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NMacLeod

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Profile Information

  • First name
    Norman
  • Last name
    MacLeod
  • Country
    United Kingdom

About me

  • About me
    Extensive experience in aviation safety, crew resource management etc. looking to broaden my understanding of safety in a different domain
  • Organisation
    South Tees Hospitals NHS Foundation Trust
  • Role
    Patient safety Partner

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  1. Content Article Comment
    Happy to, Anne
  2. Content Article
    Ambulances lined up outside hospital Emergency Departments (EDs) are a vivid, and politically embarrassing, indication of inadequate capacity in the NHS. Media reports of diktats demanding that hospital CEOs meet performance targets suggest a desire for action, but are the local solutions being implemented to ease the pressure in the best interest of patient safety? The use of ‘safety cases’ in healthcare has received some interest in recent years but the conclusion drawn by, for example, Leberati and her colleagues,[1] was that while they have some potential value they are "fraught with challenge, highlighting the limitations of efforts to transfer safety management practices to healthcare from other sectors". A survey of the literature suggests that there is a danger of conflating ‘safety cases’ with ‘safety management’ or ‘quality’ systems. Part of the problem might be that safety cases are more a concept rather than a methodology: there is no script to follow. In this blog, Norman MacLeod discusses whether the the current crisis in hospital capacity can be explored through the safety case lens.
  3. Content Article
    The relationship between management and the workforce, in very simplistic terms, can be considered one of reward in return for effort. The contracted effort is communicated through a roster. In organisations that have a continuous operation, blocks of effort are distributed to maintain the flow of output. The organisation of effort, then, is a legitimate function of management.  Norman's previous blog looked at performance variability under normal conditions. In this blog, Norman looks at the impact of physiological states and how management’s organisation of effort degrades decision-making.
  4. Content Article
    In a three-part series of blogs for the hub, Norman Macleod explores how systems behave and how the actions of humans and organisations increase risk.  In part 1 of this blog series, Norman suggested that measuring safety is problematic because the inherent variability in any system is largely invisible. Unfortunately, what we call safety is largely a function of the risks arising from that variability. In this blog, Norman explores how error might offer a pointer to where we might look. 
  5. Content Article Comment
    I’m not sure I’d agree with some of your points, Tom. I deal, in part, with WAD in the next blog. WAD will never ‘=WAI’ for a number of reasons, some legitimate but others simply a function of using humans to do work. And at the risk of being burned at the stake for being a heretic, I do feel that ‘quality’ is almost a fetish in the NHS. Has anyone ever added up the time spent on ‘quality initiatives’ and the set it against actual lasting improvements? Thanks for your comments. Looking forward to your views on parts 2 and 3.
  6. Content Article
    In a three-part series of blogs for the hub, Norman Macleod explores how systems behave and how the actions of humans and organisations increase risk.  He argues that, to measure safety, we need to understand the creation of risk. In this first blog, Norman looks at the problems of measuring safety, using an example from aviation to illustrate his points.
  7. Content Article
    It was recently reported that NHS Finance Directors were ‘incensed’ that the Health Services Safety Investigations Body (HSSIB) should think that they could be working more closely with patient safety chiefs. Whereas medical staff and clinicians represent the sharp end of healthcare delivery, the administrative functions, including finance, are the blunt end. Removed in space and time from the action, it can be hard to see how their behaviour can directly influence workplace outcomes. To understand the issue, Norman MacLeod reflects on how systems behave and the decision-making hierarchy within healthcare organisations.
  8. Content Article
    Healthcare often uses the experience of aviation to set its patient safety agenda, and the benefits of a ‘safety management system’ (SMS) are currently being espoused, possibly because the former chief investigator for HSIB, Keith Conradi, had an aviation background. So, what does an SMS look like and would it be beneficial in healthcare? In this blog, Norman MacLeod discusses aviation's SMS, its many component parts, the four pillars of an SMS, just culture and its role in healthcare.
  9. Content Article Comment
    Ann, I’m glad you found it interesting. I’ve drawn on thinking about learning (Ohlsson) and various others working in sense making and neuroscience. My motivation is to do something about the lazy use of language in safety circles. Space is limited in these blogposts. The implications of my position maybe need another blog.
  10. Content Article
    It has become fashionable to purge the term ‘error’ from the safety narrative. Instead, we would rather talk about the ‘stuff that goes right’. Unfortunately, this view overlooks the fact that we depend on errors to get things right in the first place. We need to distinguish between an error as an outcome and error as feedback, writes Norman MacLeod in this blog for the hub.
  11. Content Article Comment
    Point 1. Make it ‘statutory’ to adhere to guidance? But it’s only ‘guidance’, not law.
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