Creating ‘patient safety partners’ (PSPs) is, we believe, the right way to make real what Don Berwick called for when he said that patients and their carers should be present, powerful and involved at all levels of healthcare organisations from wards to the boards of trusts.’
These roles require support from senior leadership in the organisation, including by committing to give them equality of voice and empowerment to speak up, as well as the co-production of mechanisms for their voices to be heard up to board level. This support may come from a non-executive director or executive director with responsibility for patient safety.
PSPs can be particularly effective when the organisation recruits a team of PSPs that includes people who have been harmed when in the care of the NHS. PSPs should be involved in deciding where their input might be needed. Those with experience of being harmed can be particularly effective as patient safety champions or in staff training.
Good practice is to actively recruit PSPs with clear role descriptions. Interview panels should include a diverse range of NHS staff as well as patient/public representatives. Although not employees, once recruited, PSPs should be annually appraised, with clear objectives and training needs agreed. The new patient safety specialists once identified (see later) may also have a role in supporting PSPs.
We believe organisations should co-produce clear specifications for the different local PSP roles, so preventing tokenistic involvement, and should consider the potential advantages and disadvantages of time-limiting these roles. Training for staff partnering PSPs will support their effectiveness and should be considered as part of the national patient safety syllabus.
Patients as partners in their own safety
Patients and their families/carers should be encouraged and empowered to become ‘vigilant stakeholders’ in safety, moving from passive recipients of care to active partners. Patients (or their advocates) will be empowered to play an active role in patient safety if they understand what safe care means in their personal circumstances and have improved health literacy. Involving people in their own safety means producing tools and resources to support people’s involvement in their own care, improving access to their own data, including clinical test results, as well as providing mechanisms for people to report safety incidents.
If harm occurs, patients must be supported to be as involved as they wish to be in the work to develop an understanding of what happened so that the contributory factors can be identified and learned from. They should also be able to access support to aid their recovery.
The PSP role
PSPs should be involved in:
- Service and pathway design. Patients should be involved in service and pathway design, even if it is not always practical for a PSP to be involved. If patient representatives identify patient safety concerns, they may seek advice from a PSP on how to address this with relevant staff members in the service redesign team.
- Safety governance. PSPs can contribute and add value to safety governance by, for example, sitting on relevant committees to support compliance monitoring, responding to safety issues, reviewing data and reports, and providing appropriate challenge to ensure learning and change. We believe PSPs will be most effective where at least two sit on safety committees together to provide peer support.
- Strategy and policy. PSPs could ensure patients’ perspectives are considered and provide valuable insights on the risks to patients; for example, where transitions in care and integration of care pathways are being considered.
PSPs should have knowledge and understanding of patient safety issues. Once appointed all PSPs should receive training based on the national patient safety syllabus according to need and role. Where possible, PSPs should be trained alongside staff.
PSPs need to be considered as having a vital and equal role in driving up safety standards in the NHS. This can be demonstrated by offering remuneration for their work based on clear criteria. NHS England has developed and published a policy for identifying appropriate payment for patient involvement activity. The national patient safety team and others have adopted this policy and we believe this provides a model for the wider NHS to follow.
Next steps and monitoring progress
We have developed the basis of a PSP framework that can support the whole NHS to involve people more in the safety of healthcare. Over the coming months we will work with the national patient safety team and others to further develop our thinking and produce further guidance for the NHS. This will include the development of measurement parameters to track the success of the PSP role in helping to improve patient safety.