Enhancing Cultures of Safety
“Organisational cultures are often the root cause of patient safety failings, and these make some groups of patients particularly disadvantaged and vulnerable.
It is pleasing to note that the ‘Enhancing Cultures of Safety’ theme within the wider work of the PSRC, will focus on how we can effectively support more positive safety cultures to be developed and implemented that will provide equity of access for all patient groups.”
M. Mistry / Public and Community Involvement and Engagement member for Enhancing Cultures of Safety.
Listen to our podcast episode with Professor Nicola Mackintosh and Dr Jennifer Creese:
Our focus
A positive safety culture in health and care contexts is an environment where individual staff members, teams, patients, service users, and carers work together to ensure that safe care can be delivered.
It is an environment where there are continuous efforts to identify and improve any risks to patient safety. Anybody is encouraged to speak up about concerns. It is central to NHS England’s Patient Safety Strategy. This is because issues with the cultures within health and care organisations are often shown to be part of the problem when there have been patient safety failings.
This theme aims to explore and understand cultures of safety. This will help researchers to identify how to develop positive cultures across health and care settings to improve patient safety.
Our approach
At the NIHR Greater Manchester Patient Safety Research Collaboration (GM PSRC), this theme focuses on three key research projects:
Speaking Up For Safety - Ethnic Minority Staff
LearnIng from Speaking-up for safeTy for Ethnic miNority staff (LISTEN)
For healthcare organisations to prioritise patient safety and provide good quality healthcare for patients, all staff need to be able to speak up when patient safety incidents occur, and to feel that they are being heard and their concerns acted upon. This study aims to uncover some of the barriers faced by ethnically diverse staff to speak up for patient safety, and to offer recommendations to healthcare organisations to adopt an approach to safety culture that is more inclusive and equitable, psychologically safe and open to learning from a diverse range of staff viewpoints.
Stage 1 of this study involves a review of literature on the barriers faced by ethnically diverse NHS staff to speaking up for patient safety, alongside interviews with ethnic minority frontline staff from across the UK (up to 30).
Stage 2 of this study involves interviews (up to 12) with professionals in key patient safety roles, such as Freedom to Speak Up Guardians, Patient Safety leads and Equality, Diversity and Inclusion leads, to uncover ways by which they can support minoritised staff and any organisational challenges which need to be addressed.
The project end date is March 2025 and input by ethnically diverse healthcare staff, academic experts, patient and public advisors has been sought to ensure that the study addresses issues which are important for staff and patients in healthcare organisations in terms of quality of care and patient safety. The findings will be used for a policy dialogue workshop and dissemination activities with policy makers, research leaders and healthcare staff to influence current policy and practice in healthcare organisations. Findings will also inform subsequent research in the social care sector.
Managing Patient Safety Risks at a System Level
Managing Patient Safety Risks at a System Level (MAPS-S): understanding an Integrated Care Board’s approach to system risk management
Management of patient safety risks at the system level of a whole Integrated Care System (ICS), rather than only at organisational level, is becoming a new direction for NHS England’s policy around managing the quality and safety of care. Using the example of a local Integrated Care Board (ICB), this study looks at how and why the ICB has used a system-level approach for managing patient safety risks within its Urgent and Emergency Care (UEC) services and pathways. The focus of the selected ICB’s system-level risk management approach specifically on reducing pressures on its UEC services relates to one of the key national priorities of NHS England, identified on the basis that UEC systems across the country continue to be under substantial pressures in terms of their capacity to deliver safe, high-quality care.
Within this context, the study looks at the reasons for the ICB’s use of its system-level risk management approach and senior leaders’ understandings of how the approach would work. The study findings will provide important initial evidence regarding how this new approach may be understood within local ICSs. An initial scoping study of senior leaders’ understandings of the approach will be followed by a second phase of data collection. The second phase will look at how the approach has been introduced, understood and used in practice within the ICS’s UEC pathways, and how it has been experienced on the ground by staff within different NHS organisations. Overall, the findings from the studies will allow for a detailed understanding of the perceived usefulness and appropriacy of the approach, and for key learning to be drawn out for future improvements in its implementation and use.
From Recommendation to Action
From Recommendation to Action (ReACTION): exploring the translation of national guidance into organisational change for patient safety
The complex regulatory landscape around patient safety produces a host of guidance for care organisations and professionals to navigate and implement in practice. This project focuses on patient safety recommendations developed by HSIB/HSSIB, using documentary analysis and qualitative methods to explore:
- How such recommendations are produced and framed within specific organisational and cultural contexts;
- How they are received and interpreted, and whether/why they are integrated into existing policies and practices; and
- How such recommendations can facilitate or impede efforts to manage safety.
The work will inform future design and delivery of recommendations, and support organisations to respond.
We work closely with the Centre for Ethnic Health Research (CEHR) and our own Enhancing cultures of safety theme’s designated Patient and Public Involvement and Engagement Forum to ensure equality and diversity are considered throughout our research.
The involvement of diverse health and care staff, managers, commissioners, and policymakers in our research ensures that our work can be used across health and care settings, including in areas of highest need. This helps to narrow the gap in health and social care inequalities.
Our impact: case studies
Our programme of research for this theme builds on the success of projects that our team have previously delivered.
Key people
Professor Carolyn Tarrant (theme co-lead)
Carolyn is Professor of Health Services Research at the University of Leicester. She has a background in psychology and many years’ experience of working in health services research. She has particular interests in antibiotic overuse and acute care settings.
Professor Natalie Armstrong (theme co-lead)
Natalie is a medical sociologist and Professor of Healthcare Improvement Research at the University of Leicester. Her work uses sociological ideas and methods to understand health and illness, and to tackle problems in the delivery of high-quality healthcare.
Professor Nicola Mackintosh (theme co-lead)
Nicola is Professor of Social Science applied to Health at the University of Leicester. She has a background in critical care nursing. Her research uses qualitative methods (particularly ethnographic methods) as well as sociological theory to further understandings of patient safety and improvement science research.
This theme includes team members from the universities of Leicester and Manchester, as well as seven Public and Community Involvement and Engagement (PCIE) members.
The University of Leicester team members have particular expertise in using social science theory and methods to understand what happens in health and care settings, such as at a GP practice or care home.
The University of Manchester team members are experienced in human factors interventions (new ways of doing things that aim to improve system performance and prevent accidental harm), healthcare leadership, governance, law, and regulation.
Our PhD students
Paul John Garvey
Project title: Workload, Staffing and Patient Safety in Healthcare: Examining Practices and Contexts
Supervisors: Dr Jennifer Creese, Professor Nicola Mackintosh
Kerry Brodie
Project title: Exploring incident investigation capacity and capability in healthcare
Supervisors:Dr Mohammad Farhad Peerally, Professor Natalie Armstrong
The GM PSRC
Learn more about our other research themes
Research publications
Read our published papers
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