How much will the new Patient Safety Syllabus change the game?

In 1999, Paul DePodesta began to transform Baseball, alongside General Manager, Billy Beane. His approach to talent selection and team building not only got the Oakland Athletics to the playoffs in 2002 and 2003, it also gave rise to a best selling book and an award-winning movie; Moneyball. It changed the game. 

Last week NHS Improvement/England in collaboration with Health Education England published their Patient Safety Syllabus. They identify it is time to change what we do. It is time to change the game. 

What is the new syllabus?

The syllabus is broken into five domains based on a systems approach, investigations, aspects of human performance, an integrated safety basis of work as well as a strategic and cultural approach to patient safety. Throughout these domains, there are four themes: systems thinking, risk expertise, ergonomics and non-technical skills, and safety culture which create a mechanism for enaction. 

There is much merit to the contents of the syllabus. Without a doubt, if these principles were consistently understood and embedded throughout the NHS it would positively impact upon Patient Safety. The syllabus is an excellent foundation stone to help begin a transition towards an approach to risk management that integrates human factors for healthcare. 

Change in healthcare is not easy to achieve

To date, many attempts to improve patient safety within healthcare have had negligible results. In ‘Still Not Safe’, Wears and Sutcliffe cite the example of the UK Health Foundations Safer Patient Initiative, where improvement in intervention hospitals could not be directly attributed to the interventions and improvement may be explained by a rising tide effect. So how do we know if the game is changing or whether it is simply the tide that is rising?

Amongst the many highly valuable components of the syllabus, there is mention of Safety II. This is the work of Erik Hollnagel who proposes that we can create environments more optimal for safety by learning not only from failure but also from everyday work. We will know if the syllabus has changed the game in this regards if future iterations evolve from domains focused on “Learning from incidents” to ones that become “Learning from work”. Equally language of “preventing harm before it occurs” may become “creating the conditions for consistent excellence”.

The syllabus “draws explicitly from widely used safety methodologies applied routinely in other safety-critical industries such as aviation and process engineering… long been upheld as learning opportunities for healthcare”. Indeed there is much to learn about risk management from other industries. Too often knowledge remains in silos and conversations are insular.

A positive, outward-looking, curiosity can help improve Patient Safety. 

Paul DePodesta, however, transformed Baseball because of his intimate and forensic analysis of Baseball. He understood the system and how it could be improved. His genius did not result from a long-held respect for Al Davis’s Oakland Raiders. It was a different sport, with different rules and different systems. It is also worth noting that experiments applying Moneyball methodology to more complex team sports have failed. 

Healthcare often operates as a complex-adaptive-system. Teams perform when there is incomplete information, unclear or conflicting goals and the distinction between the right decision and the wrong one is ill-defined. It is a 24/7 world of relationships and nuanced considerations of risk. This is fundamentally different from other safety-critical industries.

So, is the new syllabus a game changer?

We will know that the syllabus has changed the game when the inherent complexity within healthcare is interwoven in our understanding of risk and integration of human factors for healthcare. This may mean we evolve from a view that human performance is something that simply requires managing to one that provides the appropriate level of support to allow people to excel in highly challenging environments.

Indeed, it may also mean we have a foundation upon which we can develop a bespoke personalised learning roadmap to enable a flexible approach, creating the conditions for the best possible patient outcomes and experience. 

The scope for the Patient Safety Syllabus to become a catalyst to integrate human factors within healthcare is considerable. The journey that this can initiate could ultimately become transformative. We may yet change the game.

Paul Stretton
Head of Innovation and Research



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