On the 21^st November 2024, the NIHR Yorkshire and Humber Patient Safety Research Collaboration (YH PSRC) hosted the second PSRC cross-centre workshop of the NIHR SafetyNet Organisational Culture Working Group. Representatives from the NIHR Greater Manchester, Midlands and Yorkshire and Humber PSRCs attended the event. It served as a productive platform for strengthening relationships established at the first workshop, where this working group focused on ‘organisational patient safety culture’ was initially formed.

Participants included research staff from relevant ‘safety culture’ themes of work including PhD students and lay leaders, as well as PSRC affiliates and core staff such as those working in Programme Management and Community Involvement and Engagement.

The workshop was co-chaired by Professor Jane O’Hara from the YH PSRC and Professor Natalie Armstrong from the GM PSRC. Jane opened the event by welcoming delegates and identifying the objectives of the workshop, which included reflecting on the first workshop, sharing learning about conducting research in this area, mapping relevant planned research across the PSRCs in years 3-5, identify opportunities for collaboration, and agreeing next steps for the group.

Keynote

Professor Carl Macrae, NIHR Yorkshire and Humber Patient Safety Research Collaboration (YH PSRC)

Professor Carl Macrae from YH PSRC gave an opening talk titled; ‘Organising safety: cultures, systems, structures or practices?’. He introduced the concept of safety culture and how it’s rooted in scholarly work including that within the field of patient safety – published some decades ago. He described how it’s perhaps sometimes an unhelpful phrase that means both everything, and nothing at the same time, and how the reams of literature about ‘measuring’ safety culture, isn’t necessarily useful to move forward and improve. An alternative way of thinking about safety culture is to understand what sits beneath it, and how infrastructure, systems and processes can be organised most effectively to ‘build’ a culture in which interventions thrive. In his paper titled ‘Learning from the Failure of Autonomous and Intelligent Systems: Accidents, Safety, and Sociotechnical Sources of Risk’, Carl developed a conceptual framework that characterises key sociotechnical sources of risk in autonomous and intelligent systems (AIS) by reanalysing one of the most publicly reported failures to date – the 2018 fatal crash of Uber’s self-driving car. Five fundamental domains of sociotechnical risk relevant to management safety more generally were conceptualised—structural, organizational, technological, epistemic, and cultural—each indicated by particular patterns of sociotechnical failure.

SOTEC framework

The resulting SOTEC framework of sociotechnical risk in AIS extends existing theories of risk in complex systems and highlights important practical and theoretical implications for managing risk and developing infrastructures of learning in healthcare. Carl concluded the opening keynote by proposing some opportunities for the future safety culture research, which included language of safety, systematic analysis, safety management systems, structure for culture, sharing knowledge, and patient journeys.

Future work

Following the opening keynote, the group were excited to learn more from Dr Justin Aunger about current and planned work being undertaken by the NIHR Midlands PSRC with a focus on organisational patient safety culture. This was followed by Professor Natalie Armstrong and Dr Lauren Ramsey sharing an overview of future planned work for their respective PSRC’s.

Group mapping exercise

To unpack the planned work in more detail and to identify areas of common interest, any gaps and opportunities for collaboration across the PSRC’s in years 3-5, a group mapping exercise took place. Firstly, each PSRC populated a flipchart with brief descriptions of their projects (e.g. project stage, topic, stakeholders interested in working with, clinical speciality, the level of the system the work will be focussed on, and methods). Discussion within PSRC’s provided an opportunity to reflect on plans and ensure work was captured from all attendees perspectives, including lay leaders and PHD students.

The second part of the mapping exercise involved members of each PSRC mixing into groups to identify where work overlapped and discuss potential collaboration opportunities. To facilitate feedback from the mapping exercise participants were asked to complete questions posed on Mentimeter, summarised below:

What did attendees learn from doing the mapping exercise?

There is a shared purpose and huge scope of the collective work with lots of cross over between the PSRCs. Themes included maternity safety and theoretical approaches.

Are there any potential opportunities for collaboration?

Yes. For example – methods, topics, sources of risk, and projects working a similar levels of the system. It is important to add value to the collective work in a similar area by taking a higher-level view of what has been learned.

What might the challenges be with collaborating with other PSRCs?

Collaboration is an additional logistic workload requiring funding, resource and a supporting infrastructure outside of goodwill (e.g. Data sharing agreements between PSRCs), but it would be worth it for deeper more transferable findings. Time to continue to reflect and collaborate in ways that are meaningful and add value are also important.

How will any potential challenges with collaborating with other PSRCs be overcome?

Making contact following this workshop, arranging more face-to-face meetings and formalising collaborative efforts (e.g. joint bid applications). Given a common focus being on maternity services, it would also be useful to set up a maternity safety group.

Big questions for safety culture

The final part of the afternoon focused on two questions; ‘What are the big questions in safety culture research that we are better tackling together?’ and ‘What are the gaps in our collective safety culture research?’. Following roundtable discussion and feedback, Carl facilitated a whole group discussion.

Discussion focussed on opportunities to ask bigger questions about safety culture at a population level, raising the question about possibilities to harness collective PSRC data sets across to collaboratively to ask questions of big data. For example, is it safer to be pregnant in Leeds or Manchester and is it safer to be poorer in Leicester or Birmingham? However, the group discussed challenges of data sharing which need to be addressed to enable collaborative work – especially complex when considering questions such as these. The group felt that ideas could be generated and taken forward as a SafetyNet as a whole, rather than individual special interest groups trying to tackle this alone, such as this one specific to ‘safety culture’.

Opportunities to collaborate

The group also discussed how working collaboratively could produce findings greater than the sum of their parts, addressing frequently posed criticism of the generalisability of qualitative research. For example, there may be opportunities for collaboration to draw out broader conclusions across all maternity safety projects to influence the healthcare system.

It was identified that across the collective work there were missing voices from groups of staff such as porters and cleaners, and the group felt that the patient and carer perspective could be more front and centre in aspects of the work. It was also identified that the role of Integrated Care Boards (ICB’s) needs more consideration in relation to where they sit and the contribution they make, as well as how the work of the PSRC’s in patient safety organisational culture fits in with the wider picture of impact within safety improvement.  This raised a broader question of ‘Whose culture are we talking about?’.

Next steps

Jane brought the workshop to a close, pulling together some of the key reflections from the day. Building on this, YH PSRC will collate information gathered at the workshop and create a physical map of work to share amongst attendees. This can then form the basis of future conversations. Given the buzz in the room on the day, and the keenness to collaborate on future plans, we hope to continue regular SafetyNet meetings and explore specific ideas to share learning and build collaborations.

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