The STEP-up programme: Engaging all staff in patient safety

Abstract

We discuss how Aspen Healthcare measurably reduced patient harm by engaging staff in ‘STEP-up’, a programme to improve the culture of patient safety. This focused on helping staff to understand their role in the reduction of preventable harm. The organisation admits 45,000 inpatients and has 300,000 outpatient contacts per year. We describe how we worked with all our 1500 staff, across nine sites, during a 12-month period. We used a short film and a four-level programme of training and development, which included elements specifically aimed at sustaining cultural changes. The results have been substantial: 95% reduction in never events, 77% reduction in serious incidents, 38% fewer falls with harm and 19% fewer falls overall. We have seen a 24% increase in incident reporting, on a background of an 11% increase in activity. Overall, the number of incidents with harm has fallen by 5%. Staff perception of our organisation as ‘extremely’ or ‘very’ safe has increased from 73% to 77%. The financial cost of this has been modest and has, we estimate, been recouped in reduced cost of serious incidents. We make the case that a programme such as this is possible, at minimal cost, in any healthcare organisation. Given the results, we argue that all healthcare leaders have a duty to implement something similar.