Enhancing cultures of safety
“We know that problems with the cultures within health and care organisations are often at the root of patient safety failings, and that some groups of patients are particularly disadvantaged by these.
I’m pleased that the Enhancing cultures of safety theme in this PSRC will be focusing on how we can support more positive safety cultures to be developed that provide equity of access for all patient groups.”
Khudeja Amer-Sharif / Public and Community Involvement and Engagement member for Enhancing cultures of safety.
A positive safety culture in health and care contexts is an environment where individual staff members, teams, patients, service users, and carers work together to ensure that safe care can be delivered.
It is an environment where there are continuous efforts to identify and improve any risks to patient safety. Anybody is encouraged to speak up about concerns. It is central to NHS England’s Patient Safety Strategy. This is because issues with the cultures within health and care organisations are often shown to be part of the problem when there have been patient safety failings.
This theme aims to explore and understand cultures of safety. This will help researchers to identify how to develop positive cultures across health and care settings to improve patient safety.
At the NIHR Greater Manchester Patient Safety Research Collaboration (GM PSRC), this theme focuses on:
Speaking up about safety
To build cultures of safety, all staff need to be able to voice safety concerns. These should be heard and acted on by organisations.
Despite efforts encouraging staff to speak up, evidence shows that healthcare workers from ethnic minority groups feel especially vulnerable in doing so. They are more likely to have a negative experience if they do raise concerns.
Minority healthcare workers are also less likely to speak to their Freedom to Speak Up guardian. This role is part of NHS England’s strategy to encourage staff to speak up. They ensure that:
- people who speak up are thanked;
- the issues they raise are responded to;
- the person speaking up receives feedback on the actions taken.
Our research aims to identify the changes needed within organisations to better support staff from ethnic minority groups to voice concerns to help improve patient safety.
Operationalisation of patient safety across diverse organisations
What patient safety looks like, how it is monitored, and who is responsible for it can vary across different health and care settings. It is vital to understand this before patient safety can be improved.
Our research involves collecting data on the patient safety processes already in place across health and care settings. This gives us a deeper understanding of what safe care looks like and how safety is balanced with other aspects of high-quality care.
We are creating recommendations for managing tensions and challenges in addressing safety across different health and care organisations. Our insight is valuable for organisations in setting priorities and developing strategies to improve safety.
Organisational responses to patient safety regulations and guidance
Our research explores how health and care organisations such as NHS trusts manage and respond to safety guidance in practice.
We are looking at why the guidance may not always be followed. Our research is developing recommendations for those who produce guidance to make sure it is fit for purpose and is usable for staff. We are also working to support organisations in how the guidance is used across different settings.
We work closely with the East Midlands Academic Health Science Network (AHSN) Expert People’s Panel and the Centre for Ethnic Health Research (CEHR) to ensure equality and diversity are considered throughout our research.
The involvement of diverse health and care staff, managers, commissioners, and policymakers in our research ensures that our work can be used across health and care settings, including in areas of highest need. This helps to narrow the gap in health and social care inequalities.
Our impact: case studies
Our programme of research for this theme builds on the success of projects that our team have previously delivered.
Professor Natalie Armstrong (theme co-lead)
Natalie is a medical sociologist and Professor of Healthcare Improvement Research at the University of Leicester. Her work uses sociological ideas and methods to understand health and illness, and to tackle problems in the delivery of high-quality healthcare.
Professor Carolyn Tarrant (theme co-lead)
Carolyn is Professor of Health Services Research at the University of Leicester. She has a background in psychology and many years’ experience of working in health services research. She has particular interests in antibiotic overuse and acute care settings.
This theme includes team members from the universities of Leicester and Manchester, as well as two Public and Community Involvement and Engagement (PCIE) members.
The University of Leicester team members have particular expertise in using social science theory and methods to understand what happens in health and care settings, such as at a GP practice or care home.
The University of Manchester team members are experienced in human factors interventions (new ways of doing things that aim to improve system performance and prevent accidental harm), healthcare leadership, governance, law, and regulation.
The PSRC team
Learn more about the researchers who deliver this work.
Read published papers about our improving medication safety research.