Host: Rudi Hennessy
Guest: Liz Barfield, Retired NHS England Clinical Safety Officer

Rudi Hennessy: Hello and welcome to the latest episode of our Digital Clinical Safety Podcast, brought to you by NHS England. My name’s Rudi and I’ll be your host. For this podcast, we have the pleasure of welcoming Liz Barfield, who is a retired clinical safety officer, who has worked at NHS England for many years. She’s worked across several programmes and has a wealth of experience across the NHS. I shall leave Liz to introduce herself.

Liz Barfield: Hi, Rudi. So I am a nurse by background. My last clinical position was in ED. I’ve worked across clinical commissioning, clinical pathway, referral pathway design. I came into Connecting for Health as it was then, again by accident, because I had an interest in electronic referral, previously known as Choose and Book. And I joined the national team to be part of that work and, obviously being a clinician, led me into digital clinical safety, which up until that point, I hadn’t really heard about, if I’m honest.

So it’s been a learning journey of discovery. And having worked on various programmes as Rudi has said, it’s been really interesting. And I think every day, to quote a cliche, every day is a school day. There’s something new to learn every day, and especially in the world of digital clinical safety.

Rudi Hennessy: When I talk to people, when we go out and deliver training, you find that a lot of clinicians have kind of fallen into that role. And, you know, I know so many fantastic clinical colleagues that have gone to, you know, gone in the same kind of direction and just brought that wealth of clinical experience, you know, to hazard assessments and that clinical risk management process.

So, yeah, just in terms of your day to day role, then NHS England and as the clinical safety officer. If you could just tell us some of your main responsibilities and what that day to day kind of activities, responsibility looks like.

Liz Barfield: It’s difficult to give a typical day because there aren’t actually two days that are the same. And so obviously being part of a national team. Most of the work is still done remotely as various members of the team are actually in different locations in the country, and we don’t get together that often. So there are a number of meetings during the day to discuss developments. So as you’ve said, Rudi, working on the vaccination programme started with Covid vaccination.

But now that’s rolling out to other vaccines, obviously flu came on board. MMR, RSV is coming on this September. HPV, and where there’s more and more vaccinations coming through the national route. Whether the data, the data flows come through through the same data flows that were set up for Covid. Giving lots of benefit around vaccination history, etcetera.

So from an average day, there could be a variety of meetings with the different squads looking at the next set of developments coming along. You know, assessing if there will be any impact on citizens the way the service is being designed. Hazard assessments again, with multiple different elements that the data flows, the invitation, the cohorting and inviting of individuals.

The data flows. From recording the vaccination right through to it appearing in the citizen’s medical record. With the GP. So there’s lots of different elements. But actually there’s never really a typical day. Keeping up to date is part of that. As well. Policy changes, JCVI guidance that comes out. So lots of variety if I’m honest.

Rudi Hennessy: Yeah, a varied role. Definitely. I think from what you said, I’d like to just reiterate, and it’s really important for me as well, is that early clinical safety assessment, the early engagement of the clinical safety officer in the development lifecycle, if you can get it earlier than that, even better. Absolutely. The earliest, the possible.

Liz Barfield: So even when you’re talking about concept, almost this is what we would like to do in these we think of the benefits actually getting a clinician in right at the beginning. And that’s where we need to be so we can help with the design of the service. And I don’t mean the technical design, you know, thinking about the user who’s going to be using this, what care setting is it going to be used in?

How do those care settings operate? How is a community pharmacy different from a hospital or a vaccination hub? Just giving vaccinations as an example, even though it’s the same system, how will it be used? And that it has been interesting with different programmes as well. The referral being one of those is it’s a national system. But it was used or probably still is used slightly differently by different providers, by the GPs.

So even though it’s one national system, it doesn’t mean to say that the users are always using it as intended. And sometimes that’s the sort of things you’ve got to think about as a clinical safety officer. How would clinicians be using this system? And how does it fit into their needs, as well as making sure it’s safe?

Rudi Hennessy: And that no citizens will come to harm. Yeah, that’s really interesting, actually, what you say about the users. And often when we talk about hazard assessment workshops, we put a lot of emphasis on the importance of having somebody in that hazard assessment workshop who works in that care setting, who works in that world, for example, and what you said about user requirements.

You need to identify user requirements early on, but then you need your clinical safety requirements as well. You mentioned the referral service. So obviously I know that you were pivotal when it came to the referral service and a lot of those initial clinical risk management activities, would you be able to just give us a bit of insight into the work that you did?

Liz Barfield: Obviously, in that time, getting the referral service to the point you know, where it could go live and obviously the kind of bar you process and beyond. So started this Choose and Book. Was the original system. And we actually moved it or rebuilt it, I should say, to the referral service, which had the same functionality from day one, because with all of the users across the country and in the acute trust community trusts, the GP surgeries, the range of different providers to turn one system off and give them something completely different in itself would have caused quite a lot of critical safety issues.

So originally a referral service was built to look and have the same functionality on day one as when we turned Choose and Book off the referral service. So we were able to because it was different under the bonnet, so to speak. And you’ll probably guess I’m not techie. It was easier to build on it. And, you know, with the introduction of APIs, and actually enable users to integrate more with the systems that they were used to.

So we did a lot of work with users. We did a lot of work in organisations, how they could streamline the processes and get the most out of the system. Having the digital system was not just to replace a paper system, it was actually to improve and streamline the process. So from that respect, we did a lot of work with organisations both referring and provider organisations.

In those days, we were working in a waterfall. So we had several large releases, as opposed to the more agile approach there is now. So we were doing user guides, we were doing training, and all of that. The clinicians also had an input into, does it make sense? Will it make sense to clinicians?

Even sometimes coming up with an example for the clinicians to see on screen, that made sense, because it’s surprising how many times if you put something on front of a screen in front of a clinician, that doesn’t make clinical sense. They spend more time talking about the scenarios and what actually what they’re supposed to be doing. So just little snippets like that get the scenarios right.

And the clinicians will then see the system not be blinded by something that’s not clinically acceptable. So we did a lot of work with organisations, and I think probably one of the biggest challenges in a referral was the cultural change that was needed. This was a different way of doing things, not a way.

The clinicians had been used to doing previously. This was one of the first national systems. Not the first, but one of the first, and actually embedding it in organisations. Getting the GPs to use the system again as intended to get the benefits out of it, getting the providers to use the system as it was designed and intended.

So lots and lots of work was done with the organisations around the cultural change. As well as obvious improvements along the way to the IT system per se. That’s an awful lot of work and an awful lot of experience that I’m sure you gained from that. And what I glean from what you said is about that culture and adoption.

Obviously, you know, as an organisation, what we’re trying to do is have digital technology that improves patient care. But then from, you know, a CSCR perspective, there’s other considerations, isn’t there? As well as our clinical risk management activities and, you know, I think we’ve discussed in the past about changing behaviours. It is important when you’re doing something like this on this scale, especially.

Rudi Hennessy: Yes. Yeah. I think I’d just like to emphasise the importance of that cultural aspect within an organisation that’s developing that new technology. And I know I worked personally with yourself and Michelle Durham and of the clinical safety officer on the referral service and what I really loved, is that you both made sure that all the staff within the team, you know, development staff, projects staff, you know, analysts were all trained and had an understanding of basic digital clinical safety.

Liz Barfield: Yeah, I’m going to say, and I’m sure I will say this again at some point during this podcast. Clinical safety is a team sport. It’s not just about the CSO. And I’ve worked with some fantastic teams along the way. And they’ve been receptive and they understand the importance of obviously their systems being safe.

Nobody wants to develop an unsafe system. That’s never anyone’s intention. And everyone working together to make it as safe as possible. I think there’s a lot of reward for all of the team. But you’re absolutely right. A lot of work was done with education, and it becomes almost second nature. That the team think of digital clinical safety themselves.

They don’t need a CSO to do that. And they know when to bring things to the CSO. They know, and certainly in the vaccine programme and in the testing programme, exactly the same, you know, with some brilliant delivery and development teams and architects. Because I’m going to forget someone’s profession here and get into trouble. But it’s having, you know, everyone wants to develop a safe system, and I think that’s you just have to build on that.

Rudi Hennessy: Certainly, around the education as well. Yeah, I couldn’t agree more with that. You did briefly mention there as well about testing and something that I observed. You know, with the referral service as a team was that you and Michelle were quite heavily involved in supporting with those kind of clinical use cases, so that testing reflected some of the work you did in the hazard assessment workshops.

Liz Barfield: Yeah. I think you’re right. And that’s I said the example of it, even when we were doing user testing, make sure that the whatever you’re putting in is clinically sound. Otherwise you’ve lost the people that you know that they focus on something else and not actually what you’re asking them to test and again with the learning material, obviously with this, all of your training experience, you know, you make it relevant to the people who make it relevant to your audience, and take them along with you.

Don’t give them something that makes absolutely no sense. Because they just spend more time focusing on that. But yeah, it’s I think it’s that clinical involvement. So it’s clinical involvement. Right upfront. And again the CSO isn’t is not. And I stress that is not a tick box exercise at the end of the development process. On the delivery process.

It’s actually something that should be throughout. And believe me, if you get the clinicians involved earlier, it means that things hopefully will not be delayed at the other end if something is not actually safe or there are some concerns, because things will be held up until it’s put right. Because going back to that, everyone wants a safe system.

Rudi Hennessy: Yeah. Yeah. Echo, what you said there it’s so obvious if a clinical risk management process hasn’t been followed, and if it’s a tick box exercise, you might get a clinical safety case report. It might be a couple of pages. It might say there was a hazard assessment workshop but probably not going to have many people are names that were in the workshop.

It’s just you in a broom cupboard, you know, typing in an Excel spreadsheet, which doesn’t help anyone, doesn’t help patient safety from a holistic perspective. So I absolutely agree with that. I know you’ve worked on so many different programmes. Another one is the testing service. you’ve been front and centre for the clinical risk management activities for that.

It’d be really great just to hear some of your experiences, that you’ve got from the work you did within the testing service.

Liz Barfield: Yeah. So when we say testing, we’re talking about Covid 19 testing here. So, obviously 2020, February 2021, it became clear things were not going quite well out in the world. March 2020 I think we had our first lockdown, somewhere in March.

It was clear that e-referral service was not going to have as many referrals through it as it had done. So I offered my services and said, I think I have some capacity. Is there anything I can help with with the Covid response?

And on the 6th of April, 2020, I joined the Covid testing team. There were a few clinicians, again, relatively senior clinicians, digital informatics clinicians, I should say. We worked with the delivery partners to very, very rapidly put in a Covid testing service, which grew from obviously, the test sites and test centers.

It grew to home testing and lateral flows, PCR obviously, university testing, school testing and it goes on. You know, we were all involved in that. And there were days when you would sit and you would watch the 4:00 Prime Minister announcement and thinking, oh, tomorrow is going to be a long day. Knowing that we had to get something out the door as soon as possible and safely, as safely as we could.

But that is one of the programmes where I think it’s that, it might not be 100% where we would want it to be, but actually the risk of not having it was greater than the risk of implementing it. And that is the only programme, I can categorically say that I was front and centre.

You know, if we don’t deliver this, what’s the impact? And again, when you’re scoring your hazard assessment, you know, we were starting off with catastrophic, and there wasn’t any two ways about it. Many, many people could have died if the testing results were delivered wrongly. So it was challenging, but very interesting and very rewarding time working in the testing programme and a fantastic team.

Rudi Hennessy: Fantastic team. And I think, like you say, it’s not every day that you’re confronted with a task where you have to do a huge job. In terms of cost benefit analysis. We do talk about it, you know, on the training, around looking at what your position must be for, you know, your future state and doing that comparison if you do get a high risk rating, but the test and service, the Covid testing service is a one of the best examples I use because we’re just not faced with that every day.

When you’ve got to roll something out that you know it’s not fallen in kind of a desirable level of risk. But actually your level of risk that you’re moving to is an improved position.

The testing service. So you’ll have been involved from its kind of inception. Undertaking clinical safety case report, you know, hazard assessment workshops, you know, documenting the hazard loads and so on. And then at that point when, we no longer required the service, I’m assuming there is some sort of kind of closure exercise that was that was and one other thing as well, obviously, was incident management as well.

Liz Barfield: We worked with UKHSA, yeah. Around with their clinical expertise and public health expertise as well. When we were looking at incident management. So again, it wasn’t just digital. We looked, we worked wider with other clinicians as well. But yes, you do. You’re right. When it came to the end and again, this was actually a first in my career and some CSOs may never actually have an opportunity to do this.

I did the decommissioning safety case along with my other clinical team. But actually closing the whole of the programme down. So and there were many, many factors and of the testing programme out, you know, I’ve mentioned a few and it was a very complex system, that obviously was integrated in patient journeys.

But yes, we safely closed that down, the early part of this year. So, yes, whilst I didn’t write the first safety case, I was involved in the development of the first safety case work and then, I was the author of the decommissioning. So, like I said, often, if you’re decommissioning a system, you’re replacing it with something.

So you’re looking at you know, safely, safely transferring of data, etcetera. This we weren’t closing it no longer needed. We need to safely close it down.

And what other things were put in place, as well, for any individuals that did still need testing, when the national solution was no longer available. So, yeah, that was definitely a challenging and very, very interesting, and rewarding programme to work on.

Rudi Hennessy: Yeah. Like you say, it’s not often that you get the opportunity to be involved from start to finish. When I speak to people, clinical safety officers, you know, newly trained, newly into the role, sometimes decommission tenders come up and how did they manage that?

And what are some of the key things that they need to be aware of and need to document? So just with that, from your perspective, I’m assuming there were things in that safety case around, you know, the patient data, data migration and things like that. But there was no migration, was there, because you’re not moving to another service.

But what type of things would you expect to see in that decommissioning safety case.

Liz Barfield: So that there was the different elements of the journey that were closed down bit by bit. So each element that was closed down, were clinically assessed that it was safe to do so. How were we doing it? What information was going to be shown?

To a citizen, if they went into the system, what would they see? What information were they being given? So it’s not just the technical bits at the back, so to speak. And the data UKHSA still, they owned the programme, and they still had access, so, but making sure that the other people didn’t have access.

So the developers, how were these things going to be closed down safely and any data that remained was actually how was it going to be held? Where was it going to be held? Who was going to be able to access it?

And then the final approval came from UKHSA. They approved the final documentation, when the system was totally closed down. And I am a great believer in diagrams and pictorial representation and I have to say, I used a lot of diagrams, and as bits of the system were being closed down, just makes it easier for somebody reading it in the future.

You could see the diagram changing colours as different bits were closed down until we finally closed it to the citizens. I think it was February this year, February or March this year, which is almost four years to the day of being turned on. And I didn’t expect that when I offered, said I had capacity.

Just making sure you’re aware of when different elements need to be closed down. And for those clinical safety officers looking to, all for a decommissioning clinical safety case report, in general, that data and data migration, is obviously a consideration.

Rudi Hennessy: It’s a huge amount of work in that testing service. And yeah, I’m sure they benefited massively from your wealth of experience that you brought to that. Just talking about all the work you did in the testing service. That’s not the only other programme. So there’s also you’ve mentioned the VAX programme, the vaccination programme.

Liz Barfield: And in the safety assurance, for the VAX programme, the insights that you can share from the work that you did across that programme, is there anything that you can share with clinical safety officers and digital clinical safety staff find helpful?

I worked across vaccs and testing. So I split my time between the two programmes. So the vaccinations were live by this point. They’d got the systems up and running. We were working our way down through the population, with the national invitations.

And a lot’s happened since then. We’ve been through various Covid campaigns, spring and winter campaigns, for different individuals. So some of the work I’ve been doing more recently has been in the what they call select and invite. So working with the cohorting as a service clinicians to make sure that we’ve got the right individuals that we’re inviting.

And then the sending out the national invitations, and NHS England. Build our own invitation management system with the filtering and the magic happens of the people that are invited, based on a number of factors.

Have they already had a vaccine? When did they have their last vaccine? Are they eligible for a vaccine? Etc. So I’ve done a lot of work on that side. But the other clinicians in that programme, like I say, there’s the element of capturing the vaccine given, recording it and then following it.

And then there’s new elements and new parts of the system, the ecosystem that have been developed along the way. And that’s been interesting as well, because there’s working with a number of different developers, third party organisations, where they’ve supported the programme as well. So that’s been interested in, in itself. And as I said, we’ve now gone from Covid, we then introduced flu and more of the section seven vaccines have been introduced.

So again, that’s been a very interesting and challenging programme as well, because some very tight deadlines when a campaign is due to start and when the public are expecting to get their vaccinations, that’s really interesting because I was just going to ask, actually, as a clinical safety officer, when you’ve got something that is evolving so rapidly and you get in regular, specification, changes how do you manage that?

You know, obviously your priority is patient safety. And you’re always thinking, okay, we’ve got these changes that have come through. I need to assess these and ensure that this system, this piece of technology is safe for patients. How do you do that in that very agile way. So for us, the clinicians, whilst we had an overview of the whole programme, we would focus on a certain areas.

I said, I focus on the select and invite, even though obviously I could support my colleagues in other areas. We had frequent clinical meetings where we’d be discussing the end to end journey. We’re thinking about it from the citizens perspective. What’s it mean to them? How are they going to access this service?

How will the information end up in the right place at the other end? So for me, it was always about it’s always about the end to end and whilst some elements may be okay, actually what we’re doing in one area is that going to impact something further down the journey. So it’s having that almost, umbrella view of exactly what’s happening and that understanding of, as I said, that the journey through the systems, and the data flows, which I think is invaluable, really, so that one element is not impacting another element further down.

Rudi Hennessy: Down the chain. Yeah. It’s really as well about, as you said, the end to end patient journey. And it just shows how important that actually is because, you know, at the end of the day, it’s a patient that’s central to, you know, to this and to why we do what we do.

Also reminds me of how important it is to have, as you said, that multidisciplinary approach where you’ve got colleagues that are supporting you, running through those demos, when you can do that structured what if, approach to asking those questions during that walk through of the end-to-end patient journey? So just having that full team who understand the importance of walking clinicians and colleagues through that, you know, the spec changes that have come through.

Liz Barfield: And I think having more than one clinician as well, because sometimes we see things through a slightly different lens. So working with pharmacists, nurses, doctors, whatever their clinical background is, it’s actually having whilst you’ve got a multi disciplinary team. Also if you have more than one clinician, sometimes there’s something that another clinician will see that you haven’t.

I know that certainly. And in some provider organisations there isn’t always that luxury. But they don’t need to be a CSO. Just the fact that they’re a clinician. Clinicians are very good at saying they do what could go wrong. Just as part of their work. Really?

Rudi Hennessy: Definitely. I’m totally with you on that. And I work with a clinician she’s a GP, Belinda on the NHS due care tools and she says actually the same year the dean has an assessment workshop to have another clinician on there. Just because we all bring such different experiences, like you say, and look at things at a different angle. So I think what where you can have in having somebody else to give that kind of difference, that difference in view is really important.

So as if that’s not enough. All the work on the programmes the referral service, the testing service and the vaccination programme, you also did a master’s in patient safety. So, hats off to you for that one. Juggling that, alongside the day job. So with that, just in terms of some of the insights I’m interested to hear from you, about that and also, if there are any recommendations that came from that, I know that you did your dissertation on examining the legal framework for the implementation of digital technology, namely, DCB0160, so I know that will be really useful for those listen to the podcast to just hear a bit more about that.

Liz Barfield: There may be some people who are listening to the podcast that were kind enough to complete my survey and questionnaire and even were involved in some of the interviews that I did. So the dissertation, the research piece was on how relevant is the DCB 160 in the NHS today?

And I thoroughly enjoyed doing that piece of research. I hadn’t done anything like that for a very, very long time. And actually being able to talk to organisations, because a lot of the work I do, but not predominantly, is around the DCB 0129 and then NHS England, you know, with the manufacturing of systems, but actually the implementation and understanding some of the challenges, in provider organisations I found that very enlightening. And really enjoyed that piece of work. But the patient safety masters overall it was interesting because very little was obviously digitally focused. But as a clinician, it was enlightening. I enjoyed the learning. And there were a number of things that you could definitely bring back into the digital clinical safety arena.

And some of those I think that really stood out was the human factors and the behavioural insights work. If you put that into context of what we do as CSOs, you know, how’s this system going to be used? Who’s going to be using it and in what care setting? Is there anything in that care setting that could impact the way the system is used?

And many people will have seen that you know, having one terminal, computer terminal, I’m talking probably old money here. On a ward when lots of people got to access it. That just doesn’t work, so even though it’s the same system, how are we going to make this accessible to all of the staff, the clinicians, whoever it is, needs to access that system?

How do we so, you know, accessibility, like, you know, looking at the surroundings. So sometimes I think we forget about things like that in NHS England because we’re not the ones necessarily using the end product. So for me, I found that very enlightening. And enjoyed the work, even though it was hard work, with everything in-house that was going on just taken from what you said, around human factors, around adoption, and just practice realities, you know, within my role.

Rudi Hennessy: And obviously, I work in the same way as you around the assurance from the DCB 0129 perspective, but it’s always a huge learning opportunity for me when I deliver training, out there to staff who are working in health and social care organisations, because you really get to understand the importance of those human factors, how it actually has an impact on safety.

So just from your experience, are there any tips that you share with clinical safety officers and those working in digital clinical safety? Yeah. Just any takeaways and lessons that you’ve learned. That’s a great question, Rudi. I guess never stop asking questions.

Liz Barfield: And it doesn’t even need to be like in a hazard assessment setting. I’m forever asking, so what if, I might not phrase it like that every time, but actually understanding and getting people to and other people to understand why we’re asking these questions. And what’s the impact? And I as I said, nobody wants to build an unsafe system.

Nobody wants to deploy an unsafe system. So just getting people to stop and think, so the why, why are we doing this? What are the benefits? What will we achieve by doing this? What are the risks that we’re taking out for the citizens or patients? And how can we deliver this in the best and safest way?

That’s probably not one tip, is it? But I think just never stop asking questions. There’s always something more to understand. And always think of it from the patient or citizens perspective. What does it mean to them. What’s the impact on them? Yes, we obviously need to consider all the things, you know, IG, cyber, data, etc. but what’s the impact on the person?

And I guess that takes you right back round to a hazard assessment. Really. You know, we’re looking at the harm that could happen to an individual. And I guess just keep that in the forefront.

Rudi Hennessy: Yeah. I couldn’t agree more. Asking those important questions and multidisciplinary again comes into that, doesn’t it. And you mentioned hazard assessment. And just from your experience over all those different programmes, I couldn’t even guess how many hazard assessment workshops you’ve been part of, but are there any, you know, are there any tips? Is there anything that you feel in terms of a structure or a method that works best for hazard Assessment Workshop?

Liz Barfield: So with all your expertise in teaching, this is you know, all these answers really. But, for me, I would say the walk through is critical. You need someone to take you through from start to finish what the journey is and break it down into sections. There will be lots of discussion. Make sure you’ve got, where possible, the right people in the room.

You’ve already mentioned clinicians from the care setting. We’ve not always had that luxury. Where we’ve been working remote remotely. And again, developing the system in the DCB 0129, as opposed to the deployment, DCB0160. There are different viewpoints. But I guess try and get as many viewpoints as possible getting the right people in the room.

So you don’t do exactly, as you said, Sit in a broom cupboard with a spreadsheet, filling it in yourself, because that’s not helping anybody. There’s been some very interesting discussions ongoing. I wouldn’t say every time everyone agrees, and sometimes that’s the part of making sure you document the justification of why you might be scoring something the way you’re scoring it, whether that be high or low or so.

Rudi Hennessy: So making sure some you’ve got some justification. So if somebody comes back six months time and say why did you do this? This doesn’t make sense. You can see the justification, clinical justification. Why you’ve come to a decision, you’ve come to. I’ve found that in a hazard assessment workshops you don’t always agree all of the time there because as we’ve mentioned, we’ve all got different experiences, knowledge to bring to the table.

So it’s highly likely that someone might land on significant in terms of a severity, but. Yeah, just talking about and having a justification, especially with that, relationship between a manufacturer and a health, or social care organisation. You know, it might be that a manufacturer deems a certain hazard you know, the risk assessment is within an acceptable range. And the health and social care organisation, believes it’s a medium to high risk. That’s acceptable as long as you get the right people there, you know, you document everything. You’ve got that end to end care process. You can see the points that which you integrate with all the other systems. But yeah, my favourite hazard assessment workshops, I’ve got to say, are face to face. But that’s not to say that virtual doesn’t work, is it?

Liz Barfield: No. Agreed. I would prefer to do them face to face, but obviously, certainly from a national perspective, they’re the right people you need to invite. Could be in multiple different places around the country. So it’s not always practical to get people together, but getting them together, whether that be virtual or face to face, is the important bit, Face to face I think you can read the room better, people might be more inclined to join in.

Rudi Hennessy: You might need a little bit more facilitation skills If it’s virtual, but having the hazard assessment, you know, is absolutely key. That we had somebody, undertaken hazard assessment the other day virtually. And we had a colleague, project manager, and she was running through and documenting and had to mentor and care processes up and very much new in depth the functionality, and the end to end care process.

And I can’t emphasise enough how important those type of people are as well, in the hazard assessment workshops. Somebody who can answer your questions technically, you know. Absolutely, absolutely. Yeah, definitely. And another thing that people just on hazard assessment workshops ask me when we go out delivering training is how many hazard assessment workshops will we need?

And my kind of response is it’s, you know, around the scale and complexity of the system, you know, the number of deployment units. So it varies massively, doesn’t it? Oh, yeah, I agree. So in areas where it was waterfall, we may have had multiple hazard assessments because we were looking at multiple things being deployed.

There’s times when we had an awful lot of hazard assessment workshops because we went through each deployment unit. You know, you when you walk in through the screens and the end to end process, you know, you’re having some great discussions. And then you might have just got to a point where you’ve identified causes and you’ve identified your hazards and you need another meeting, to look at your controls and your risk assessment.

Rudi Hennessy: And I think that’s also something that hopefully people listening can take away from, as well as the hazard assessment workshop, the aspect around the risk assessment and justification. So that’s key as well. Liz. So while we have you what would you say has been the most rewarding kind of aspect or part of your role?

Liz Barfield: Again, an interesting question, really, because there’s been so many, if I’m honest. So I think from if just from a national perspective, is that’s what the podcast is about, National CSO it is doing things making a difference on a large scale. So all the programmes that I’ve worked on have been different, challenging and rewarding, in different ways.

But I would say probably the one that really springs to mind, has been the Covid testing, being involved from start to finish. And the impact it will have had on not just tens of thousands, possibly even hundreds of thousands or even millions of people that will have gone through and done at least one Covid test during the pandemic, if not multiple, that touched the system.

And it’s to have been involved in something of that scale. I would say it’s possibly, you know, one of my biggest achievements, something that, again, not many people have the opportunity to be involved in, and for me, that’s there’s been a lot of, I mean, a lot of hard work, but a lot of reward out of that.

So for me, like I said, it’s difficult to pinpoint down to a particular thing. So I think I have to go at programme level. But it’s knowing even if you save one individual from coming to harm because of the work you’ve done, you’ve done a good job.

And that’s probably you know, one of the things as a CSO to take away, yes, I’m talking about large scale national scale. Not everybody works at that scale. And that doesn’t matter. What you do is important. And what you do makes a difference to patients and citizens that use your systems, as you say. It’s about why do we do the job that we do, isn’t it?

Rudi Hennessy: You know, it’s like, what’s the point? You know, what’s the point in all this? The patient is a central role to everything that we do. And to serve one patient by being pre-emptive, you know, proactive about causes, that may occur. You know, I like how Andy says it, he tends to say, what can go wrong? How bad can it be? And what can we do about it? Which is essentially what we do, isn’t it.

Liz Barfield: Exactly, exactly.

Rudi Hennessy: Well, it’s been absolutely wonderful having you on, Liz. And thanks so much for just coming and sharing some of your insights with us, just one last thing.

If there’s a key message, I know we’ve had lots of tips and, you know I’ve learned a lot from listening to all the work that you’ve done on the programmes and I’ve worked on some with you. Is there a key message that you’d like to leave those listening with.

Liz Barfield: Clinical safety is a team sport. You’re not alone. Don’t ever think you’re alone. Nobody wants to develop or implement that’s unsafe, so push on that open door. And never stop asking questions. I know that’s not one key message, really, but that’s probably what I would say to any CSO out there.

Rudi Hennessy: I love that. Yeah. Keep asking questions, push on those doors, and hopefully those listening can take confidence from hearing some of your experiences, you know, to have confidence to ask those difficult questions, to keep asking and to keep trying to embed that culture of digital clinical safety, which, you know, I understand isn’t always easy with competing priorities.

Well, again, it’s been a privilege to have you on, lovely to catch up with you. And I hope that listeners found it as informative as I did. As I say, we’ve worked together on a referral service and some vacc. But it’s the first time of hearing the journey that you went through with the testing service.

So really, really interested in, and a great opportunity, as I said, to have a chat with you. So just for those listen to the podcast, I’ll make sure that we leave links in the show notes with useful resources. So any web links, any books that might be useful to read? I’ll leave those all in the show notes.

So thank you everyone for listening. And thank you so much for joining.

Liz Barfield: Thank you.