According to Hippocrates, the first principle for healthcare professionals is to take care that they suffer no hurt or damage (Edelstein, 1943) and yet education for most of the professions historically has included nothing on safety and safety science.
There is often a simplistic view that patient harm is synonymous with individual negligence at worst, or lack of individual awareness at best. There is an increasing understanding of the complexity of health and the confluence of many different factors that, when combined, to use Reason’s (2000) analogy, align the holes in the Swiss cheese and allow inadvertent harm to occur.
The authors of the reviewed study propose a pedagogical approach to educating healthcare students that draws on the empirical evidence and situates it within the students’ unique, contextual experiences of healthcare services. Using Rasmussen and Amalberti’s work on how everyday workarounds can move practice away from evidence-based standards, SLIPPS illuminates how good people can work in environments that threaten patient safety.
By exploring the complexity, the student can begin to move away from a blame culture and towards prospective solutions that create the conditions where things go right more often. This reflects the ethos of High Reliability Organisations, where professionals must expect the unexpected (Weick et al., 2008) rather than assume they can be certain that their processes and protocols will ensure safety. This will present students with major challenges; in the UK at least, the top-down approach to safety leads to standardised processes but variable outcomes. Students who seek to achieve standardised outcomes but with variable processes may fall foul of the compliance culture that dominates healthcare systems.
The authors have focused on developing a repository of learning events from across Europe and a range of engaging media for stimulating health professional students to think reflectively and reflexively. The project is ongoing and the use of international collaborations looks promising. However, the improvement of relationships between education providers and healthcare organisations is not an end in itself. It is not clear from the reviewed paper how the impact of this approach to educating new registrants will be evaluated, and whether it will move practice from looking backwards at the incidences of harm to considering how to achieve the presence of safety.
Biography
Elaine Maxwell is a former Executive Nurse Director in the NHS and an associate professor of Leadership at London South Bank University. She is currently Clinical Adviser at the National Institute of Health Research Dissemination Centre, where she works to increase to knowledge transfer and uptake of evidence in healthcare services.
References
- Edelstein L. (1943) The Hippocratic Oath: Text, Translation and Interpretation, Baltimore, MD: Johns Hopkins Press. [Google Scholar]
- Reason J. (2000) Human error: Models and management. British Medical Journal 320(7237): 768–770. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Weick KE, Sutcliffe KM, Obstfeld D. (2008) Organizing for high reliability: Processes of collective mindfulness. Crisis Management 3(1): 81–123. [Google Scholar]