Quality and safety vs. operations? It doesn’t have to be an impossible relationship.

Every organisation with even a moderate longevity has seen it- the tension between operational demands and those of the quality and safety team. It can’t just be about numbers, can it?

Let’s look at the roles involved: An operational manager has KPIs to meet, occasions of service to deliver; metrics to be reported to the funder; providing evidence of value as well as ensuring enough overhead for the organisation; managing the human and other resources within their purview. The safety and/ or quality team has a different focus- ensuring organisational activities are safe and evidence based.

Different foci yes, but why is there so often conflict between the two? Conflict or occasionally the opposite- a lack of engagement where clinical staff are unfamiliar with their governing policies and even local procedure, leading to inconsistent care, incidents, injuries, and poor morale.
In some organisations, safety can be seen as a costly nuisance. However, the fact remains that safety is inextricably linked to quality and productivity. They are interdependent.

Is the agitating factor one of time? Time spent engaged with quality and safety tasks such as learning, reflecting, reporting hazards is time spent in activities that are not directly linked to production or service. Despite managers understanding that quality and safety activities are essential, it may seem like unproductive time spent. When reporting time comes does the temptation to focus specifically on production become too much?

Another potential factor in the potentially quarrelsome relationship is the question of whose job is it anyway? If there’s a quality and safety role operating within the organisation, isn’t it their responsibility to ‘do’ the quality and safety stuff and let operations get on with their daily business? Added to existing time pressures, this kind of organisational belief or culture has the potential to develop into one in which professional accountability can transform into unsafe practice as more time is lost to burn out and procrastination in psychologically unsafe working environments.

With a good clinical governance framework in place, an organisation can take a systematic approach to quality and safety, rather than adopting a reactive approach. Listening to service users and staff at all levels means that everyone has the same goal- and a specific role to play to deliver safe and quality health and social care.

It is key that when applying ‘everyday’ clinical leadership (Vance et al., 2019.) that the individuals working in the organisation understand their roles- and how they contribute to safety and quality. It is also important to have an overview of the roles of others. A common staff complaint in organisations is the lack of knowledge about what other departments or key roles do.

A healthy organisation doesn’t over burden staff with “risk mitigation” education and inductions that no one remembers a month later, but they share values and the belief that staff delivering clinical services cannot achieve good clinical governance alone- and neither can the executive team. They must work together. They must talk. And they must listen. To each other. Too often, ego can trip up even the best clinician or manager. Good organisational values and a secure framework for safety and quality will ensure that decisions are made consistently with less ego interference.

A framework is not a magic bullet, of course leadership from the CEO and executives is essential, but clinical governance should not be person dependent. With a framework in place, turnover will impact quality and safety less.

A quality and safety framework that offers value will support a clear understanding of roles and responsibilities between safety, quality, and operations. The key link being the client or patient experience. This effective framework should be owned and supported by the executive team.
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The framework should contain a commitment to an annual quality and safety plan that assists all personnel to understand both the financial and time commitment that underpins quality care. A good annual plan is collaborative and consultative and provides clear avenues for communicating about safety and quality problems.