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Developing a culture of safety

Karen Rogers, Director, Herefordshire Care Homes

Safety in care homes has never been more in focus than it is now, due to the devastation caused by COVID-19.

The impact of the decision by the NHS to discharge over 20,000 people into care homes resulting in 1000’s of outbreaks and around 16,000 deaths is well documented. At the time, government guidance stated there was no need to test discharged patients because people infected with COVID-19  “can be safely cared for in a care home”.

Whether patients already infected with COVID-19 could be safely cared for in a care home was arguable but what was obvious was the greatly increased risk to the safety to other residents and staff who would be in such close proximity.

We were one of the services to have so far escaped the devastation of COVID-19 and there are, I believe, a number of reasons for this.

In early February as the death toll increased globally, we watched as the virus spread and devastated Spain and Italy, like others we witnessed what would happen if this virus entered our care homes.

We referred to the COVID-19  Hospital discharge guidance – produced by European centre for disease prevention (ECDP)  published 20TH  February – recommending that two negative tests were received before a patient could be discharged from hospital  into a care home. We adopted the principles of this guidance as our ‘admission policy’ and subsequently refused all admissions which failed to meet this criteria.

On 7TH March we took the difficult decision to close our doors to visitors, which I believe saved many lives.

I also believe that the investment in developing a strong safety culture over many years gave us a head start. This allowed us to swiftly integrate stricter safety measures rather than writing completely new practices. Inevitably this still brought challenges to the staff and mistakes were made but because we have developed a culture of support staff felt able to safely challenge their colleagues and seek the best practice to ensure we minimized the spread of infection in our care homes.

Safety culture in care homes isn’t fully understood, there isn’t a single agreed definition despite safety being one of the most important aspects of quality in health and social care organisations.

In trying to understand how safety incidents occur in care homes there are a number of important factors to explore:

  • Absent or inadequate safety cultures
  • Excessive blame which prevents recognition of error and also impedes learning and effective action to improve safety.
  • Understanding good standards of safety but also being alert to the possibility of error. To anticipate rather than respond.

Adverse incidents

The journey to developing a safety culture was a challenging but fascinating journey which included a number of important quality initiatives.

One of these quality improvement initiatives was the introduction of a system to identify trends from adverse incidents.

Quarterly monitoring and reporting

By introducing adverse incident reporting and sharing the findings with all staff a positive safety culture has developed over time with a shared understanding of the need to reduce the risk of harm to people and embed safety at the heart of everything we do.

These safety critical attitudes, beliefs and behaviors were embedded into a shared culture of understanding and expectations.

Producing a safety culture is a long term and continuous process, which has evolved over time.

No one predicted Covid-19 but as an organisation taking safety so seriously we were ready to face the challenge with open eyes.



Edel Harris





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