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Large scale organisational intervention to improve patient safety in four UK hospitals: mixed method evaluation

BMJ 2011; 342 doi: https://doi.org/10.1136/bmj.d195 (Published 03 February 2011) Cite this as: BMJ 2011;342:d195

Author's reply - Evaluation of Safer Patients Initiative

Dear Sir,

We thank the chief executive officers of SPI(1) sites who contributed
letters in response to our articles,[1][2] and comment as follows:

1. They seem to imply that the results of SPI(1) were entirely
negative, when we found some changes favouring SPI(1) and none going the
other way.

2. A sharp improvement in the vigilance of monitoring was noted
across the NHS in both phases of SPI, so knock-on effects on the need for
cardio-pulmonary resuscitation are indeed plausible. It would be
worthwhile to try to find a way to make measurements of cardiac arrests
that are consistent across organisations and over time.

3. Our data are based on a method that is explicitly described and
pre-specified; measured by the same observers across hospitals; episode of
care is blinded; and data are controlled in space as well as time - the
figures quoted in the letters do not meet any of these criteria.

4. We think there are many fine NHS institutions that did not take
part in SPI where the chief executives' families would be well cared for.
Noting that improvement has taken place is not tantamount to saying that
things are fine: we are all fully in agreement about the need to avoid
complacency.

5. We agree that improvements may have occurred beyond the
observation period, and said so in the paper.

The chief executive officers and the authors share a desire to
improve care and to measure improvement. So we hope they would support us
in a further assessment to test the last point above.

Yours faithfully,

Richard Lilford.

References:

1. Benning A, Ghaleb M, Suokas A, Dixon-Wood M, Dawson J, Barber N,
Franklin BD, Girling A, Hemming K, Carmalt M, Rudge G, Naicker T, Nwulu U,
Choudhury S, Lilford R. Large scale organisational intervention to improve
patient safety in four UK hospitals: mixed method evaluation. BMJ. 2011;
342:d195.

2. Benning A, Dixon-Woods M, Nwulu U, Ghaleb M, Dawson J, Barber N,
Franklin BD, Girling A, Hemming K, Carmalt M, Rudge G, Naicker T, Kotecha
A, Derrington MC, Lilford R. Multiple component patient safety
intervention in English hospitals: controlled evaluation of second phase.
BMJ. 2011; 342:d199.

Competing interests: An author of the above papers.

18 February 2011
Richard J Lilford
Professor of Clinical Epidemiology
University of Birmingham