Patient safety from executive hospital management to wards: a qualitative study identifying factors influencing implementation

Aim: To examine the journey of safety initiatives from executive hospital management to ward.

Background: Hospital management teams are often responsible for identifying safety priorities and ensuring delivery of these.

Method: Naturalistic study design within a large NHS Hospital Trust. Using semi‐structured interviews, focus groups and secondary data analysis, the study examines the implementation of safety initiatives.

Results: While hospital management developed five safety initiatives, only one of these (falls prevention) was actually seen to permeate all layers of the organisation. Other initiatives stopped one layer down. Both middle management and ward staff added to the list of initiatives developed, resulting in 16 priorities. A range of positive and negative influences to successful implementation are identified.

Conclusions: Safety initiatives need positive reinforcement at all levels to be addressed appropriately. The research suggests that a model related to improvement science may prove useful in ensuring that priorities are addressed.

Implications for nursing management: Care should be taken to ensure that safety initiatives are successfully implemented at all levels within an organisation. Identifying priorities with staff and sharing values and priorities are a key approach to leading such initiatives.