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Making health tech safe for patients
On World Patient Safety Day, Dr Mona Johnson, Deputy Clinical Director of Patient Safety at NHS Digital and a practicing GP, explains how NHS Digital systems and services keep people safe.

As a GP, working on patient safety at NHS Digital meant I needed to shift my mindset. I had to move from the relatively straightforward – though not always easy – task of thinking about the safety of the person in front of me in the consulting room, to thinking about all those patients, in front of GPs or other health and care providers, up and down the country, whose clinical care is facilitated by technology and ‘human systems’ (such as behaviour and culture) – and how these interact.

Dr Mona Johnson sitting in front of her computer in the GP practice where she works.

Clinical Safety is a practical specialism which looks at ensuring the design and implementation of health technologies meets safety standards (DCB0129 and DCB0160). I first met the processes that underpin DCB0160 when I worked at NHS Direct doing the implementation of NHS111.

Many of the clinicians here at NHS Digital came to know the safety standards by living and breathing them when working on similar implementations or change projects. Like them, I used these processes to build a system to capture and learn from patient safety concerns, known throughout the NHS as clinical governance. At the heart of every system of clinical governance is patient safety.

At NHS Digital, we have built our clinical governance system around clinical risk. This means that everyone – both clinical and non-clinical colleagues – can flag risks using robust internal processes that can be escalated all the way up to our chief medical officer, if necessary. We advise our non-clinical colleagues to also alert their clinical lead when raising a risk, as they might be able to help resolve it. Outputs on clinical risk are also reported to the NHS Digital board.

It’s not about getting to ‘no risk’. It’s about ensuring unnecessary risks are difficult to take – and when they are taken, it’s by deliberate choice.

The safety standards require that we deliver ‘safety by design’ so our products and services – and those we approve – are safe on purpose.

What do I mean by this? Well, imagine a mountain path. It may be easy to place a low fence to stop folks wandering over the edge. In some places the drop off at the side of the path may be especially steep. There, it may be necessary, not only to have a fence, but to place a sign or a detour.

We can easily understand that signage the whole length of the path is not necessary. Indeed: too many signs may mean we ignore them. Too many detours, and we miss the vantage points. Taking unnecessary risks to see the view or, take what appears to be a more direct route. We may follow the experienced mountaineer who has made a calculated risk to go off-piste, when we lack the equipment or expertise to traverse the crevasse safely.

Using this analogy, we can begin to understand more about the idea of safety by design. We are all too familiar with this sort of “alert fatigue” as we are faced with “Agree” many times per day just browsing the web. In a similar sort of way, alerts are most effective when they alert to the risk, and we can make a meaningful choice. It’s not about getting to ‘no risk’. It’s about ensuring unnecessary risks are difficult to take – and when they are taken, it’s by deliberate choice.

We are lucky at NHS Digital to have arguably the greatest concentration of clinical safety specialists in the country.

With these sorts of principles and safety standards in mind, each digital product and service is reviewed by our clinical safety officers, alongside specialist clinical safety engineers, at a weekly Clinical Safety Group meeting. This group grants the ‘Clinical Authority to Release’ before a product or service can go live.

We are lucky at NHS Digital to have arguably the greatest concentration of clinical safety specialists in the country. I’ve been able to share some of my experience with colleagues at NHSX as we have worked together to develop the Digital Clinical Safety Strategy for the NHS.

Although our clinicians and Clinical Safety team are experts on patient safety around health technology, it really is a team effort across the whole organisation. Together we are all helping staff keep patients safe in the wider NHS.


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Last edited: 17 September 2021 9:07 am