How has implementing PSIRF strengthened culture – and what can others learn?

Spire Healthcare’s cultural journey through 2024 highlights how any healthcare organisation can leverage frameworks like PSIRF, coupled with supportive initiatives like Quality Improvement and Freedom to Speak Up, to drive meaningful change and create environments where safety, trust, compassion and collaboration thrive.

Change such as encouraging openness, breaking down silos, empowering colleagues, building trust, and embedding continuous learning are powerful and better for patients.

In 2024, Spire Healthcare took a bold step towards enhancing patient safety by implementing the Patient Safety Incident Response Framework (PSIRF) across its network of hospitals. This was a legal obligation for NHS patients in England, but Spire chose to implement for every patient – private and NHS – in England, Scotland and Wales. Developed by NHS England, PSIRF redefines how healthcare organisations approach patient safety incidents, shifting the focus from blame to system-wide learning and improvement. For Spire, this was not just a compliance exercise – it represented a cornerstone of cultural transformation, fostering openness, collaboration, and continuous improvement.

This work culminated in Spire being named as a finalist at the 2024 HSJ Patient Safety Awards, in the ‘Developing a Positive Safety Culture’ category. This recognised Spire’s dedication to embedding safety principles into our DNA.

Central to culture were two key enablers alongside PSIRF: a robust Quality Improvement (QI) strategy and the organisation’s commitment to the Freedom to Speak Up (FTSU) initiative, both of which were deeply integrated with PSIRF to support a positive cultural shift.

PSIRF: A new approach to patient safety

PSIRF represents a paradigm shift in healthcare. It moves away from blame-based responses to patient incidents, and emphasises:

• Proactive risk management, identifying potential safety issues before they occur
• Open, inclusive incident reviews involving patients, families, and staff
• System-wide learning to drive sustainable improvements

For Spire, implementing PSIRF meant rethinking longstanding practices, re-educating teams, and creating a culture where safety was seen as everyone’s responsibility. However, the success of this cultural transformation was amplified by the organisation’s ongoing commitment to Quality Improvement and Freedom to Speak Up, which bridged PSIRF’s principles with everyday practice.

The connection between PSIRF and Quality Improvement

Quality Improvement (QI) is an integral component of healthcare delivery, focusing on systematically improving processes to enhance outcomes for patients and staff. PSIRF and QI share the same goal: ensuring patients receive the safest, highest-quality care possible. At Spire, QI became the engine that translated PSIRF principles into actionable, measurable changes.

Embedding QI into PSIRF implementation

Embedding QI into PSIRF required a focus on three key areas: data-driven learning; staff-led improvement initiatives; and aligning strategic goals.

1. Data-Driven learning: Spire utilised QI methodologies such as Plan-Do-Study-Act (PDSA) cycles to analyse safety data and implement system-level changes. This approach allowed the organisation to test, refine, and scale solutions derived from incident reviews
2. Staff-led improvement initiatives: PSIRF encouraged multidisciplinary teams to take ownership of improvement projects. Spire supported staff with QI training, empowering them to drive meaningful changes that aligned with PSIRF’s focus on systemic learning. Interest in QI training has risen by 100% since PSIRF implementation
3. Aligning strategic goals: QI provided the framework to ensure that learning from PSIRF reviews was not siloed, but fed directly into broader clinical and operational goals, creating a seamless loop of continuous improvement

This integration of QI with PSIRF shifted the culture from reactive problem-solving to proactive improvement, ensuring that patient safety became embedded in everyday practice.

The role of Freedom to Speak Up in cultural transformation

The Freedom to Speak Up (FTSU) initiative played a vital role in supporting Spire’s implementation of PSIRF. FTSU Guardians are responsible for ensuring that staff feel safe and supported in raising concerns, a key enabler of the no-blame culture PSIRF seeks to foster.

Creating a psychologically safe environment

Creating a psychologically safe environment relied on three factors: encouraging openness; supporting staff well-being; and closing the feedback loop.

1. Encouraging openness: By reinforcing the importance of speaking up without fear of judgment or reprisal, FTSU Guardians at Spire helped to create a culture where staff felt confident reporting incidents and sharing insights. This openness was critical for PSIRF, which relies on honest reporting to identify systemic issues
2. Supporting staff wellbeing: FTSU Guardians provided emotional support to staff involved in incidents, addressing the ‘second victim phenomenon’ where a colleague experiences distress after an adverse patient event. This care helped sustain morale and ensured that staff felt valued and respected
3. Closing the feedback loop: FTSU created a bridge between staff concerns and organisational action. By feeding insights into PSIRF incident reviews and QI projects, Spire demonstrated that speaking up leads to tangible improvements, reinforcing trust across the organisation

The combination of FTSU and PSIRF sent a powerful message: every voice matters in creating a safer healthcare environment.

How Spire achieved a positive cultural shift

Spire’s integration of PSIRF, QI, and FTSU led to profound cultural changes that were recognised at the 2024 HSJ Awards. The organisation was named as a finalist in the ‘Developing a Positive Safety Culture’ category. 

Key achievements noted in the award submission included:

1. Breaking down silos: By linking incident reviews, improvement projects, and staff feedback, Spire created a unified approach to safety that involved clinical and non-clinical teams alike
2. Empowering Colleagues: Through QI training and FTSU initiatives, colleagues were equipped with the skills and confidence to identify problems, propose solutions, and take ownership of safety improvements
3. Building trust with patients: PSIRF’s focus on transparency and inclusion strengthened relationships with patients and their families, ensuring they felt heard and respected during incident reviews
4. Embedding continuous learning: Safety reviews became opportunities for growth rather than blame, fostering a culture of curiosity and resilience

A sustainable legacy of safety and improvement

The cultural impact of PSIRF, bolstered by Quality Improvement and Freedom to Speak Up, has left a lasting mark on Spire Healthcare. By aligning these initiatives, the organisation has not only met the technical requirements of PSIRF but also created a sustainable safety culture that prioritises compassion, collaboration, and learning. This can be replicated by other organisations, to benefit patients.

Looking Ahead

Spire’s journey is far from over. The organisation plans to:

• Expand QI training to all staff, ensuring continuous improvement remains central to its operations
• Enhance data-driven risk management using advanced analytics
• Further integrate patient and staff voices into safety planning and decision-making

As a leader in the independent healthcare sector, Spire is setting a powerful example for others to follow. The recognition as an HSJ finalist is a testament to the organisation’s dedication to creating safer systems for patients and staff alike. By uniting PSIRF with QI and FTSU, Spire Healthcare has demonstrated that cultural transformation is not just possible — it is essential for delivering exceptional care.

Written by Maryellen Dean
Group Director of Integrated Quality Governance, Spire Healthcare