In July 2021, NHS England rolled out the national Learn From Patient Safety Events (LFPSE) service — a centralised system that healthcare staff can use to record and access information related to patient safety events using the NHS database.
As an LFPSE-compliant vendor, we’re writing a series of blog posts to help healthcare professionals better understand this new incident recording system. You can check out our previous articles here:
#1 The Five W’s of LFPSE — The New Incident Reporting System in the UK.
#2 Lucie Mussett - LFPSE Project Lead at NHS England Breaks Down the New Incident Recording System
#3 5 Reasons Why You Need MEG's LFPSE-Compliant Incident Reporting System
This piece is yet another expert interview, this time with Marcos Manhaes, Head of Patient Safety Incident Reporting at NHS England.
Leading the transition from the NRLS to LFPSE, Marcos strongly advocates for transparency of patient safety data and systems interoperability across the NHS. He has over 30 years of experience in intelligence, data analysis, systems development, and assurance across private international organisations, public hospitals, and UK national public health bodies.
We had the opportunity to talk to him about the implementation of LFPSE within organisations, what providers must bear in mind during the transition from NRLS to the new incident recording system, and more. Here are some interesting insights from our conversation.
‘Improve learning’ is said to be a key objective of the LFPSE service. What does this look like and how will it be achieved?
Our focus with the LFPSE service is to improve the quality of patient safety data and give providers better access to that information.
Given that one of the dimensions of data quality is timeliness, LFPSE will provide organisations access to real-time data relevant to the current situations and contexts, such as staffing shortages or a flu crisis, rather than old information that was, for instance, recorded over six months ago.
LFPSE will also allow healthcare providers to go back and update their existing incident records, which wasn’t possible in the NRLS. And because all updates are real-time, it will be visible to all as the single version of the truth rather than multiple cuts of data extracted at different times.
To improve access to patient safety data, we’ve developed a Data Access application where providers can run queries and get customised reports. For instance, if an organisation is creating a new patient safety initiative and wants to gather evidence to support their work, they can use the app and get that information anytime. This also means organisations do not have to depend solely on the monthly, quarterly, or annual reports from NHS England that may or may not give them the exact information they're looking for.
"Learning to minimise the potential for things to go wrong and maximising the potential for things to go right is key."
Incident reporting systems are often criticised because they emphasise learning from errors or things that went wrong and overlook the things that went right. But there has to be a balance — learning to minimise the potential for things to go wrong and maximising the potential for things to go right is key.
And that's what the Good Care dataset in LFPSE is designed to do. Healthcare workers can share good practices within their organisation that are creating a positive impact; others can access that data and learn from it. At the end of the day, we hope that all these different features will support learning.
How are the technological advancements in the LFPSE service beneficial to healthcare providers?
Because the NRLS is a legacy system built over 20 years ago, it doesn't provide the features or the user experience that today's modern software is capable of. And so, we needed a better, updated incident recording system — one that's cloud-based, considers the user journey, and is easy to maintain. That's why we created the LFPSE service.
In terms of technology, Machine Learning is something we're quite excited about. Though it's early days, we can already see positive results from using it to monitor the data. Because our analytical and clinical capacity in terms of reviewing incidents is limited, being supported by automated processes allows us to identify new risks, address them, and gather valuable data that healthcare providers can then access.
And there's really no limit regarding numbers because we can process millions of records or the entire database in just a few minutes —something that's impossible to do manually. We're also training the machine to learn from the feedback and experience of the clinical team when they evaluate incidents, about which records are interesting, relevant, new, or unusual. This allows us to identify and filter out incidents we could have otherwise missed, simply because of the sheer volume.
Another tech improvement we're working on is making suggestions to the user through the system. For instance, when a healthcare worker reports an incident related to medication management, we can provide feedback, suggestions, or resources such as national guides to help them navigate that situation. We can also perform sentiment analysis to identify the emotional state behind the description of an incident and support them accordingly. For example, if they're upset about the incident, we could direct them toward resources to support their well-being.
This new system has great potential, and we're excited about what's to come.
What are some common concerns that healthcare providers have about LFPSE and what are your thoughts on them?
We've received a lot of feedback from healthcare staff, which is desired and expected when launching a new system or implementing a change. And so, it's very important for us to observe and listen to how people feel about the switch from NRLS to LFPSE and what they need in terms of support from us.
For instance, some providers want access to real-time data but don't want to make real-time submissions. So, it's a trade-off between the convenience of making submissions at a later date and the necessity of real-time data to evaluate patient safety, for example, during events like a nursing or ambulance strike. Having access to that data in real-time helps us deal with emerging issues as they are developing, as well as be better prepared for another such event in the future.
In situations like these, it's all about having open and honest conversations with providers, understanding their needs, challenges and constraints, reassuring them about how raised issues will be mitigated, and describing the benefits and possible risks of not having real-time data, i.e., the inability to respond quickly to emerging issues or the potential for patient harm.
"It's all about having open and honest conversations with providers, understanding their needs, challenges and constraints and reassuring them about how raised issues will be mitigated."
Similarly, another concern is underreporting. One of the main reasons staff don't report incidents is the fear of being penalised for speaking up. The other issue is the lack of feedback. People report incidents and don't hear anything back. We're trying to address these points as part of the wider patient safety strategy.
And then there is a third reason: the time taken to report an incident. This is linked to the user journey and user experience. To address this issue, providers need to work with their local risk-management system vendor and advocate for modernisation and user-centric design. By providing feedback to their existing LRMS partner and advocating for changes to user interfaces or data entry processes, they can optimise their incident recording system and increase efficiency.
That's one of the reasons why we've extended the LFPSE deadline from March 2023 to September 2023. We hope that healthcare organisations make the most of this time to iron out issues and push for their LRMS vendor to do better in terms of interface and user experience. I suggest providers look at different apps, not necessarily risk management applications but any app they like, and get some ideas about new features and user experience.
What can LRMS vendors do to help healthcare organisations implement LFPSE?
As a vendor, it's crucial to have an open dialogue with the customer and focus on delivering a system that prioritises user experience; work with the organisation on the best way to implement LFPSE within their local risk management system.
It's also important for vendors to not think of LFPSE implementation as a one-off project but an iterative one where customer feedback is continuously taken and implemented optimally, improving the entire incident reporting process.
So it's all about doing that user research and continually liaising with your customers to not just help with the transition to LFPSE but also provide a better interface and experience at the end of the day.
In addition, do not hesitate to contact me to discuss some ideas and new ways to make LFPSE integration easier and user experience better.
What can healthcare organisations do to help with LFPSE implementation?
The first step is to accept the change from NRLS to LFPSE. Like I said earlier, we simply cannot continue running on 20-year-old software. It's expensive and requires a lot of manual maintenance. The best thing to do is work with us in the national team to make this as simple and easy as possible for everybody.
We are reliant on people telling us how we can change things to make 'X', 'Y', and 'Z' work. This engagement with the end user is crucial for the delivery of a better system.
Communication is also key. We've put together many resources like screensavers and posters that organisations can use to tell their staff about the change. Additional resources are available on our website and the NHS Futures platform in the form of videos and guides. We're also offering sessions for people who want to know more about LFPSE or have questions about the new system. You can sign up for these sessions on the NHS England website and FutureNHS collaboration platform.
Alternatively, our contact details are also listed on the NHS England website. If you have any questions or need support, we are a very small team but we're all hands on deck!