How to improve the reliability of healthcare, from Sir David Dalton

“The average hospital in Europe will experience the same number of deaths from avoidable and unsafe events as a double decker bus full of passengers,”¹ said Sir David Dalton, ex NHS Trust Chief Executive Director, in his presentation on the reliability of healthcare and the challenges toward a holistic patient safety approach at the BD Multidisciplinary Advanced Course on Vascular Access (MACOVA) 2022 in Berlin. 

Sir David recounted his 18 years of experience in developing a quality improvement mindset at the Salford Royal Hospital and the key strategies that allowed his team to reach toward higher healthcare reliability to reduce patient harm. 

High reliability organisations in healthcare 

Sir David described that a high reliability organisation, both in and out of the healthcare sector, requires something unique. “Not just having a plan, but having a way of thinking and organising yourselves differently.”¹ 

One key characteristic of a high reliability organisation that Sir David noted is the shift of “old power” to “new power,” and it all starts by engaging with staff at a relational level. Old power, he said, was held by few and funnelled down into the staff, whereas new power was shared and fostered within the staff teams to empower their daily tasks.¹  

A traditional management position, he explained, was like throwing a stone: you could track the velocity and direction, and pinpoint where it would land. With this power, a manager could give clear goals, telling staff what to do and how to do it. 

However, healthcare is much more complex, and achieving reliability within the entire organisation was much more like throwing a bird. “You can start off by giving it direction, but you’re never really sure where that bird is going to land, and it therefore requires much more than having those clear goals of what improvement you need, how much and by when.”¹ 

Improving healthcare reliability at Salford Royal Hospital 

To demonstrate this reliability driven approach, Sir David gave an example: at Salford, they were seeing a high number of cardiac arrest calls outside of critical care areas, and the clinical staff were struggling to identify the early signs of deterioration in the health of their patients. 

The traditional approach to solving this, he said, would have been for upper management—himself, or his medical and nursing directors—to decide what should be done differently.  

However, in following the strategy of a high reliability organisation, he went directly to the nursing staff and asked, “What would you do differently? What is it that you really want to test to see how you can spot the signs of deterioration sooner than you are at the moment?”¹ 

The team presented a set of issues in areas that Sir David admitted he never would have thought about. They went on to test new strategies based on this staff feedback in different wards and areas of the hospital to unravel the challenges and find the best approach. 

“Change occurs when you connect with people, when you engage and involve them,” he said. “My job is to support them and test those ideas to see what works.”¹ 

The role of transparency in the reliability of healthcare 

Sir David proudly shared that in 2008, Salford was the first hospital in the United Kingdom to publish a quality improvement strategy with a clear aim and focus on reducing the level of harm that patients were experiencing. ¹ 

Highlighting the importance of openness and transparency, he explained that many organisations were hesitant to publish information about patient harm within their hospitals. “They’re wrong,” said Sir David. “Good, bad, indifferent—data is extremely powerful.” ¹ 

At every ward in the Salford Royal Hospital, Sir David and his team publicised their patient safety indicators to all visitors and staff, including the harmful events that occurred there that year and the number of staff on the floor compared to the number they planned to have. 

“It’s a signal to staff about what you attach importance to,” he said. “In order to have a learning culture, you’ve got to be able to persuade people that it’s important; that we want to know not only what goes well, but what doesn’t go so well.” ¹ 

Healthcare reliability depends on the multilevel engagement of the organisation, and for Sir David Dalton and the Salford Royal Hospital, it all starts with transparency, shared responsibility and teamwork.  

About BD MACOVA 2022 

BD MACOVA 2022 was held in Berlin on the 8-10th June and welcomed over 300 guests and 31 speakers from 35 countries.  

The event carries a rich history of engaging leaders in vascular access  to share their experience and insight into vascular access management (VAM) with those looking to expand the use of vascular access devices and services they provide in their hospitals.  

This year’s theme was to create a community of VAM-bassadors (Vascular Access Management Ambassadors) to help improve patient outcomes. 

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