Safety management systems

In October 2023, we published Safety management systems: an introduction for healthcare. This report provided an overview of how safety management systems (SMSs) operate in other industries, where SMSs are a regulatory requirement.

An SMS is a proactive approach to managing safety which sets out the necessary organisational structures and accountabilities to manage safety risks. It requires safety management to be integrated into an organisation’s day-to-day activities.

An SMS explainer video was produced to introduce the principles described in the report. We are now exploring the extent that these principles are used or could be used to inform safety management across the healthcare system.

Everyone working in healthcare has some measure of responsibility for patient safety. When an organisation is accountable for patient safety, they should ensure that systems and processes are in place to effectively manage safety. This includes healthcare providers and integrated care systems (ICSs).

ICSs bring together providers and commissioners of NHS services across a geographical area to plan care in order to meet the needs of people. An ICS aims to join up hospital and community-based services, physical and mental health, and health and social care to improve long-term outcomes and minimise inequalities. Many patient safety risks go beyond organisational boundaries and may not be managed effectively without a clear safety management process. Gaps in responsibility and accountability can have serious consequences for patient safety.

We will undertake two investigations that consider how safety management is coordinated and integrated across the healthcare system. This will be achieved by ensuring that the patient voice is represented and that challenges to safety management are understood by hearing from patients that may have been harmed.

Safety management systems: accountability beyond organisational boundaries

The first investigation will report on pathways of care for the health needs of patients that require multiple contacts across different healthcare settings and providers. Contacts with the healthcare system will be mapped with a detailed account of organisational patient safety accountabilities. We will explore recurring risks when patients receive care from multiple services, and we will consider vulnerable patients.

Safety management systems: involving NHS staff and patients

This investigation will begin on conclusion of the first investigation. We will consider how NHS staff and patients could be involved in any integrated SMS approach. We will gain a better understanding of the pressures and difficulties that NHS staff face when performing safety management activities within and across an ICS. This will help us determine if SMS principles could be used to improve safety management. Patients and their carers need to be able to voice safety concerns and this might require coordination across multiple healthcare providers to ensure that these concerns are acted upon.

We are keen to collect a diverse range of views that may contribute to identifying opportunities for the improvement of safety management. As part of the evidence collection, we intend to carry out interviews with NHS staff, patients, and carers. We will continue to speak to patient groups to determine methods of engaging with patients that encounter multiple organisations to address their healthcare needs.

Each investigation will produce an investigation report that may make safety recommendations or safety observations relating to the applicability of SMS principles to healthcare. The intended focus is on understanding what is needed to undertake effective safety management activities across organisational boundaries.