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Models of good practice for patient engagement in patient safety

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We know from academic research that patient engagement reduces the risk of unsafe care and harm, in patients own care and improving safety for all. Some organisations are investing time (if not money!) in recruiting, training and supporting patient leaders to work with Executives and senior staff, sharing their experience and as they engage with staff and patients, report back what they see. The model in Berkshire, as shared with me by Douglas Findlay, patient leader, is that they don’t make decisions on what needs to change and how, but report back what they see for others to  learn and act. Do we know of other models of good practice? What can we learn and share from them?

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Hi Helen,

Great topic.  I am a Critical Care Outreach nurse.  We have just started involving patients and their families in the escalation process with regard to deterioration.

We know that recognising the deteriorating patient is challenging in a busy hospital.  We rely on our NEWS charting and escalation process, but we miss the valuable insights of our families and patients. 

In healthcare we often ignore the patient voice - here, we are encouraging that voice to let us know when things are not 'right' .

We are setting up 'call for concern' where patients and families are given a mobile number that the outreach team hold.  They can raise concerns straight to us, we would then treat that as a referral to our service.

I was wondering if anyone else had started this initiative?

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Hi All

This is my first post on the hub (I hope it's in the right place....please let me know if not!).

I am Dani, a Critical Care Outreach Nurse at Southend Hospital, Essex.

We have had our 'call for concern' service for many years now, but are in the process of re-launching it.

I hope to share some recent experience with you to help anyone who is also working on their Call for Concern service currently.

It's such an invaluable service to offer to our patients and visitors and one I personally feel very passionate about.

Last year, I carried out an audit which proved my suspicions.... our potentially excellent service was there ready and waiting for calls, but was underused. The audit proved that very few staff even knew our service existed! (when I am back in the office....I can update you with some actual figures if anyone would like to know?).  As staff were not informing patients/visitors of our helpline and supporting them to call us due to their own limited knowledge, calls were reliant on patients/visitors spotting the odd patient information leaflet here and there (although these were often not visible on the wards and, in my opinion, rather outdated anyhow).

This led me to start my mission!  So far I have designed/revised a new patient information leaflet and it's in the pipeline to be printed (frustratingly, this has now taken over a year to finalise due to various hurdles I have had to jump over).  I have already prepped business cards, posters and stationary all in hope of ensuring patients, staff and visitors are aware of our service and understand how and when to call us.  Once the leaflet is finalised, I will start working on the rest of the publications.

Our Outreach team are informing patients and families during our routine clinical Outreach reviews and especially making a point of ensuring patients have our details when we 'discharge' them from our Outreach 'books' (ie. no longer regularly reviewing them).  We are also supporting our 'neck-breathing' patients to contact us (I love seeing the relief on their face when they realise they can just text us if they feel they're in trouble, as most feel extra vulnerable being unable to shout for staff attention).  Critical Care and HDU staff are also talking to their patients about our service to support them during their transition to ward level care and provide them with some reassurance (and safety net).  Patients and visitors are encouraged to share our contact details with their friends and families for future admissions. We are also working hard to promote our service on Twitter.

In January 2019, I also launched our quarterly Outreach Newsletter which is aimed at all hospital staff.  This has been a huge success and am regularly receiving great feedback about these.  I ensure Call for Concern is a regular topic featured in our Newsletter to get staff talking about it.  (happy to share our Newsletters with anyone interested?).

When completing the audit and seeking staff feedback, a common theme was mistaking "Call for Concern" with "Cause for Concern" which locally, we know as a phrase to highlight issues with any failing student nurses.  The word 'Concern' in general, also appeared to create a barrier to calling us.  Following on from this, we decided to name our "Call for Concern" service "We're Listening".  The name is still negotiable, but appears to be working currently.... it originated from staff/patients saying "so.... if we feel we are deteriorating, we've told the ward nurses and doctors, and we still feel nobody is listening.... we call you?".... that summed it up pretty well for us, so the name was born.

In the early days, I identified another barrier to success.....team reluctance to promote the service.  This was due to belief that we would receive an abundance non-urgent PALS calls (believed not to be relevant to our focus of work), and we would not be able to manage the extra workload it would create, as we were already stretched.  I was privileged to discuss various concerns with Mandy O'dell herself (via Twitter) and was also reassured by her insightful article.  I would highly recommend reading this and speaking with Mandy if you can.  I am happy to pass on a few tips that she kindly shared with me too, if you are unable to discuss these with her directly yourself or access the article.  Now that our team have been reassured by this, they are also much more willing to promote the service and appreciate its value.  We have identified deterioration in so many patients that potentially may have been missed/delayed.....it seems worth all the effort! Since taking over the Call for Concern service, I have been keeping a log of all our calls to help identify common themes that may arise...I am happy to share what I can (for confidentiality reasons) if anyone would find this useful?

I have a few more ideas/plans in the pipeline so will try to update you with how I get on in due course.  One of these being an email address that I have had created for public us.  It's not yet launched (as waiting on the leaflet), but we hope it will be another means of contact (likely for less-urgent matters).  The email is received by the Outreach team and our Hospital Out of Hours team so hopefully a quick response can be made.

Anyway, I hope some of my experiences described above may be of use.  For anymore information, please contact me and I will happily help if I can.  I am still lucky to work with the Outreach nurse who originally set the service up at Southend (Angela).... so if you would like me to ask her any specifics, just let me know and I will ask on your behalf.

Good luck, and look forward to networking with more of you on here soon.

Take Care


Feel free to follow us on Twitter: @Dani_CCOT and @CCOT_Southend



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Hi Dani,

Thanks for the post.  What a fantastic initiative and something that we, as a team , in Brighton are doing too.  

I hear your frustration with the hurdles that you face when carrying out QI.  I wonder if our topic lead @Jono Broad could give you some advice  on over coming these hurdles.

@Emma Richardson I understand you have just launched C4C at Brighton..... do you have any tips for @Danielle Haupt?

keep up the great work!

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Hi Dani,

Yes, you're in the right place. We're at beta (tech speak for starting out and wanting feedback) and great posts like yours will really help kick off conversations and sharing knowledge.


I don't have detailed knowledge of your service and this initiative (I'm not a clinician) but at Patient Safety Learning we are going to be developing with colleagues (from the World Heath Organisation) an implementation guide for safer care - how to implement and spread great ideas like yours - helping with how identify opportunities and provide ideas to overcome barriers. This won't help you in the short term (sorry) but we could build on your insight in shaping our work. We'll be starting this work in the next month or two. Would you be okay if we contacted you directly when we do?

Love to hear any other's contributions and resources.

Thanks again for posting, Helen 

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Hi Helen and Claire

@Helen Hey Helen, thanks for your feedback..... pleased I managed to find the right place to post! And thanks @Claire Cox for uploading the article in the correct spot!

Helen, I actually posted the above post on 'Call for Concern' to assist other teams, as I have had multiple teams request assistance with rolling out this service within their own Trust.  As we have been privileged to have had this service in place in our Trust for many years.........I thought it would be helpful to share a different perspective on some of our experiences.

You mentioned it wouldn't necessarily help me in the short-term..... this is no problem..... I think the 'hub' is an amazing idea and feel it has potential to be an invaluable resource for us all in the near future.... so this is good enough for me.

I have already had some really kind, positive feedback from Kettering Outreach Team about my post above.  I hope to see them on here soon, as I believe they will have some really useful feedback to share with us all.  I have encouraged them to discuss their questions/experience etc on this thread. 

I plan to put together a post soon about our recent team Newsletter success which I started in Jan 2019.  We have had some fantastic feedback regarding these from many staff within our Trust.  I am also overwhelmed with the amount of positive feedback I have received from other Trusts about these.  A number of teams have since approached me to assist with their own team Newsletters within their Trusts.  For this reason, I thought it might be a useful thing to post on the 'hub'?

As requested, I am more than happy for you to contact me directly to help shape your work over the next few months.

I am working hard to promote the 'hub' within our Trust, so I look forward to seeing a few familiar names appear soon! (fingers crossed).

Keep up the good work Patient Safety Learning Team!

Thank You

Speak soon.


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Hi All,

As Dani has already mentioned, the CCOT team at KGH are undertaking many QI projects and have been truly inspired both on this forum and through twitter.

It is providing us with great insight and most of all inspiration to push through. As we all know, spearheading change and QI is not an easy task!

We definitely need all the help we can get, and so will lap up all of the invaluable experiences other trusts have.

And hopefully, in turn can use this forum to share our experiences.

All the best, and looking forward to seeing more posts.



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Hi @Kirsty Wood thanks for the post!

I know that @Emma Richardson has started call for concern at Brighton.  

If you have other QI projects that you need help on, think about posting in a new community area and get a conversation going.  

QI is hard and sometimes lonely work - it would be great to have a whole community to call on for support.


claire ?

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My 1st post on here. I am championing a concept called Below Ten Thousand in the operating theatre. It's basically a language tool that allows any member of the team to call 'Below Ten Thousand' if we have lost situational awareness, it is too noisy or there is just too much distraction in the theatre. 

I love this concept for so many reasons but 1 is that when patients are undergoing surgery they are totally in 'our hands' so see this as giving them a voice so to speak when they are asleep. I am posting this because this concept is a QI project where in the future I hope to involve the patients in writing the Standard Operating Procedure?

I would love to present the concept to a patient group. I have even wondered are there any Dragons Den competitions in the NHS that are judged by patients?? Not judged by a hierarchy........

Thank you for reading,

Rob Tomlinson

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I’m not sure about the contestants, but I know the NHS would win a Great Leap Forward in Safety culture and consumer confidence. 

Once people used to watch ‘Air Crash Investigation’. 

Now they watch ‘Scully’ and read ‘Flight QF32’. 

Actually, having thought about prizes, I DO know!

The contestants could win a week with Patient Safety Learning. That would do me!


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Patients would be the judges.... we could pitch a new idea / QI Project that may need some funding? This could be open to healthcare staff with innovative ideas instead of having them rejected by hierarchy... let the patients choose?

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Hi Helen, Claire and team

My first note on 'the hub'! Fantastic knowledge sharing platform. My focus at the moment in a busy Healthcare Organisation that consists of 55 General Practices across the country, is how we engage with our patients and by that I feel we need to ask our patients how we are doing caring for them. We don't ask our patients enough what they want and expect to receive from a care team in general practice. We have attempted questionnaires and surveys in the past and feel there must be a better way of engaging with our patients - advocacy groups perhaps etc. I would be interested in receiving feedback and experiences I could take learning's from.  I am interested in improving the design of our organisation so that staff can provide the best and safest care. thanks aine

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Great to hear all the Call 4 Concern developments going on. Happy to talk if anyone needs any advice/support etc, but also happy to hear of any initiatives/tips that would make this service more accessible for patients and families.

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I have just presented the Below Ten Thousand Concept to a patient participation group. I can tell you that they were so interested and willing to be involved in the concept.

After this I then read the excellent review of your conference in The Clinical Services Journal; in particular Jo Hughes from Mothers Instinct's thoughts. Very hard hitting and much needed which was followed by a quote from the Chief Executive Peter Walsh "Overall there is a role for patient engagement at every level of care. Patients can help to keep themselves safe, remain engaged if something does go wrong and contribute their knowledge to patient safety initiatives across the system".

I am in the process of developing a workshop which focuses on Never Events and Noise / Distraction in the operating theatre. It is being designed with all members of the operating team and patients involved too.

I am really excited and have received some great help from Claire Cox. I have attached a paper I wrote a while ago. If anyone would like any information or would like to chat please get in touch,AFPP Article.pdf

Rob Tomlinson

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On 29/09/2019 at 08:39, Rob Tomlinson said:

@Rob Tomlinson We have a 'Dragons Den' event at Kettering General Hospital. 

Shortlisted teams of KGH staff are given the chance to pitch their ideas to a group of 'Dragons', which will be made up of local business leaders (including our Trust Chairman). However, the event is open to the public to attend and they play a big part in cheering the contestants on. The very best innovations will win the funding to turn their idea into reality.
In line with its passion for improvement and positive change, KGH will be using an innovation fund of £100,000 to advance an idea, or group of ideas, that the 'Dragons' agree will make the biggest difference to patient care or experience.

Take a look at our youtube video...



On 29/09/2019 at 08:39, Rob Tomlinson said:



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