Methodology and guidance: How to do an investigation

Articles in this category

1. WHO: Minimal Information Model user guide (14 September 2018)

   • Patient safety incident
   • Data
   • (and 2 more)

     Tagged with:

     • Patient safety incident
     • Data
     • Organisational learning
     • PSIRF

   By Patient Safety Learning, 5 March

   • 0 comments
   • 71 views
   • 
   • Added by Patient Safety Learning
   • 5 March

2. What you find is not always what you fix—How other aspects than causes of accidents decide recommendations for remedial actions (Novemeber 2010)

   • Qualitative
   • Investigation
   • (and 1 more)

     Tagged with:

     • Qualitative
     • Investigation
     • System safety

   By Claire Cox, 4 December, 2019

   • 0 comments
   • 806 views
   • 
   • Added by Claire Cox
   • 4 December, 2019

3. Using the structured judgement review method: A guide for reviewers (2016)

   • Patient death
   • Process redesign
   • (and 3 more)

     Tagged with:

     • Patient death
     • Process redesign
     • Confidence
     • Training
     • Case report

   By Claire Cox, 6 October, 2019

   • 0 comments
   • 3,369 views
   • 
   • Added by Claire Cox
   • 6 October, 2019

4. Using appreciative inquiry to transform health care (August 2013)

   • Appreciative inquiry
   • Innovation
   • (and 3 more)

     Tagged with:

     • Appreciative inquiry
     • Innovation
     • Transformation
     • Quality improvement
     • Australia

   By Patient-Safety-Learning, 9 December, 2022

   • 0 comments
   • 356 views
   • 
   • Added by Patient-Safety-Learning
   • 9 December, 2022

5. Undertaking mortality case record reviews policy and procedure (14 September 2020)

   • Patient death
   • Investigation
   • (and 3 more)

     Tagged with:

     • Patient death
     • Investigation
     • Patient / family support
     • Harmed Care Pathway
     • England

   By Patient-Safety-Learning, 10 July, 2023

   • 0 comments
   • 238 views
   • 
   • Added by Patient-Safety-Learning
   • 10 July, 2023

6. The transformation of accident investigation: From finding cause to sense making (2015)

   • Investigation
   • Methodology
   • (and 3 more)

     Tagged with:

     • Investigation
     • Methodology
     • USA
     • Leadership
     • Organisational learning

   By Patient Safety Learning, 26 May, 2021

   • 0 comments
   • 1,054 views
   • 
   • Added by Patient Safety Learning
   • 26 May, 2021

7. The process and perspective of serious incident investigations in adult community mental health services: integrative review and synthesis (4 January 2024)

   • Investigation
   • Mental health - adult
   • (and 4 more)

     Tagged with:

     • Investigation
     • Mental health - adult
     • Self harm/ suicide
     • Organisational learning
     • Root cause anaylsis
     • Safety II

   By Patient-Safety-Learning, 18 March

   • 0 comments
   • 80 views
   • 
   • Added by Patient-Safety-Learning
   • 18 March

8. The life of a national investigation (HSIB workshop, 16 September 2021)

   • Investigation

   By Patient Safety Learning, 16 October, 2021

   • 0 comments
   • 726 views
   • 
   • Added by Patient Safety Learning
   • 16 October, 2021

9. The investigator's toolkit: Using Appreciative Inquiry in safety investigations (HSIB, 5 June 2023)

   • Investigation
   • Appreciative inquiry
   • (and 4 more)

     Tagged with:

     • Investigation
     • Appreciative inquiry
     • Methodology
     • Information sharing
     • Patient safety incident
     • Organisational learning

   By Patient Safety Learning, 5 June, 2023

   • 0 comments
   • 585 views
   • 
   • Added by Patient Safety Learning
   • 5 June, 2023

10. The investigator's toolkit: SEIPS (HSSIB, 17 January 2024)

    • PSIRF
    • Investigation
    • (and 2 more)

      Tagged with:

      • PSIRF
      • Investigation
      • Patient safety incident
      • Methodology

    By Patient Safety Learning, 18 January

    • 0 comments
    • 509 views
    • 
    • Added by Patient Safety Learning
    • 18 January

11. Systems-based models for investigating patient safety incidents (28 April 2021)

    • Investigation
    • System safety
    • (and 2 more)

      Tagged with:

      • Investigation
      • System safety
      • Patient safety incident
      • Systems modelling

    By Patient Safety Learning, 6 May, 2021

    • 1 comment
    • 2,048 views
    • 
    • Comment by Keith Bates
    • 6 May, 2021

12. Significant Event Audit guidance (RCGP Patient Safety Toolkit)

    • Audit
    • Investigation
    • (and 3 more)

      Tagged with:

      • Audit
      • Investigation
      • GP
      • Patient safety incident
      • Organisational learning

    By Patient-Safety-Learning, 1 May, 2023

    • 0 comments
    • 257 views
    • 
    • Added by Patient-Safety-Learning
    • 1 May, 2023

13. Safety analysis over time: Seven major changes to adverse event investigation

    • Safety process
    • Safety management
    • (and 2 more)

      Tagged with:

      • Safety process
      • Safety management
      • Process redesign
      • Impact anaylsis

    By Claire Cox, 23 September, 2019

    • 0 comments
    • 947 views
    • 
    • Added by Claire Cox
    • 23 September, 2019

14. ROSPA: Accident investigation training

    • Investigation
    • Root cause anaylsis
    • (and 1 more)

      Tagged with:

      • Investigation
      • Root cause anaylsis
      • Training

    By Patient Safety Learning, 22 October, 2019

    • 0 comments
    • 915 views
    • 
    • Added by Patient Safety Learning
    • 22 October, 2019

15. Root cause analysis: Why we need to change the focus

    • Investigation
    • Root cause anaylsis
    • (and 1 more)

      Tagged with:

      • Investigation
      • Root cause anaylsis
      • Quality improvement

    By Jerome P, 7 October, 2020

    • 10 comments
    • 10,394 views
    • 
    • Comment by Jon Holt
    • 20 October, 2020

16. Root cause analysis gone wrong (May 2018)

    • Root cause anaylsis
    • Investigation
    • (and 2 more)

      Tagged with:

      • Root cause anaylsis
      • Investigation
      • Patient safety incident
      • Organisational culture

    By Patient Safety Learning, 23 February, 2020

    • 0 comments
    • 717 views
    • 
    • Added by Patient Safety Learning
    • 23 February, 2020

17. RCA2: Improving root cause analyses and actions to prevent harm

    • Investigation
    • Root cause anaylsis
    • (and 1 more)

      Tagged with:

      • Investigation
      • Root cause anaylsis
      • Methodology

    By Patient Safety Learning, 15 March, 2021

    • 0 comments
    • 2,599 views
    • 
    • Added by Patient Safety Learning
    • 15 March, 2021

18. Presentation on Root Cause Analysis and Just Culture: A practical application to drive improvement (March 2019)

    • Accountability
    • Organisational learning
    • (and 4 more)

      Tagged with:

      • Accountability
      • Organisational learning
      • Just Culture
      • Leadership
      • Root cause analysis
      • Risk management

    By Patient Safety Learning, 26 June, 2019

    • 0 comments
    • 847 views
    • 
    • Added by Patient Safety Learning
    • 26 June, 2019

19. Patient and family engagement in incident investigations: exploring hospital manager and incident investigators’ experiences and challenges (October 2018)

    • Communication
    • User-centred design
    • (and 2 more)

      Tagged with:

      • Communication
      • User-centred design
      • Qualitative
      • Patient involvement

    By Patient Safety Learning, 26 June, 2019

    • 0 comments
    • 773 views
    • 
    • Added by Patient Safety Learning
    • 26 June, 2019

20. NHS Wales: Framework for the joint investigation of patient safety Serious Incidents (SIs) related to NWIS delivered or supported services

    • Healthcare
    • Patient safety incident
    • (and 10 more)

      Tagged with:

      • Healthcare
      • Patient safety incident
      • Policies / Protocols / Procedures
      • Safety process
      • Patient safety / risk management leads
      • Digital health
      • Investigation
      • Root cause anaylsis
      • Never event
      • Near miss
      • Patient death
      • Patient harmed

    By Gethin, 24 January, 2021

    • 0 comments
    • 1,090 views
    • 
    • Added by Gethin
    • 24 January, 2021

21. NHS National Clinical Assessment Service: Case investigator training programme: Sample Investigation Report (25 March 2013)

    • Investigation
    • Training

    By Patient Safety Learning, 26 June, 2019

    • 0 comments
    • 875 views
    • 
    • Added by Patient Safety Learning
    • 26 June, 2019

22. NHS England: Swarm huddle (August 2022)

    • Patient safety incident
    • Organisational learning
    • (and 4 more)

      Tagged with:

      • Patient safety incident
      • Organisational learning
      • Investigation
      • Communication
      • Methodology
      • Information sharing

    By Patient Safety Learning, 15 February

    • 0 comments
    • 164 views
    • 
    • Added by Patient Safety Learning
    • 15 February

23. NHS England podcast: Machine learning and LFPSE – revolutionising how we learn from patient safety events

    • PSIRF
    • LFPSE
    • (and 3 more)

      Tagged with:

      • PSIRF
      • LFPSE
      • Technology
      • Organisational learning
      • Patient safety incident

    By Patient Safety Learning, 16 June, 2023

    • 0 comments
    • 387 views
    • 
    • Added by Patient Safety Learning
    • 16 June, 2023

24. NHS England Patient safety incident investigation tools

    • Patient safety incident
    • Patient harmed
    • (and 1 more)

      Tagged with:

      • Patient safety incident
      • Patient harmed
      • Investigation

    By Patient-Safety-Learning, 14 October, 2021

    • 0 comments
    • 2,687 views
    • 
    • Added by Patient-Safety-Learning
    • 14 October, 2021

25. NEBOSH HSE introduction to incident investigation

    • Root cause anaylsis
    • Investigation
    • (and 2 more)

      Tagged with:

      • Root cause anaylsis
      • Investigation
      • Patient safety incident
      • Training

    By Patient Safety Learning, 22 January, 2020

    • 0 comments
    • 1,057 views
    • 
    • Added by Patient Safety Learning
    • 22 January, 2020