Tom Rose

Are the slides available please?

Better process visibility/documentation would help. The new British standard, BS ISO 7101:2023 would help with this. Currently it's a case of the blind leading the blind. Documenting healthcare processes is not difficult if it's kept simple. It would be a big step towards a Learning Health System.

I agree that the NHS's version of quality is not sustainable nor effective. For WAD to equal WAI in the NHS will take a lot of work and careful design. The current situation with WAD must change, and, I should add, WAI. I'm looking forward to Parts 2 and 3. Thanks. 

The NHS is a long way from the aviation industry when it comes to safety and you have hit the nail on the head with this blog. A solution for the NHS will not be found until two two conditions are first met. For simplicity I have come up with two formula. Fist: WAD=WAI, and second: QI=CI. There is a great deal of change required for the NHS to meet these two conditions, far too much to show here. WAD is Work as Done. WAI is Work as Imagined. QI is Quality Improvement as interpreted by the NHS, and CI is Continuous Improvement. Once these two conditions are met then the NHS can start to implement three, universally recognised systems. These are Process Management System (PMS), Quality Management System (QMS) and finally a Safety Management System (SMS). Clinicians', on there own, will not achieve this, they need to seek help from outside the NHS. 

'Health and Care processes' and 'assuring processes are safe' are mentioned during the video. Lots of work required here in the NHS. Are you talking about 'work as imagined' or 'work as done'? because in the NHS they are very much not the same thing. You can't design a SMS without Process Management. You will find that all the industries that you listed above have very strict Process Management Systems as the key foundation to their SMSs.

I'm working on the design for a Quality Management System with an integrated Safety Management System for the NHS. It's proving to be hard to get support for this as the NHS think that they have already got quality and safety covered.

This is a great blog. very well done. Fantastic imagination in putting it together. Work-as-done is so important. Much more important than work-as-imagined as this is very rarely to current practice. Have you seen my Roadmap and Framework for change?

https://www.eventbrite.co.uk/e/quality-management-in-the-nhs-tickets-696649366007?aff=oddtdtcreator&utm_campaign=Informz&utm_medium=Informz&utm_source=Email

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On 02/08/2023 at 00:39, tikena17 said:

Hi Claire. A great tactic that illustrates complex policies and procedures within healthcare process and to explain the concepts of safety 2 which focuses on the concept of work-as done versus work-as-imagined which reflects the approach to safety 1 for my day-to-day experience working as a family physician I can model what I actually do work-as- done tends towards simplification of policies and procedures The imaginary or the developed as standard that transform it into something like a simple flow chart for all those complex and many policies and procedures litriture .Despite this, I still believe in the need to find a tactic that accommodates the two methodologies as an entry point to simplify policies and procedures so that it achieves its end  goals in providing a safe healthcare service that preserves the patients safety and healthcare providers safety Within clinical human factors and health system redesign

It is that very tactic that I have been working on. There is no simple solution but never-the-less a solution is required and quickly.

What a great example of what is wrong. Very well done. I am in the process of designing a Roadmap and Framework to address this issue in the NHS. It will not be a quick fix as all processes in the NHS need to go through the process illustrated by you. It will also require recourses outside the NHS. But - it is a necessary and much needed activity. I have been working on this issue for 7 years, since retiring, and have not made much progress with the NHS. They need to understand that they can not make the necessary changes without professional help from proffecanals that know what they are doing. Key issues to be addressed include a just culture and staff welfare.

The key difference between the airline and hospital environments is that that airlines manage their processes. This is a pre-requisite for error reduction in healthcare.