The report describes safety management system (SMS) principles that support a proactive and integrated approach to managing safety, set out the necessary organisational structures and accountabilities and will continuously improve. The report also highlights that a structured approach to safety management is already taken by other ‘safety-critical’ industries such as aerospace, aviation, maritime, rail, oil and gas, defence, and nuclear power.
An SMS requires safety management to be integrated into an organisation’s day-to-day activities. There is no one-size-fits-all SMS, however, there are four recognised areas associated with many frameworks: safety policy, safety risk management, safety assurance and safety promotion.
We have produced a video introducing the SMS concepts described in this report for further understanding.
We spoke to those working in safety management in healthcare to understand the current picture. Our report notes that provision of safe care is a priority and ‘in the past 25 years there has been a growing focus on patient safety’ and gives examples of work being done. However it does highlight that despite this focus and many improvements there are ‘still recurring risks and incidents in healthcare.’
In one interview quoted in the report, a safety leader said “the identification of patient safety risks is more haphazard than I am comfortable with” and “our system is based on ‘first do some harm’, when it should be ‘first do no harm’. Most of safety is deficit driven. We need to get to a system which starts with making sure up-front things are as safe as they can be”.
Our report states that ‘an overall systems approach is needed – that is, one that encompasses all aspects of healthcare including non-clinical services, which can have a significant impact on patient safety.’ The work we have done also recognises that any SMS implementation would have to be suitable and appropriate to the needs of healthcare.
In that context, our national investigation looked at the need and role of SMSs in other safety-critical industries with the aim of better understanding the requirements, barriers to implementation and how everyday safety work could be supported in healthcare.
Through analysis and interviews with safety leaders and other industries, we identified three key opportunities to create an organised approach to safety management.
- SMS development: there is variability in language and definitions for safety management principles that describe the safety activities, functions and processes that are already common across healthcare.
- Safety accountability frameworks: for effective safety management, clear lines of accountability and responsibility are needed. Within an SMS, everyone has some measure of responsibility, such as reporting unsafe conditions. Accountability takes responsibility to another level. When someone is accountable, they are responsible for systems and processes that assure safety.
- Safety maturity frameworks across the system: existing safety maturity frameworks in healthcare do not promote the principles of SMSs, do not define the key components of a healthcare SMS, and do not provide organisations with a road map for incremental development of their safety activities.
Insights from other safety-critical industries
The team interviewed 20 people working in these industries in safety orientated roles, hearing how they have developed and implemented SMSs and assessed safety maturity within their particular areas. One of the findings under our ‘safety accountability framework’ heading was that there is ‘consensus within other safety-critical industries that effective safety management is only possible when there is a clear accountability framework that underpins the process.’
Next steps and our future work
The report made two safety recommendations focusing on the establishment of an SMS co-ordination group, and the development of regulatory assessment for safety management activities. The report also sets out what our future work on SMS and applicability to healthcare could look like – for example we could map current safety management activities in healthcare to SMS principles and identify opportunities for improvement.
Sian Blanchard, Head of Patient Safety Insights at HSSIB, says: “The continuous improvement of patient safety is a priority for all modern healthcare systems and our investigation has highlighted the need for a more proactive approach to safety management. Whilst there are some elements of SMSs already within healthcare, safety is not yet fully embedded into the governance and culture of organisations as it is in other industries.
“We recognise the complexities and nuances within healthcare, but an SMS is not set up to be another manual or set of procedures, it is a dynamic approach that is tailored and evolves and matures with industries. It is important that different agencies continue to work effectively together and with this first report we have identified some of the opportunities to join up the healthcare systems and work towards a coordinated SMS approach.”