Intended for healthcare professionals


Is quality of care improving in the UK?

BMJ 2011; 342 doi: (Published 03 February 2011) Cite this as: BMJ 2011;342:c6646

Patient safety: no room for complacency

Dear Sir,

That safety and quality is rising in the NHS [1, 2] is cause for
optimism but not complacency. Harm to patients remains stubbornly high
with most recent estimates set between 3 and 25% in acute care and about
9% in primary care [3]. Furthermore, reliability of routine clinical
processes would not meet standards set in other safety critical industries
(for example, a recent study showed a failure rate of between 13 and 19%
in four key clinical systems [4]).

In building on its learning from the Safer Patients Initiative, the
Health Foundation remains at the vanguard of patient safety.

* In 2008, we launched an innovative programme bringing together
leading academics and practitioners from across 4 health systems to co-
design new solutions to current challenges in patient safety. This work
has informed the design of Safer Clinical Systems - our new UK-wide
initiative to apply proactive approaches to detecting risks in clinical
systems of care and mitigate these through implementing appropriate
strategies from systems thinking and human factors.

* In 2010, we hosted a colloquium to explore the emerging discipline
of improvement science with leading thinkers including those from
evaluation, biostatistics, RCTs, ethnography, social science and patient
safety alongside practitioners. They identified the common challenges to
those working to improve quality and the knowledge we need to build in
order to address them. We have now established an international network
led by Paul Batalden, Professor of Paediatrics, Community and Family
Medicine at the Dartmouth Institute for Health Policy and Clinical
Practice and Professor of Quality Improvement and Leadership at Jonkoping
University in Sweden, to further develop the science of improvement and
provide multi-disciplinary support to our newly launched post-doctoral
fellowship in improvement science to develop original, applied research
dedicated to improving healthcare in the UK.

* Later this year our annual innovation scheme (Shine) will support
healthcare organisations to develop pragmatic solutions to some of the
commonly identified barriers to improving quality such as a lack of
improvement capacity and capability in the workforce, poor measurement,
and insufficient clinical engagement.

Too many lives - of staff and patients - continue to be blighted by
the consequences of avoidable harm. In the face of unprecedented cost
pressures and system reform, leaders at every level need to continue to
make patient safety a priority.

Yours faithfully,

Dr Jo Bibby,
Director of Improvement Programmes,
The Health Foundation


1. Benning A, Dixon-Woods M, Ghaleb M, Suokas A, Dawson J, Barber N,
et al. Large scale organisational intervention to improve patient safety
in four UK hospitals: mixed method evaluation. BMJ2011;342:d195.

Benning A, Dixon-Woods M, Nwulu U, Ghaleb M, Dawson J, Barber N, et al.
Multiple component patient safety intervention in English hospitals:
controlled evaluation of second phase. BMJ2011;342:d199.

3. The Health Foundation (forthcoming, 2011). Research scan: Levels of

4. The Health Foundation (2010) Evidence in brief: How safe are clinical

Competing interests: The Health Foundation commissioned and funded the Safer Patients Initiative.

04 February 2011
Jo Bibby
Director of Improvement Programmes
The Health Foundation