Part of a Case for Support for a Research Proposal

A Problem with NHS Hospital Patient Safety Programmes

Early NHS policy responses to the growing awareness of patient safety problems identified the need to introduce programmes that aid ‘a just culture’, build local capacity, and sustain change through performance improvement monitoring (DH 2001, NAO 2005). Since the establishment of the National Patient Safety Agency (NPSA) in 2001, these policy goals have been pursued in England and Wales through the four main hospital safety programmes summarised in Table 1.

Table 1: NHS Hospital Patient Safety Programmes in England and Wales

Source: Summarised from Health Foundation 2008

Inspired by safety approaches in other ‘high-risk’ industries (e.g. airlines) and the work of the US-based Institute of Health Improvement, NHS hospital patient safety programmes aim to improve service reliability by implementing evidence-based clinical practices, and enhancing performance monitoring systems (Sutcliffe and Weick 2001). In each NHS hospital patient safety programme, organisational factors are acknowledged to be ‘critical’. However, in contrast to the evidence-base supporting the clinical interventions, relations between organisational factors and the outcomes of hospital patient safety programmes are both under-theorised, and not well understood in empirical terms (Shortell et al., 2007; Grol et al., 2008). There has been no systematic and independent analysis of the relationship between organisational factors and the outcomes of patient safety programmes in NHS hospitals (McKee et al. 2008, Bate et al. 2008, Bates 2008) Despite this, the designers of hospital patient safety programmes prescribe various combinations of the organisational features outlined in Table 2 below.