System Safety

About the programme

The programme aims to create optimal conditions for patient safety and quality improvement by supporting the implementation of the Patient Safety Incident Response Framework (PSIRF) in healthcare settings serving NHS patients in England.

The PSIRF is a key part of the NHS Patient Safety strategy which was approved by the NHS England board in 2019. The PSIRF supports the overarching strategic aim of helping the NHS to improve its understanding of safety by drawing insight from patient safety incidents.

PSIRF aims to support significant improvement by introducing several changes as part of four overarching aims:

  • Compassionate engagement and involvement of those affected by patient safety incidents.
  • Application of a range of system-based approaches to learning from patient safety incidents.
  • Considered and proportionate responses to patient safety incidents.
  • Supportive oversight focused on strengthening response system functioning and improvement.

Who we are working with

We have a dynamic learning community from across Yorkshire and the Humber. Its members are from NHS, non-NHS healthcare providers and ICSs and hold a variety of roles including Patient Safety specialists, clinicians from across the multi-disciplinary team and senior leaders.

We also work with a group of Patient Safety partners, facilitating peer to peer work and support.

Main deliverables

We will continue to:

  • Maintain effective partnerships and communication between key stakeholders to embed PSIRF in line with the national guidance. This includes effective stakeholder engagement between ICS Quality and Safety leads, provider Quality Improvement (QI) leads, Patient Safety specialists, Patient Safety partners, as well as with Coroners, Care Quality Commission, regulatory bodies and other relevant individuals and organisations while implementing PSIRF.
  • Support ICSs and providers to create a sustained link between patient safety, quality improvement and organisational development to meet the PSIRF objectives.
  • Ensure a system wide focus while implementing PSIRF:

– across pathways of care (primary/community/acute)

– across systems (health, social and care services)

– across different provider types (hospitals/ambulance/community/independent sector).

  • Support providers to develop robust patient safety incident response plans focussing on developing sound improvement priorities and how insight from safety events can be used to inform improvement both reactively and proactively.
  • Support organisations to embed a culture of continuous monitoring (of progress and impact of PSIRF) and improvement.
  • Offer support, where necessary, to some services that may require additional guidance and access to wider networks to transition to PSIRF, e.g. supporting maternity services, independent and mental health providers.

How to get involved

Please contact:
Mel Johnson, Patient Safety Collaborative Programme Manager and System Safety Workstream lead.