoke up when you were concerned that a patient allergy was about to be overlooked and thus kept a patient safe? And of course, in the process of doing so, kept a colleague safe too. That interwoven view of safety is what this book is about. It is an inclusive look at how to do things right more often, as individuals, and in the context of team-based relationships. As much as anything else, it is about self-care, staying safe ourselves, because if we do not, we are less able to care safely for our patients.

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For healthcare to be safe for our patients and ourselves, the organisations in which we work must be safe and resilient. In my first two chapters, I will assess in which areas of healthcare we can largely rely on our organisations systems to provide a reliable backbone to safety; and in contrast, where does safety depend more on the mindfulness and actions of clinicians simply because our systems are not resilient enough? I refer to this as identifying the gap. I use the term clinician throughout the book to include all professionals involved in providing clinical care: nurses, doctors, midwives and allied health professionals. Identifying the gap is about clinicians being mindful of where the systems under which we work are least able to keep us and our patients safe and therefore where, as clinicians, like it or not we carry the greatest safety burden. By doing so, I hope to develop insight into the possibilities for, and limits of, safety in our organisations.

To develop that tension, I will explore in Chapter 3 the reality that where our organisations systems provide us with the most fragile safety framework is where the work our leaders and system-designers envisage we will do work as intended (WAI) is not accurately able to reflect the work we actually do work as done (WAD). This occurs, for example, when because of resource constraints such as time, skill-match or staffing and equipment issues, we find that to achieve organisational goals as best we can, we have to do things differently from what our leaders or systems envisage; we work around the problem. The more WAD can be moved to approximate WAI, the safer an organisation will be because WAD will then have a higher degree of predictability. When circumstances make us deviate from WAI, we need to be mindful that safety may be compromised. It is largely us as health professionals that can improve safety in such circumstances by identifying, reporting and suggesting cures for unsafe work-arounds. I will therefore develop the concept that there is much we can do as individual clinicians to increase healthcare safety. Because we increasingly provide patient care in multidisciplinary teams; it is within those teams that safety can best be enhanced. To be champions for safety in the ways I will suggest, we need to feel psychologically safe in the teams we work in, that if we wish to challenge a team norm or habit, that will not only be tolerated without derision, but actively encouraged in the belief that the free expression of ideas is a vector to improvement.