Taking into Consideration Physical and Psychological Safety Both for Patients, Staff and Clinicians

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Sep 16, 2019
by Mirabelle Morah
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Taking into Consideration Physical and Psychological Safety Both for Patients, Staff and Clinicians

Charles Vincent, clinical psychologist explains the importance of measuring physical and psychological safety for patients and staff Charles Vincent giving a presentation at Salzburg Global Seminar

“Mostly, when we try to measure safety over time, you want to think: ‘How often has this hospital caused harm? Do they do things properly? Is care reliable?’ These are the sort of classical measures of safety and quality of care,” says Charles Vincent.

Vincent, director of Oxford Healthcare Improvement Center, UK, is a trained clinical psychologist and has carried out numerous researches on the causes of harm to patients as well as methods for improving safety across the health care system.

He has returned to Salzburg to take part in a new program, Moving Measurement into Action: Designing Global Principles for Measuring Patient Safety. He served on the faculty of another Salzburg Global Seminar program in 2001, Patient Safety and Medical Error. So, what does the picture look like 18 years later?

“All the time, things are changing in certain areas…” says Vincent. “So the safety challenges also keep changing, and this makes it quite difficult to think about… the question, ‘Is health care getting safer?’ overall is complicated because it's a moving target.”

Vincent is considered a leading figure in the patient safety field and has dedicated much of his working life to discover how to make health care safer.

In 2013, he authored a report with Susan Burnett and Jane Carthey on “The measurement and monitoring of safety.” The authors highlight five dimensions to be included in “any safety and monitoring approach in order to give a comprehensive and rounded picture of an organisation’s safety.” These dimensions include past harm, reliability, sensitivity to operations, anticipation and preparedness, and integration and learning.

One of the key questions for this year’s program in Salzburg is “What is the role of patients in measurement?” Vincent says, “I think patients can do lots of different things although, while I'm a patient, I don't want the burden of feeling I'm also responsible for the safety of the organization. I'd like the doctors and nurses to sort that out and not worry me about it.

“But I think it’s very important… if you’re redesigning a service, say you want to start changing how your outpatient clinic works, you’ll learn a lot from talking to patients and families about what the experience is like…”

Complicated care doesn’t take place just in hospitals and health clinics, however. It can also take place at home. Vincent believes this is a big challenge for patients and families which hasn’t been fully thought about. He says, “They have all the problems that doctors and nurses have, except they don’t have the training…”

Another key question global health leaders in Salzburg have been asking over the past few days is how organizations can measure psychological safety not only for patients but also for staff and clinicians.

With his expertise as a clinical psychologist, Vincent explains psychological safety can mean different things to different people, but one of the most important meanings in the context of this program is that staff and clinicians feel free to speak up about their problems or the problems of the organization when they can see that patients are being harmed.

“One of the characteristics of a hospital that you or I would want to go to is that staff would feel they could have an open conversation about problems they see. And the most dangerous organizations are the ones where everything is hidden, and you can't say anything… So psychological safety is something you have to have before you can really start measuring or doing anything much else because unless you have that openness and willingness to talk about problems, it's very hard to then act on them or do anything really...” Vincent says.

In addition to the psychological safety of staff and clinicians, participants have been asked to consider if there are potential measures for physical safety as well. Vincent says, “I think there are physical hazards that we can measure, like falls [and] back problems. For nurses, there is a lot of lifting people…

“Many doctors and nurses get very, very stressed, and fatigued by their work, and we don't really measure that. We just see people leaving and wonder why. So, potentially, there’s lots of things we could do along that line as well.”


The Salzburg Global Seminar program, Moving Measurement into Action: Designing Global Principles for Measuring Patient Safety, is part of the Health and Health Care Innovation multi-year series. The program is being held in partnership with the Institute for Healthcare Improvement. This program has been supported by the Gordon and Betty Moore Foundation.