Biography

 I trained as a clinical psychologist and worked in the British NHS for several years. Since 1985 I have focused on conducting research on the causes of harm to patients, the consequences for patients and staff and methods of improving the safety of healthcare. I established the Clinical Risk Unit at the Department of Psychology, University College London where I was Professor of Psychology.  In 2002 I moved to become Professor of Clinical Safety Research in the Department of Surgery and Cancer at Imperial College in 2002.  From 1999 to 2003 I was a Commissioner on the UK Commission for Health Improvement.  I have acted as an advisor on patient safety in many inquiries and committees including the Bristol Inquiry, the Parliamentary Health Select Committee, the Francis Inquiry and the Berwick Review. From 2007 to 2013 I was the Director of the National Institute of Health Research Centre for Patient Safety & Service Quality at Imperial College. I moved to the Department of Experimental Psychology in January 2014 with the support of the Health Foundation to continue my work on safety in healthcare.

 Research Summary

My research is concerned with understanding how healthcare can become safer.  While healthcare brings huge benefits errors are frequent and many patients come to some harm during their care. This area of work is now usually described as ‘patient safety’. Much of my early research was aimed at understanding why things go wrong in healthcare and developing methods of analysing the problems that occur.  We also found that about 10% of patients in British hospitals suffer some kind of harm during their care, about half of which is preventable.  All other healthcare systems have similar problems not just the NHS. My colleagues and I have also studied teamwork in the operating theatre and in other contexts as good teamwork is essential to safe, high quality care. We have developed methods of measuring teamwork and training programmes using simulation to enhance teamwork skills.  I also have a longstanding concern about the effect of errors on both patients and staff.  Patients can suffer a variety of psychological problems after medical error in addition to any physical effects.  The impact on staff is also considerable. For instance surgeons may suffer great anguish when they feel responsible for the death of injury of a patient.

My current work focuses on three main areas:

The benefits and risks of healthcare in the home. Healthcare is increasingly being provided in the home but this can pose considerable challenges as patients and families have to carry out complex clinical tasks which were previously only carried out by professionals. We are developing methods of providing training and support to parents caring for children with complex illnesses.

Managing risk under pressure.  Healthcare staff work under considerable pressure in many settings which poses considerable risks to patients and to the staff who care for them.  Clinical staff are trained to manage clinical emergencies but there is little guidance or preparation for managing whole units or departments. We are studying and developing the strategies that healthcare staff use to maintain productivity and safety when under pressure.

Safety in low resource healthcare settings.   Improving the safety of healthcare in countries with lower resources can potentially provide huge benefits for patients and reduce the burden on staff of working highly pressured and stressful environments in which demand for care is always greater than the resources available.  I am working with colleagues in global health to develop ways of understanding the vulnerabilities of these healthcare systems and developing effective low cost interventions to protect patients and support staff.