How was Sign up to Safety different? Would we do it the same way again?
By Cat Harrison
Sign up to Safety has been running since 2014, launched with the aim of helping organisations improve the safety of the care they provide, and has since gained membership from almost 98% of NHS provider organisations in England.
As we draw to an end in March 2019, we are left feeling that the future of patient safety needs to be focused on caring for those that care for patients. This needs to be the main motivator for improving care, with staff well-being increasingly recognised and understood as intrinsically linked to the standards of care experienced by patients.
We can see, from five years working with people from across the entire system, in all settings, in all size organisations, that there is common need and common barriers experienced by those caring for others day to day. Helping those on the frontline and all through the system be psychologically, physically and emotionally well, and that they feel cared for and confident they will be heard if they speak up, as well as looked after if things don’t turn out as expected, will help them with the pressures and decisions they face day to day in what is a complex, messy and stressful environment.
Without explicit acknowledgement of the complexity they face and a human understanding of the toll this can take, plus help to remove or surmount the barriers (like bullying, hunger, tiredness, incivility etc) that can be controlled, we are making it harder, not easier, to work safely regardless of whatever toolkit, intervention or change we want to put in place.
The future of patient safety needs to be focused on caring for those that care for patients
We have reached this understanding through our work since 2014 but in hindsight, I can see how our approach right from the start has allowed us the space to get to this place. We’ve always cared about the people we were relying on to make this campaign work.
We started out with a sense check and purposefully attempted not to just do more of the same, and instead reflect on what the past was telling us. We tried to let go of our existing assumptions about what made care safe, often forged over years’ in which we frankly haven’t seen the improvement that we hoped previous approaches would yield. We also freed ourselves up as much as we could from the pressure to ‘have all the answers’ – instead openly acknowledging that we were here to learn more about what it is to work safely. And crucially, Suzette collected together a diverse group of people who had the expertise to challenge each other whilst proactively fostering a sense of team identity and a caring environment that allowed challenge to happen without threatening each person’s sense of identity and worth.
My role was to lead on the communications and engagement, so I’d like to explore what this all meant in a practical sense in terms of how we spoke to and what we did to encourage involvement from our target audiences.
You could see our task as a vast version of internal communications; we were aiming only at staff, wherever they worked in the NHS in England. We hoped to galvanise this myriad of people into sharing a vision and to take action that would improve the safety of care at a local level.
We shaped the campaign to be a snowflake model, which meant it hinged on talking successfully to a relatively small group of people locally who would then localise what we said or asked for as they desired and disseminate it across their own organisations. This meant that we needed to develop messages that appealed en masse, bridging the gap between what we wanted to see happen and what our audiences needed, and were simple enough to trickle down without losing sense or appeal.
What made a huge difference was starting from where our audiences were, practically and emotionally. The sorts of questions we asked ourselves were…what else did they have on their plates, what other asks were there from elsewhere in the system that ate into their time, what was the financial landscape that affected their roles, how did they feel as often one of the only people within their organisations responsible for proactively improving safety?
This thoughtful approach to understanding who we wished to talk to, and on the flip side, who we hoped would listen to us and really hear what we had to say, allowed us to identify key similarities and shared experiences amongst a very wide group of individuals that spanned all settings in the NHS.
Interventions to improve patient safety have often been setting-specific or role-specific, but instead we focused on the shared human experience of those leading improvement, how they felt and what they aspired to, which allowed us to create unifying messaging that was relevant to all.
The segmented approach to communications, which is often the right approach in so many other situations, here could have resulted in entrenching existing tribal identities, so again, as part of our approach to doing things differently, we took a very different path with common (yet meaningful) messaging across all channels and to all audiences.
This was partially a solution to low resources and a huge task, where we simply couldn’t have achieved cut through if we had attempted a segmented approach across all types of people we needed to reach with the time and budget we had, but also, this was a response to what we’ve seen happen (and sometimes been a part of ourselves) in the past.
What made a huge difference was starting from where our audiences were, practically and emotionally
We’ve seen from experience that often strategies for such a patient safety project (local or national) start from a place of a somewhat flawed, tunnel vision that can fail to see each member of a target audience as a person, who each want to do a good job, with competing pressures and difficult decisions to make. Instead focusing purely on what the project leaders want, what those being targeted do wrong, should do differently, and the technical aspects of improvement without acknowledgement of and respect for each individual’s own passion, commitment, experience and expertise. Instead we saw an opportunity to highlight the shared humanity of those who work with patients by focusing on the importance of relationships for patient safety.
This was part of our attempt to put people centre stage in a meaningful sense and sought to find common ground by linking to what drives each member of the NHS, caring for people in a safer and more effective way.
We were also aware that national campaigns can be a little on the arrogant side without meaning to be by assuming they are owed attention and adherence simply due to the nature of their position. Instead we resisted that assumption and tried to always help rather than ask of those we wanted to influence. We proactively tried to build up trust and respect, and this approach, where we saw ourselves as peers – not top down bosses – for a group of people we wanted to work with us and to inspire and help, influenced the tone we used as well. The tone in turn informed our actions and filtered through every aspect of the campaign. For instance, we wanted our tone to be positive and collaborative. We wanted to show people we cared for them and wanted to help them; and this also acted as a sense maker for what we did – when planning a new phase, we were able to ask ourselves, did this tactic help people so what they want to do, did the messaging help them feel understood and respect their knowledge, do they have a chance to tell us what they think and are experiencing?
We knew that if we answered these questions correctly, then we were getting around some of the most important barriers that stop people taking the action you want them to and would give ourselves a chance to learn more about what works.
Effectively, our approach was an unusual integration of activist-led communications techniques with a deep understanding of the science of patient safety, with experts from both fields working closely together. This was a true collaboration and a key aspect of what made us achieve our aim of helping people think differently about patient safety. It helped us settle on a strategy that stood apart from what had gone before, learning lessons from previous campaigns and approaches internationally. This meant that our approach was genuinely different and played a key role in shifting perception of what patient safety is. We have helped people to redefine it in their localities to be more than limited to short term individual projects and we have helped to introduce more people to the evidence and thinking that is driving this evolution, taking it from theory to practice.
Essentially, when you boil it down, we practised what we preached and identified that if we wanted people to be safer than they had to feel safer; if we wanted things to change, we had to do things differently; if we want to foster a just and learning culture, than we have to behave in a fair and humane manner.
What would I do differently?
We aimed to help people think and act differently about patient safety, and over the course of the years’ of work, we identified the need to stop, reconnect and listen to each other as a way to help people be heard and to foster a more positive approach to patient safety.
The results we saw show that we had a wide-ranging impact, and we influenced how people acted at a local level. This I wouldn’t change.
In terms of communications and engagement, like everyone in the NHS, we had to make some tough decisions in terms of what we would prioritise given what we could afford. This meant we had to shelve what would normally be a major focus for a campaign like this; a proactive self-focused media strategy. We did generate media coverage that generated a combined circulation of 28 million people, all of which included several key messages, but still, we had to do this with smart thinking rather than extensive resource.
Although not ideal, our other marketing tactics and word of mouth appeal helped us to gain incredible traction with involvement in some form from over 98% of the NHS in England anyway.
A lack of media presence may have resulted in us being somewhat under the radar for a campaign of this nature, but where we did focus our small resources made a difference. Qualitative feedback we have used throughout the campaign to shape what we do and what we say has shown that what we have said has mattered and been impactful. We simply did what we thought would work rather than what made us look good, and in this case, those were different things.
We had such a wealth of feedback from people across the campaign, often on a one to one basis or via events, as well as through formal surveys. If I could change anything, it would be to have made more use of these to increase the sense of impact and collective-ness amongst our members. We made story telling a major part of our approach however, and used personal experiences and blogs throughout the campaign. But next time I would revisit individual stories more frequently to see how people’s experiences evolved. Sadly though, mostly a one-off blog was all people could commit to despite desires to do more, due to other commitments and time restraints.
Something that I wouldn’t change but needs to be highlighted, is that this sort of emerging approach to a campaign – one that allows for learning as a campaign or project evolves – relies on flexible and short-term communications techniques. You can’t plan for the longer term. This has potentially made it harder to get cut through on messages – it makes sense that it is a lot easier if you focus on one set of never changing messages over a set period of time – but this forced us to keep things really simple and remain true to telling our own story transparently, with a lot of attention paid to how we can keep people with us as we evolved.
I’m sure that as time goes on, I will think of more and more things I could have done differently – that is the nature of a worrier *bah* – but I can honestly say that what we did do was done with integrity, self-reflection and a desire to learn.
About the author;
Cat Harrison is the communications and engagement director for the Sign up to Safety team, and has advised numerous FTSE100 companies as well as national charities and health-related organisations. Her expertise lies in the development of impactful campaigns, the role of language and behaviour in working safely, and how this links with just culture and staff wellbeing. You can tweet her @catharrison4 and read more about the team here.