17 September 2019

Patient safety is fundamental to the College’s commitment to excellence in the practice of pathology. This blog explores the work we do for members to help them improve safety and quality of the services and care they provide.

 

As the College’s Vice President for Professionalism and Clinical Director of Safety and Quality, we're proud of the College’s support for the World Health Organization’s World Patient Safety Day on 17 September.

Patient safety is fundamental to the College’s commitment to excellence in the practice of pathology. Our newly launched Patient Safety and Quality Strategy – developed by the Professionalism department – is a statement of our intent in this matter: it brings together a range of existing and new programmes. We’d like to take the opportunity to highlight the work the College is already undertaking that supports patient safety by developing and maintaining high standards in pathology education, training, research and practice.

Workload and workforce

For many, ensuring sufficient staffing, resource and investment in the service has to be part of the equation of patient safety. The College’s Workforce team gathers intelligence to highlight the challenges faced by the pathology workforce and advocates for more investment in staffing, including through our workforce surveys and reports. We also highlight the potential for transformational improvements in pathology services through the investment in digital developments and new technologies. Over the coming years, our patient safety team will work closely with our Workforce team to provide an accurate representation of the pressures on and risks in the system, as well as the importance of staff wellbeing for patient safety.

In addition to monitoring and drawing attention to the state of the pathology workforce, the College helps NHS organisations as well as other employing bodies (including universities, public health teams and the NHS Blood and Transplant Service) with recruitment to medical and scientific posts across all pathology specialties. We provide model job descriptions for all specialties, and also review and approve consultant level and specialty doctor (SAS) job descriptions – in 2018 we approved 473 job descriptions. Later in the recruitment process, we arrange for College-nominated assessors, who are members of the College, to attend interview panels known as advisory appointment committees. This helps to ensure that employers are able to appoint the right candidate. For the NHS, this process contributes to the statutory framework overseeing the appointment of consultants.

Clinical guidelines and recommendations

A range of our core publications support patient safety by promoting best practice in pathology. For example, our specialty-specific and cross-specialty best practice recommendations are systematically developed statements intended to support practitioners and patients to take the appropriate actions in specific clinical circumstances.

We also produce a range of information and guidance through a critically evaluated and robust NICE-accredited process, to ensure pathologists are fully equipped with the knowledge to provide the best standards of care for patients and their families. These include our autopsy guidelines, which are technical documents that aid practising pathologists carrying out coroners post mortems. Our cancer pathways and tissue datasets help pathologists consistently report more common cancers and define the range of acceptable practice in handling pathology specimens.

Members are invited to contribute to all of our clinical guidelines, cancer pathways, tissue datasets and best practice recommendations through our documents in development online consultation tool. The College also inputs into all NICE consultations on national guidance that are relevant to pathology. We seek expert advice from members to constructively inform the preparation of clinical guidelines, health technology appraisals, diagnostic technologies and quality standards.

Continuous improvement and CPD

CPD is a core part of all our members’ careers and supports patient safety. To create safer healthcare systems, healthcare staff need the skills and opportunities to continuously improve safety themselves. Another publication series – our patient safety bulletins – is designed to help members learn from incidents in other organisations in a quick and simple way. These bulletins can be used to support continuing professional development (CPD).

We are also compiling a wide range of resources to aid learning about patient safety and safety science. These will include our existing resource libraries on quality improvement (QI), A3 problem solving and audit. Members can earn CPD credits for reflective work using our resources as part of our CPD scheme, which provides a framework by which pathologists maintain their knowledge and skills. The College also approves online resources and national and international events for CPD credits.

Through access to an easy-to-use CPD portfolio system, members can store and catalogue CPD activities they’ve undertaken to improve and enhance their practice. The portfolio also works as a tool for appraisals and revalidation. We provide a similar online system for trainees: the Learning Environment for Pathology Trainees (LEPT) system. The College manages the continuous development, implementation and evaluation of workplace-based assessments for medical and clinical scientist trainees, which can be used to support the Annual Review of Competence Progression process. Both of these systems are powerful tools for professional development.

Mentoring is another powerful tool, both for professional and personal development. The College’s CQI Mentoring Scheme provides support to members seeking to develop their QI skills by completing a QI activity in their workplace. Through our CQI Awareness Month in May 2019, we provided further opportunities for learning from QI experts in pathology through webinars, podcasts and published articles. There will be similar opportunities to increase your understanding of patient safety tools and methodologies during safety awareness week in March 2020.

Supporting safety culture

In essence, safety culture is about people and how they work together – how their collective beliefs, attitudes and values shape their behaviours. To improve safety culture, there is a need to move towards approaches that recognise the complexity of the systems we work in, that healthcare is ‘high risk’ and that errors are inevitable. Sometimes, though, errors occur that may have been avoidable. In instances where employing organisations have concerns that errors may have been caused by poor performance, our performance review guides provide information and guidance to help consider the best course of action for investigation. We have guides for case note and duty of care reviews, as well as a guide on conducting an investigative audit.

Our invited reviews service can also assist healthcare organisations to evaluate a service or an individual's practice to discover whether problems exist and, if so, in which areas. Through the service, we support healthcare organisations to implement standards.

Alongside our services and guides, we are the lead royal college for medical examiners – a transformative part of the NHS safety system. We provide medical examiner training, information on setting up a medical examiner system and advice on how to become a medical examiner.

The future of patient safety in pathology

We have been gradually building our range of patient safety guidance and resources over the last few years. We have also worked hard to ensure patient safety is reflected in the latest examinations processes and curricula development. We set a high standard for postgraduate pathology qualifications: the Fellowship of the Royal College of Pathologists (FRCPath) is a mark of professional standing. Gaining fellowship of the College by examination is an indicator that a pathologist has achieved many of the competencies required for practice at consultant level, including an awareness and understanding of patient safety. At the other end of the training journey, our newly published undergraduate curriculum reflects the current state of practice in pathology and introduces patient safety to all aspiring doctors.

The College’s Patient Safety and Quality Strategy brings together all of the elements we've described here and sets our direction of travel for the next few years. We have a vision, though how we achieve it will need to adapt over time. We are keen to hear your thoughts on how pathologists and scientists can work together with the wider healthcare service (for example, how we do through the Choosing Wisely initiative) to maintain and improve patient safety and – ultimately – patient care.

If you have any thoughts or comments about patient safety, please get in touch with us at: professionalism@rcpath.org