The Royal Marsden Hospital Manual of Clinical Nursing Procedures - Lisa Dougherty [121]
From 1 April 2009, for the first time, healthcare providers were obliged to register with the CQC their compliance with the Hygiene Code and from 1 April 2010, with the CQC’s Essential Standards of Quality and Safety. These quality standards are divided into 28 outcomes, which must be consistently achieved, 16 of those outcomes relating directly to care delivered to patients by frontline staff.
The CQC has powers of enforcement and is required to adopt a risk-based approach and efficiently target action where it is needed (DH 2007, 2008). In relation to governmental efforts to control healthcare-associated infections and quality standards, the CQC is able to fine hospitals, close wards, suspend services and increase inspection visits where hygiene or care quality requirements are not being met. In the wake of the Mid-Staffordshire NHS Trust case (Healthcare Commission 2009) and the subsequent independent enquiry (Francis 2010), risk scrutiny is to be strengthened by the establishment of ‘risk summits’. Inspectors, health watchdogs and regional NHS chiefs will vet the safety of every hospital and share information so that patterns in sub-standard care can be identified. Other reforms include faster alert systems to identify trusts with high mortality rates and risk profiling to identify organizations threatened by management changes and high staff turnover or vacancy rates (Francis 2010).
Risk management and organizational change
Making sure patients come to no harm is a key component of ensuring high-quality care for all. The quality agenda described above has a key focus on establishing and measuring targeted outcomes and establishing very clear reporting structures.
Running alongside the quality agenda in the NHS has been an increasing focus on and use of formal risk-based management approaches (Power 2007). This has also been stimulated by a wider strengthening of faith in its importance to the functioning of a well-governed organization, which is internally and externally accountable for how it handles uncertainty and risk (Power 2007). The leaders of healthcare organizations are being held to account for the levels of risk and harm within their organizations, making investment in robust systems for managing risk, from ward to board, a very high priority.
The publication of An Organization with a Memory (DH 2000) and Building a Safer NHS for Patients (DH 2001) highlighted from international research the need for organizations to learn more when things go wrong. With the publication of patient safety data such as infection rates in hospitals, patients are also lobbying for better, safer care in hospitals. It is estimated that around 10% of patients (900,000 using 2002–3 admission rates) admitted to NHS hospitals have experienced a patient safety incident and that up to half of these could have been prevented. This study also estimated that 72,000 of these incidents might have contributed to a patient’s death (Vincent 2006). Whilst the majority of those incidents relate to system failures involving many healthcare professionals, nurses have a key role to play not only in preventing harm but also in the analysis of patient safety incidents which inevitably occur, and the dissemination of lessons learned to prevent reoccurrence of incidents.
The quality agenda has provided the NHS with a much greater focus on managing risk and maintaining patient safety than ever before but with such pressure to achieve excellent clinical outcomes comes the risk of professionals being apprehensive in reporting when adverse incidents occur. Quality agendas such as the one outlined above are, however, officially viewed as a method for promoting reflective cultures in which learning rather than blame and defensiveness predominates (Berta et al. 2005).
The vision for the NHS is one where patients and staff will be enabled to report errors and guided by this information, healthcare services will individually and collectively progress through continuous improvement.
Development of a ‘No Blame