Collaboration is the key to helping overcome the health and care challenges both now and in the future.

Simon Watson, Medical Director at Healthcare Improvement Scotland, reflects on how patient safety has evolved in the past 20 years and looks ahead to the challenges of the future.??

In the space of about 20 years, the idea of patient safety has gone from something that few clinicians felt comfortable talking about, to something that not only are we talking about, but we’re doing on a grand scale. Quite simply, the Scottish Patient Safety Programme broke the mould, presenting a great example of how a whole country could agree on healthcare key priorities and work together in a co-ordinated way and learn from them.

I have vivid memories of really difficult conversations around patient safety in the past where, if we tried to get into that discussion, it was met with a lot of defensiveness, hostility and a sense that somehow you’re accusing somebody of being a bad person or incompetent.

So the first revolution if you like, was a cultural one, to actually talk openly about it and get a bit of confidence that we could learn from other sectors and this shift began to happen around 20 years ago. The second revolution was to do this on a nationwide scale and Scotland did this through a range of initiatives as part of, or closely related to the Scottish Patient Safety Programme.

“The Scottish Patient Safety Programme is a great example of how a country could agree on healthcare key priorities and work together.”

Innovative examples of patient safety work

Now we’re addressing patient safety within hospitals, GP practices, hospices and other social care settings in a way that was hard to imagine 20 years ago. For example, the safety of healthcare in prisons is being addressed. If you pause and think, the impact of a pandemic on a prison population and the prison workforce and the potential for harm, distress and unrest is quite daunting. It’s a setting where, as well as the spread of the pandemic, there were other important factors to consider such as people not being able to get treatments to help deal with their addictions. That situation could have escalated ?very, very quickly.

Healthcare Improvement Scotland did an amazing job of helping prison health services to rapidly move to a completely different way of providing addiction treatments. They did everything from training to learning – creating support networks and working on a whole gamut of areas around that one setting.

“We can be proud of our work in prisons during the pandemic.”

It only affected a small proportion of the population, but in important, challenging and often overlooked one. It also shows the inclusiveness of patient safety and the focus on all people in our population.

What are the challenges?

When we look to the challenges of the present, we need to come up with solutions that are achievable and doable – and for people to have confidence in them. And to meaningfully help people work in a collaborative way. When people are stressed, trust is lowest, and the conditions to genuinely work and address challenges in a collaborative way become most challenging.

“As a national organisation, the biggest assets we’ve got are the people we have.”

We know that people who haven’t been treated as well or as quickly as we’d have wanted them to be, because of the pandemic, are now sicker, needing more care and there’s less resources in the system to deal with them. So, there’s a bit of a perfect storm brewing.

To have a safe system, we define the following things as important: financial stability, having a good workforce, stable leaderships and clear processes without excessive demand. Right now all of those things are being challenged nationally coming off the back of the pandemic with the economic disruption we’re experiencing as a country.

“The underlying conditions mean that right now we’re sailing into a headwind.”

Focused on the way ahead

There were some major threats to the health of the population before the pandemic and some of these are getting bigger not smaller. Antimicrobial resistance is one of the single biggest threats to humanity that we’re facing at the moment. There are plenty of reports highlighting that and we have a very specific role in that area. One of the challenges is to make sure we keep focusing on that and doing our best.

Whilst A&E waiting times and many others are on the increase, we need to look at multiple horizons and how we deal with them. Whilst we recognise we have the immediate issue of what we’re calling the winter crisis, we also have further horizons beyond the winter to consider. We must use intelligence to understand where the highest risks are and what our most important priorities should be and be ready for the challenges beyond the next few months.

But the key focus needs to be on collaboration and problem solving together. Patient safety will only improve in these challenging times if these areas are everyone’s focus. I believe our organisation – our knowledge, experience and skills – can play a vital role. In the same way as we have in the past, we’re ready to be a force for improved patient safety now and in the future.

Simon Watson is Medical Director at Healthcare Improvement Scotland.?

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