Case study 4: Situational Awareness for Everyone (S.A.F.E.)
Global State of Patient Safety 2023
Country where the case study originated highlighted in red. Where relevant, additional countries where this programme has been implemented are highlighted in blue.
What is it?
Situation Awareness For Everyone (S.A.F.E) is a collaborative programme developed by the Royal College of Paediatrics and Child Health UK, enabling clinical teams to improve communication, build a safety culture and improve outcomes for children.
The concept behind the programme is that patient safety should be about managing risk, not simply about responding to incidents. S.A.F.E involves teaching clinical teams in a practical, jargon-free way, supporting them to understand what they do well, what needs to improve, and how they can measure the impact of changes they make.
The programme includes training on situation awareness, which means understanding their working environment, how it changes, and how to react in response to those changes. It also includes pre-planning of safety huddles (short, multi-disciplinary briefings) on wards, where teams are supported to ask questions based on the Safety Measurement and Monitoring Framework (see case study 3), such as how reliable is the care we are providing?
S.A.F.E has been implemented in over 50 teams in the UK, and in several countries including Australia, Argentina, Italy, and Ireland. It has also been implemented to varying degrees in Mozambique, Ethiopia and Sudan.
Why was it developed?
The S.A.F.E principles are designed to reduce avoidable harm and error to acutely unwell children, improve communication, close disparities in health outcomes and enable parents, children and young people to be better involved in their care.
Instead of making patient safety about academic and technical concepts, S.A.F.E is about empowering people on the frontline to be proactive about safety and incorporating this approach into their everyday work:
“Safety is a mindset. So, it’s not about technical things. It’s not doing root cause analysis. If people are in a situation, thinking about safety, so that’s what we’re teaching them.”
How can it be adopted?
When implementing S.A.F.E in resource poor settings, it is important to adapt the course to the time that people have available and to understand their context.
“[When implementing in other countries] Unless you’ve been to where they work and understand their constraints, then what you teach about patient safety is academic. You’ve got to go into the hospitals and understand where people work and see their lived conditions."
‘Train the trainer’ courses can support sustainability and create local leaders who can manage the ongoing implementation. It is important to have the lead consultant and nurse to attend the training to set an example, and then bring staff involved in all areas of patient care to the session.
"I think of patient safety learning and teaching like immunisation, by having a ‘booster’ every few months, so that people keep talking and thinking about safety all the time”.
How can the measurement of patient safety be improved?
It is important to not just measure outcomes, but also elements such as safety culture and leadership, and whether these elements improve over time. However, no single set of data can give a complete picture of the safety of a unit, and the challenge remains in how the data is used to implement the change that is needed:
“Well, we know what to do. But the big problem is we don’t know how to get people to do it.”
Key resources and contact details
Situation Awareness for Everyone (S.A.F.E) Online Training
Peter Lachman: peterlachman@RCPI.IE
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