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

Evaluation of SPI

Dear Sir

I was the CEO of Luton & Dunstable Hospital , the England pilot site
for the Safer Patients Initiative 2004-8. The main objective of SPI1 was
to reduce adverse events (as measured by the Global Trigger Tool) by 50%
over the first 2 years of the Initiative. This was achieved by Luton &
Dunstable Hospital. In addition, we achieved a 55% reduction in cardiac
arrests, and believe this to be the main reason for our HSMR reducing from
being regularly 110 to being regularly in the 90s. In our ITU we saw an
elimination of central line infections and a virtual elimination of
ventilator associated pneumonia, both previously seen as inevitable
"complications " of patient care in an ITU. SPI1 did not aim to improve
patient satisfaction nor staff attitude , two indicators measured by the
Evaluation.

Experience of SPI1 at Luton & Dunstable Hospital encouraged the
Board to make patient safety its highest priority, strategically, and this
was demonstrated and reinforced continuously by the actions taken over
many years. The new approach we took to transforming patient safety was
largely led by enthusiastic clinicians , indeed in my 34 years as an NHS
manager, nothing has resonated so much with Doctors as this.

The Evaluation authors make much of safety and quality improvements
occurring across the whole of the NHS during this period, therefore SPI
not contributing more, over and above . This observation is at odds with
my own experience in both the leadership of the national patient safety
first campaign and since then as an independent consultant. There are
still too many hospitals not implementing best practice improvements to
avoid patients deteriorating nor recognising the possibilities to avoid
harm in ITU care. Many hospitals still do not even count Cardiac arrests
nor see them as failures in care. We still accept unacceptable practice
going on in our hospitals every day, and need a complete mindset change to
convert " first do no harm " into pro active action at every level.

The authors compare " some despair at an apparent lack of progress" in
the USA " with a more encouraging story on patient safety in the NHS " , a
rather complacent opinion in my view.