Safety first! This common saying is especially applicable in the healthcare industry, where errors and mistakes can have dire consequences. For a health manager, patient safety is not merely a checklist of protocols but a leadership responsibility that defines the values, beliefs and behavioural norms of their facility. This article explores practical, evidence-based steps that leaders can initiate immediately to improve reporting, learning and teamwork.
South African health managers already need to stretch limited resources, with little room for the additional costs of medical negligence claims. Safety failures impose a heavy financial cost on the Department of Health that would otherwise go towards improved health delivery. Beyond the financial drain, these incidents erode public trust and divert essential funds from infrastructure and drug supplies.
Studies have linked leadership as being an important contributor to a successful patient safety programme. Effective management requires a shift from "command and control" to a collaborative style often termed "influence-ship", which relies on persuasion and evidence to reconcile professional aspirations with resource limitations.
One of the most immediate actions a manager can take is implementing structured leadership walk arounds. These are informal visits by the executive team to clinical units to engage in frank discussions with frontline staff about safety concerns.
Frequency: Conduct rounds at least once a week.
The Scribe: Use a designated scribe to document concerns and achievements.
The Feedback Loop: Ensure issues raised are addressed promptly, as failure to follow through leads staff to view the exercise as mere "visibility" rather than a genuine safety initiative.
Ineffective communication is a leading contributor to patient safety incidents. To mitigate this, managers should implement the SBAR (Situation, Background, Assessment, Recommendation) framework, a tool recommended by the World Health Organisation.
The SBAR tool was successfully trialled at Groote Schuur Hospital in Cape Town, where its implementation by neonatal nurses and doctors led to quicker care for acutely ill patients and increased junior staff's confidence when communicating across professional hierarchies.
A significant barrier to safety in South African facilities is a "blame culture", where fear of retribution drives 50% to 96% of medication errors underground. A Just Culture balances individual accountability with a system-level understanding of human fallibility.
Managers should categorise errors into three categories to determine the appropriate response:
Human Error: Unintentional lapses; managed through consultation and system redesign.
Risky Behaviour: A conscious "drift" toward shortcuts; managed through coaching and removing incentives for the behaviour.
Recklessness: Conscious disregard of substantial risk; managed through disciplinary action.
Safety huddles are 10-to-15-minute "stand-up" meetings held at the start of a workday or shift. Unlike formal meetings, huddles focus on the "action plan of the day", identifying high-risk patients or potential equipment failures before they result in harm.
Leading a cultural shift requires advanced management competencies. The Foundation for Professional Development (FPD) offers an Advanced Certificate in Health Management specifically designed for South African health professionals.
Relevant modules within this programme include:
Leadership: Fostering the emotional intelligence and ethical decision-making required for a Just Culture.
Strategic and Operational Management: Optimising processes and resource allocation to reduce the systemic roots of safety failures.
Action Research: Providing a structured approach to rapidly implementing and evaluating safety interventions within a specific ward or facility.
Health managers must align their safety initiatives with the Office of Health Standards Compliance (OHSC). The OHSC monitors safety through its Early Warning System (EWS), which tracks indicators such as procedure-related avoidable deaths and patient-harm incidents. Compliance with these standards is a prerequisite for facility certification.
Cultivating a positive patient safety culture is an ongoing journey of leadership commitment and organisational learning. By implementing practical tools such as walkarounds and SBAR, and by transitioning toward a non-punitive Just Culture, South African health managers can protect their patients, their staff, and the financial viability of their establishments.
The most effective way is to establish a Just Culture. When staff trust that they will not be punitively disciplined for unintentional human errors, they are more likely to disclose near misses. Managers should treat these reports as "free lessons" to improve the system rather than occasions for blame.
SBAR provides a structured language that bridges hierarchical gaps between nurses and doctors. Research at Groote Schuur Hospital showed that it reduced the time taken to relay key facts during emergencies and increased the accuracy of telephone referrals, leading to prompt clinical reviews.
Huddles are brief (10 to 15 minutes), informal and focused purely on the immediate "action plan of the day" to prevent harm. Standard meetings usually focus on broader administrative or process issues. Huddles are proactive, intended to identify risks before they happen during the upcoming shift.
Walkarounds should be kept informal and relatively short (under an hour). It is recommended to give clinical teams prior notice so they can prepare their safety concerns, and to use a structured format with only a few facility-specific questions to keep the discussion focused.
The OHSC uses an early warning system that monitors 11 specific risk indicators, including retained foreign objects after surgery and neonatal deaths. They triangulate data from routine inspections, media alerts and voluntary incident reports to identify facilities requiring urgent intervention.