Hein Le Roux shares his thoughts on joining the Sign Up To Safety campaign, as well as some of the lessons he’s picked up from working in Australia and coaching his son’s under 9s rugby team. Since 2013, Hein has been a board member with the Gloucestershire CCG whilst also working as a half-time GP in his Minchinhampton practice. He’s also the primary care patient safety lead for the West of England AHSN.
My eight-year-old son, Jack, plays rugby for our local club and, along with some of the other dads, I help to coach the boys and girls on a Sunday morning. The children and their parents place their trust in us and we know that our roles are to ensure they have fun, develop the best skills possible and remain safe by not getting injured.
Whilst we all strive to have a good experience, things inevitably do go wrong for the children (and us coaches) and often the natural response is to become defensive; we all fear judgement.
When things go awry it is often because of a host of factors, most of which are not in any one person’s direct control and yet there is a fear of blame. Our antidote is to be values-based and revolves around kindness. We encourage everyone to be open, supportive and to learn from each other when things, inevitably, do go wrong.
When I get to work on a Monday I often reflect on my amateur coaching experience the day before, as there is potentially much resonance with my day job as a GP. Our coaching goals contain the basic elements of Darzi’s medical definition of quality: clinical effectiveness, patient experience and patient safety.
Patient safety is, in many ways, a novel concept in general practice. As the national picture sets out, individually we are all working incredibly hard to deliver great patient care, however the concepts and principles of patient safety require a different skill and mind set.
Other than ‘task’ factors around reliable systems and processes, they also require ‘people’ skills, particularly teamwork towards achieving common goals. This then fosters openness, continual learning, honesty, collaboration and being supportive – much like what we are trying to achieve with the under 9s rugby team.
Our practice (Minchinhampton) unanimously agreed to join the Sign Up To Safety (SU2S) campaign. It offered us an external opportunity to reflect on some of the basic principles of patient safety and how we could apply them to our work on the coal face.
Improving patient care is increasingly becoming a joint endeavour between professionals and patients. Our practice’s Patient Participation Group (PPG) has enthusiastically joined and supported our cause to promote safer patient care and this is very important for us.
The West of England Academic Health Science Network has offered our PPG members free access to the Institute for Healthcare Improvement (IHI) open school on patient safety and quality improvement (QI) which provides additional insight. The lack of integration across care settings within many practices and on a bigger scale across the health community can come as a surprise to patients and, with their help, hopefully we can improve this situation.
My passion for patient safety and QI originated when I was working as a GP in rural Australia. Our practice had the usual issues of working hard individually, but lacked the standardised systems and processes across the practice to make care much more reliable and thus more effective and safe. Usually each GP liked things done in their own peculiar way and this could cause quite a headache for the nursing and admin staff, who had to remember who was working and how they liked things done.
Our practice then signed up to a national primary care QI initiative (the Australian Primary Care Collaborative) using IHI methodology and tools to enable the front line (receptionists, nurses and GPs) to solve their own problems in a more systematic way. It was breathtakingly simple, using a model for improvement and measurement to help people improve.
Apart from the technical skills, the key element that led to the greatest improvement was the focus on teamwork, with each member valued for their contribution rather than the traditional hierarchy we worked in. In my opinion, this seems to impede great patient care.
On my return from Australia back to the UK I was fortunate to work for the NHS Institute for Innovation and Improvement. Through this I attended the IHI’s Patient Safety Leader’s course in Boston, listening and learning from some inspiring patient safety leaders. The messages and lessons are so relevant to our work on the coal face, but they do require culture change in the way we work away from individuals to something more collaborative and team based.
We have much to learn from the under 9s rugby team!