Our recommendations for reforming patient safety

Proximie’s mission is to enable safe surgery across the world, but there are significant challenges facing healthcare, especially in the UK’s NHS. We have a golden opportunity to improve patient safety in surgery, but action is required to make that ambition a reality.

Since 2015, there has been a 30% increase in the proportion of procedures with a safety incident and in 2021/2022 there were 407 Never Events – more than one a day., with the cost of poor patient safety in surgery to the UK economy is estimated to be around £5.6bn a year. Technology has the potential to change the way things are done for the better, but more needs to be done to bring this issue to light.

Proximie authored a report based on new analysis of NHS data, the perspectives of 1,500 UK patients who have undergone surgery in the last five years, and input from experts. We embarked on this project with the support of key voices in surgical safety to raise awareness of this important issue, explore the challenges facing patient safety in surgery and ideate and share how we can change the trajectory.

Our aim was to define recommendations for policy makers, clinical teams and stakeholders which could turn the dial on patient safety in surgery.

Our group included leading surgeons, who understand life in the operating room, healthcare leaders, who understand systemic problems, and a patient advocate, who understands the needs of patients:

• ‍Professor Peter Brennan, Consultant Oral and Maxillofacial Surgeon, Portsmouth Hospitals NHS Trust and Council Member of the Royal College of Surgeons of EnglandProfessor Martin Elliott, Provost of Gresham College and Emeritus Professor of Paediatric Cardiothoracic Surgery at University College London
• Tanya Claridge, Acting Group Director of Clinical Governance, Group Patient Safety Specialist, Manchester University NHS Foundation Trust
• Helen Hughes, Chief Executive, Patient Safety Learning
• Dr Nadine Hachach-Haram, Founder and CEO, Proximie and Consultant Plastic Surgeon

We explored the challenges facing patient safety in surgery, and reflected on the experience of patients because it is critical that patients are at the heart of any discussion about surgery reform. We recommend that to truly make a change to patient safety in surgery we must set the safety bar higher, improve data standards, develop a culture of continuous learning, always learn from examples of best practice, include patients at every step, encourage a ‘speaking up’ culture, and push for innovation.

To better understand the current thoughts and opinions on safety during surgery, we surveyed 1,500 people from the UK who have undergone either elective or emergency surgery in the last five years and found that 76% had safety concerns during the surgery process. The safety concerns that patients experience also have a significant impact on their wellbeing with:

• 21% of respondents that reported safety concerns said that they were reduced to tears
• 18% said their worries stopped them from sleeping
• 11% said that they were so worried about their safety that they became ill

All the insight gained from surgeons, patients, and NHS and patient safety leaders, combined with unique data analysis formed our report, Patient safety in surgery: the urgent need for reform. The whitepaper highlights that to reform patient safety and make lasting improvements, a system wide cultural change is required.  As well as analysing the current state of patient safety in surgery, the contributors to decline, and the barriers to reform, we conclude with seven suggestions for all healthcare staff to consider in order for lasting change to occur. These are:

1. The NHS must set the safety bar higher with clearer regulatory, legal and national expectations.
2. We need to improve data to better understand what is happening in surgeries across the country. Having a concrete record of exactly when and where things go wrong, rather than relying on memory will allow us to learn from mistakes and best practice
3. A culture of continuous learning should be instilled into the surgical profession. We need to make the most of opportunities to evaluate performance at all stages of the surgical career and support the notion that even the most senior surgeons still have learning to do
4. Preventing Never Events and learning from when things go well should be the norm. This practice is religiously carried out in the aviation industry. When an airplane crashes, airlines invest significant time and resource into understanding what happened and how future incidents can be prevented
5. Patients should be engaged at every step of the care pathway. Our survey results show that the majority of patients experience anxiety and concerns throughout their care. To change this, we need to engage with patients by improving the information supplied to them and ensuring that they have the opportunity to ask questions and engage in decisions about their care
6. Efforts should be made to improve culture in the multidisciplinary team. Having an open and honest team environment where everyone feels confident speaking up will encourage important discussions about patient safety
7. We need to look to new ways of doing things if current guidance and initiatives aren’t having the effect needed. We advocate for a healthcare system where innovative trials and pilots are supported and there is increased funding and capacity for innovation

For more detail about the insight underlying our recommendations, the full white paper Patient safety in surgery: the urgent need for reform, can be read here.