I am delighted to introduce the special feature section on patient safety in this edition of Surgeons’ News. Since the College’s inception, our focus has been on education, training, assessment and the maintenance of high professional standards to ensure patients receive high-quality, safe care. Our Patient Safety Group, ably chaired by Anna Paisley, is at the heart of our core college activity, and the guidance and initiatives it leads on ensure we remain focused on ensuring patient safety across all aspects of surgical and dental care. 

To mark World Patient Safety Day the following series of articles highlights a number of these initiatives and activities. I am grateful for those who have provided contributions across a range of diagnostic, management and process endeavours. 

Globally, one in 10 patients experience harm from healthcare, with 12% resulting in permanent harm or death and 50% of those outcomes thought to be preventable. Patients most at risk live in low and middle-income countries and come from more vulnerable groups such as ethnic minorities, older patients and children. In addition, those at higher risk are patients being treated in highly specialised settings – ICU, emergency and surgery – and those managed in primary care. 

To raise awareness of these issues, the World Health Organization (WHO) developed three patient safety challenges: 2005 Clean Care is Safer Care; 2008 Safe Surgery Saves Lives; and 2017 Medication Without Harm. The Safe Surgery Saves Lives campaign included the use of surgical safety checklists to improve perioperative safety.

In 2019, the WHO introduced World Patient Safety Day (WPSD), to be observed each year on 17 September. The slogan for the inaugural WPSD was ‘Speak up for safety’. The overall objectives of the awareness day are to enhance global understanding of patient safety, increase public engagement in the safety of healthcare and promote global actions to enhance patient safety and reduce patient harm. 

The origin of WPSD is grounded in the fundamental principle of medicine: ‘First, do no harm.’ The involvement of senior leadership at all levels is seen as essential to recognise the importance of patient safety in healthcare and improvement. WPSD continues to gain momentum year on year, and has attracted global promotion through media campaigns, stakeholder engagement, publications, symposia, awards, films, art events and pledges. Safety is promoted with the vibrant colour of orange, with a call for national monuments to be lit in orange. 

From 2019, WPSD has continued with a priority theme: 2020 Health Worker Safety; 2021 Safe Maternal and Newborn Care; 2022 Medication Safety; and 2023 Engaging Patients for Safety. 

During the Covid pandemic in 2020, the need to have ‘safe health workers, safe patients’ was highlighted as a necessity, as evidenced by many wellbeing campaigns. 

As a recognised area of harm, ‘Act now for safe and respectful childbirth’ was the slogan for 2021. Following the WHO’s third challenge with the aim of a 50% reduction in medication harm, ‘Medication without harm’ was the slogan for 2022. Last year, there was a call to ‘Elevate the voice of patients’ to be involved in their own care and help with the development and design of healthcare systems. In support of the 2023 WSPD theme, the WHO published the world’s first ever Patient Safety Charter, setting out 10 fundamental patients’ safety rights in healthcare.

The WHO has selected ‘Improving Diagnosis for Patient Safety’ as this year’s WPSD theme. It is recognised that 16% of preventable errors in healthcare are thought to be down to diagnostic error, with all adults experiencing this at least once in a lifetime. 

Diagnostic safety is key to understanding symptoms and accessing correct and timely treatment for patients. Diagnostic safety errors can occur following delays in diagnoses, incorrect diagnoses, missed diagnoses and failure to communicate diagnoses with other healthcare staff and patients. While knowledge and competence are essential for healthcare staff to deliver diagnoses to patients, non-technical skills including situational awareness, decision making, communication and teamwork and leadership are also essential. 

The Patient Safety Group at the College is delighted to share this feature in Surgeons’ News, with articles aimed at highlighting the importance of diagnostic safety for patients and clinicians, as well as areas of patient safety work in which the College has been involved.

The Royal College of Surgeons of Edinburgh continues to mark WPSD with the publication of blogs highlighting patient safety with the chosen priority themes. Last year, to ‘Elevate the voice of patients’, we published 14 blogs along with a number of talking heads – for this, we had a wide variety of contributors, including from our two patient safety representatives in the Patient Safety Group at the College.

How RCSEd is advancing patient safety

Upholding patient safety and ensuring the highest possible standards of patient care have been at the heart of the College’s activity since it was founded more than 500 years ago. The Patient Safety Group supports and coordinates all the College’s patient safety initiatives. We have a multidisciplinary membership drawn from all the faculties of the College, including representation from the wider surgical team and patients themselves.Over the years, the College has developed resources to help improve patient safety, as detailed below.

Supporting World Patient Safety Day 

The College is delighted to lend enthusiastic support to the sixth WPSD, highlighting this year’s theme of diagnostic safety. The College is running this special feature in Surgeons’ News, together with a series of blogs and talking heads on surgical and dental topics in this area.

Training Courses 

These include the highly successful NOTSS Programme, PINTS Course and DeNTS Course, which aim to educate the whole perioperative team in non-technical skills (teamwork, communication, situation awareness and leadership) that underpin safe operative surgery and dentistry. The innovative ICONS Workshop, developed with patients, provides training in sharing the complex decisions involved in informed consent.

The Addressing Conflict in Surgical Teams Course explores causes of conflict within the surgical workplace and discusses different strategies to address this, including how to have difficult conversations, the art of negotiation and how to approach a challenging situation.

The Team Based Quality Review Workshop provides advice for surgical and dental teams undertaking adverse event reviews. Support is provided on how to follow a system-based approach, capture multiple perspectives from the wider healthcare team as well as patients, maximise learning and, importantly, ensure a non-threatening atmosphere and blame-free culture.

The Helping Surgeons When Things Go Wrong Course explores the impact of mistakes on all those involved; looking at how best to support and prepare each other; and how we might appropriately respond to patients and their families in the aftermath. Making and living with mistakes is a core part of what it means to be a surgeon, yet it is seldom discussed.

Web-based Resources

These include the Surgical Ward Round Toolkit, which aims to reduce errors and improve safety.

Patient Safety Webinars 

This popular 10-part series features contributions from renowned experts in the patient safety arena, drawn from a wide range of disciplines.

Let’s Talk Surgery Patient Safety Podcasts 

The College’s patient safety podcast series allows in-depth personal discussion with patient safety experts on a range of subjects

Surgeons’ News Articles 

The Patient Safety Group has published many articles in Surgeons’ News, covering a broad range of topics, along with articles highlighting the work of NCEPOD and charity Patient Safety Learning.

MSc in Patient Safety and Clinical Human Factors 

We have worked with the University of Edinburgh as part of the Edinburgh Surgery Online Programme to develop an MSc in Patient Safety and Clinical Human Factors. This three-year part-time programme supports any graduate healthcare professional in using evidence-based tools to improve the safety of everyday healthcare systems.

National Campaigns

These include the very successful Lets Remove It campaign, running since 2017, to reduce bullying and undermining and its detrimental effect on patient safety. 

National Guidelines 

The College has developed several national guidelines to influence healthcare policy and improve the working environment, such as Improving the Working Environment for Safe Surgical Care and Improving Safety Out of Hours.

Patient and Carer Support 

The Patient Safety Group has developed high-quality, innovative and accessible resources to help patients and their carers better navigate surgical care and empower them to be advocates for their health.

Staff Resilience and Wellbeing 

We recognise that staff resilience and wellbeing is a key factor in helping ensure safe patient care, and this has been a major recent focus for the College. The College Trainees’ Committee has taken the lead and the Patient Safety Group have been proud to support them in this endeavour.

The Committee has run successful wellbeing weeks over the last four years. These raised the awareness of the importance of wellbeing among all members of the surgical team and included activities such as webinars, virtual workshops and sessions on cooking, mindfulness, yoga, art and how to make work fun. CPD points for the webinars in the series were provided, underlining the value the College places on this subject.

The College’s Moon and Back campaign, launched in 2021, encourages all members of the surgical team to take time out of their schedules to focus on mental health.

Please visit the College’s website and social media channels for more information. It is great to be able to share these resources with you during the WPSD campaign and help raise awareness of the importance of patient safety in everyday surgical and dental practice.