Objectives & Background The NHS safety culture predominantly focuses on negative events with staff being encouraged to report incidents via online tools such as IR1 or Datix. Obligations in relation to a formal duty of candour further perpetuate a culture based around reporting negative outcomes. While it is vital to learn from errors in healthcare having this as the sole focus results in unintended consequences that positive performance is not recognised and transfer of good practice is delayed.
Methods In February 2016 after becoming aware of the Birmingham Children's Hospital's “Learning from Excellence” initiative we set up an online GREATix reporting tool at Leicester Royal Infirmary. Any staff member can submit an online nomination if they observe excellent practice from another member of staff or team. The nomination is then reviewed and direct feedback sent to the individual. In addition GREATix themes or valuable learning examples are discussed at our monthly Critically Careful Forum (a multidisciplinary education and governance meeting.) We describe the results and learning from this initiative between 10th February and 30th June 2016.
Results Initially commenced as a pilot for the Paediatric Emergency Department with minimal publicity we observed a ‘ripple’ effect as nominations spread throughout the wider hospital, and even further afield.
Cascading of interventions that improve patient care, such as use of a hip spica in undisplaced femoral fractures, is an example of the clinical impact the initiative is having. Staff members of all professional backgrounds and multiple specialities have commented on its positive effects and several other centres have contacted us keen to develop a similar system of their own. The ripple effect of GREATix nominations and themes reported are displayed.
Conclusion A positive reporting system may produce benefits in patient safety without creating a potentially toxic reporting system. While GREATix is not a substitute for incident reporting it adds value in a system that is frequently under-resourced. The real benefits on moral and culture still have yet to be realised but it shows real promise as an improvement tool.⇓
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