Thread by @DBadenoch

Join me 1000 BST for a #Quality2021 workshop on Reliability and Resilience - moving from Safety I to Safety II. The discussion will be around improvement methodology, with @JBraithwaitee1, Axel Rose and @IanLeistikow.

A little background about our facilitators.

@JBraithwaitee1 is Founding Director of the Australian Institute for Health Improvement.

On his YouTube channel, he has a handy 3-minute video about #Safety-II. #Quality2021

Axel Ros is Chief Medical Officer, Region Jönköping County, Sweden, and a specialist in General Surgery. He sits on the Swedish national patient safety committee. #Quality2021

internationalforum.bmj.com/europe/2021/03…

Based in the Netherlands, @IanLeistikow is an inspector and advisor at the Dutch Health & Youth Care Inspectorate and professor at Erasmus University Rotterdam where he does research on governmental regulation of healthcare quality.

#Quality2021

internationalforum.bmj.com/europe/2021/03…

A new speaker in the line-up: Mary Patterson is paediatric emergency physician and, from tomorrow, Chair of Emergency Medicine.

We look forward to hearing her experiences.

The session is in three parts:
- The elements of Safety II
- A short video
- Breakout rooms

#Quality2021

Some definitions:

Reliability, from @TheIHI

Moving from Safety - I (thinking about preventing adverse events) to Safety - II (focusing on what goes right to help improve performance)

#Quality2021

Resilience

#Quality2021

Professor Nakajima's video showcases her supporting existing adaptive behaviours in a hospital pharmacy.

This is Safety-II thinking. Helping to make sure things go right, rather than not going wrong.

So, how do we learn from such examples? Time for a breakout!

#Quality2021

Some thoughts from our group:
- efforts to standardise prescribing practices in A&E
- moving from Safety-I (culturally embedded) to Safety-II is a challenge
- learn from other industries, e.g. oil
- Safety-II is a positive message

#Quality2021

Now we're back in the room.

Need to bone up on Safety-II?

Here's the NHS England White Paper (PDF)

#Quality2021

england.nhs.uk/signuptosafety…

Root Cause Analysis - Safety-I

A Safety-II question for RCA - "What did we do when things went right?"

@JBraithwaite1

You need both Safety-I and -II.

And another from Mary Patterson:

"What else was going on at the time?"

So now we're watching a video by Andrew Johnson showing how important it is to value front line staff in Safety-II.

#Quality2021

Andrew shows how staff generally adapted well to #COVID19

The Safety-II approach was core to learning from them what was going well in the time of crisis.

Andrew's team managed to triple capacity in intensive care.

#Quality2021

My highly select group agreed that Safety-I thinking has been embedded in the culture and gets in the way of thinking about what goes right.

Blame culture isolates individuals and make them fearful.

#Quality2021

Question: Do we need DATA on what's going well?

Mary: More useful would be creating space for staff to reflect on what went well.

Axel: Data is useless if you don't reflect on what's behind it.

@IanLeistikow : Data feeds into "narrative accountability"

#Quality2021

Axel introduces the next presentation: How do you do Safety-II on a systems level?

#Quality2021

Nikki and her team looked at perioperative anticoagulation,

They started at the top, encouraging organisations and building networks to facilitate national learning.

Working with front line staff, and inspiring organisations to change.

#Quality2021

Third breakout session thoughts:

- Safety-II is positive and sustainable
- Safety-I can have negative effects on the system
- Regulatory bodies should accept a degree of error
- "Near misses" are very helpful
- Good results from GreatIx

#Quality2021

med.scot.nhs.uk/wellbeing/grea…

Cultural issues around "what went well?":
- Some folk don't like boasting!
- Health care tradition on focusing on the negative
- We grew up with Safety-I

The drive to more things right should be just as strong as the drive to avoid error, says @JBraithwaite1.

#Quality2021

Question: Can we measure #resilience?

Axel: Not in hard facts and figures. Use tools to reflect and understand what's going on.

Mary: Resilience is dynamic. For example, frontline workers found a multitude of solutions to #PPE problem during the #pandemic.

#Quality2021

That's it from Safety-II for this morning. A superb session, perfect balance of chalk and chat. Many thanks to our facilitators.

Axel's final remarks:

"There is learning in everything that happens all the time. We have to organise this in the system."

#Quality2021