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Content ArticleHospital boards members are charged with developing appropriate organisational strategies and cultures and have an important role to play in safeguarding the care provided by their organisation. However, recent concerns have been raised over boards’ ability to enact their duty to ensure the quality and safety of care. This paper in BMC Health Services Research provides a critical reflection on the relationship between hospital board oversight and patient safety. It highlights new perspectives and suggestions for developing this area of study.
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News ArticleThe Joint Commission Resources (JCR) has announced the appointment of two world-class and leading healthcare experts to serve as international outside directors on its board of directors: Abdulelah M. Alhawsawi and Sangita Reddy. As international outside directors, Dr. Alhawsawi and Ms. Reddy will provide their global expertise and direction to improve safety and quality of healthcare in the United States and abroad. They will be full voting members of the 13-person board of directors, which serves as JCR’s governing body. The board includes healthcare professionals, business executives and quality experts from around the world. “Dr. Alhawsawi and Ms. Reddy have dedicated their lives to transforming healthcare globally, and we are thrilled to welcome them to Joint Commission Resources’ Board of Directors,” says Jonathan B. Perlin, president and chief executive officer, The Joint Commission. “These board appointments bring unique international expertise and perspective on healthcare policy and the challenges and opportunities to advance quality and safety worldwide.” “We are so pleased that Dr. Alhawsawi and Ms. Reddy are joining Joint Commission Resources’ Board of Directors,” says Jean Courtney, interim president and chief executive officer, and chief operating officer, JCR. “They each bring in-depth and unparalleled international healthcare expertise. This will be invaluable as JCR continues to expand its mission to improve patient safety and quality of care around the globe.” Read full story Source: Joint Commission Resources, 16 August 2022
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News ArticleA quarter of Black, Asian and minority ethnic (BAME) non-executive directors of NHS trusts have seen or experienced discrimination in the course of their work, a report reveals. While almost four out of five (79%) of these BAME non-executives said they challenged such behaviour when they encountered it, only half (50%) said that led to a change of policy or behaviour. The other half felt they had been ‘fobbed off’ or subjected to actively hostile behaviour for having spoken up,” says a report commissioned by the Seacole Group, which represents most of the BAME non-executive board members of NHS trusts in England. It adds: “This level of discrimination is unacceptable anywhere and even more so in the boardrooms of NHS organisations. Too many Black, Asian and other ethnic NEDs (non-executive directors) are being subjected to it and left to deal with it on their own.” Read full story Source: The Guardian, 21 July 2022
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Content ArticleWith integrated care boards (ICBs) becoming statutory organisations it is time for them to hit the ground running. Professor David Colin-Thome, chair of PCC, reviews the Fuller stocktake, and identifies the opportunity for ICBs to facilitate the recommendations in the report and enable the development of neighbourhoods that will make a difference.
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Content Article
Draft Code of governance for NHS provider trusts (May 2022)
Patient Safety Learning posted an article in Boards
This code sets out a common overarching framework for the corporate governance of trusts, reflecting developments in UK corporate governance and the development of integrated care systems. -
Content Article
Leading a culture of safety: A Blueprint for success (2017)
Patient Safety Learning posted an article in Exec teams
Patient safety experts and researchers have increasingly pointed to the role of organizational culture in the success of patient and workforce safety initiatives. Yet, creating a culture of safety in health care settings has proven to be a challenging endeavour, and there is a lack of clear actions for organisational leaders to take in developing such a culture. 'Leading a Culture of Safety: A Blueprint for Success' from the Institute of Healthcare Improvement (IHI) was developed to bridge this gap in knowledge and resources by providing chief executive officers and other healthcare leaders with a useful tool for assessing and advancing their organisation’s culture of safety. This guide can be used to help determine the current state of an organisation’s journey, inform dialogue with the board and leadership team, and help leaders set priorities. -
Content ArticleThe Safety Culture Programme for Maternity & Neonatal Board Safety Champions was commissioned by NHSE/I Women’s Health Policy team. The programme was co-designed with stakeholders including Board Safety Champions, Leaders from the Maternity and Neonatal system and Maternity Voices Partnership through March 2021. The programme is underpinned by the NHSE/I framework developed by the Maternity Transformation Programme Board. The aim of the framework and the programme (concluded on 25 March 2022) is to create the conditions for a culture of safety and continuous improvement across perinatal services to improve the quality, safety and experience of care. View the presentation slides from the recent Aqua event and an overview of the HSIB Investigation Programmes highlighting the differences between the National Investigations Programme and the Maternity Investigations Programme.
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News Article
Medical regulator faces questions over board members’ links to drug firms
Patient Safety Learning posted a news article in News
The UK medicines watchdog has been urged to strengthen its conflict of interest policy after it emerged that six of its board members are receiving payments from the pharmaceutical industry. Board members involved in overseeing the regulator’s “strategic direction” also have financial interests in companies including US and Saudi drug giants and firms with ambitions to break into the UK’s healthcare market. Some offer consultancy services while others help run or own shares in drug and medical device firms, according to official transparency records. There is no suggestion of wrongdoing, but the findings have led to concerns about perceived conflicts of interest among senior figures at the Medicines and Healthcare products Regulatory Agency (MHRA), an executive agency of the Department of Health and Social Care responsible for regulating drugs and medical devices and ensuring they are safe. The MHRA said that “in order to be an effective regulator” it needed to “bring together the right expertise from across industry, academia, the public and beyond”, adding that board meetings are held in public and non-executive board members – to whom the potential conflicts relate – are not involved in “any work or decisions relating to the regulation of any products”. But critics raised concerns about the potential for bias – or the perception of it – and called for stricter rules on conflicts of interest for those working in pharmaceutical regulation. Read full story Source: The Guardian, 17 April 2022 -
News Article
Trust board backs medical director who wrongly dismissed whistleblower
Patient Safety Learning posted a news article in News
A trust board has backed the medical director who oversaw the dismissal of a whistleblower in a case linked to patient deaths. Portsmouth Hospitals University Trust told HSJ John Knighton had the full support of the organisation when asked if he faced any censure over the wrongful dismissal of a consultant who raised the alarm about a surgical technique. Jasna Macanovic last month won her employment tribunal against the trust with the judge calling its conduct “very one-sided, reflecting a determination to remove [her] as the source of the problem”. The judgment found that the disciplinary process Dr Knighton oversaw was “a foregone conclusion” and as such had broken employment rules. The nephrologist was twice offered the opportunity to resign with a good reference, once during her disciplinary hearing and again on the day the outcome of that hearing was delivered. The trust told HSJ nothing in the judgment suggested Dr Knighton should face any action about his conduct and none had been taken. It said there were no reasons to doubt his credibility or probity. The trust did not respond when asked if any apology had been offered to Dr Macanovic. A spokesperson said: “We are committed to supporting colleagues raising concerns, so they are treated fairly with compassion and respect.” Read full story (paywalled) Source: HSJ, 13 April 2022 -
Content ArticleDeveloping an organisational approach to improvement in healthcare is a journey that can take several years. It requires corporate investment in infrastructure, staff capability and culture over the long-term. These resources from NHS Providers explain why organisation-wide improvement in healthcare matters, and how to get started.
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Content Article
Key questions for boards: What to ask yourself and others
Patient Safety Learning posted an article in Boards
NHS Providers provide a selection of example questions boards should ask themselves in relation to their role in improvement. These aim to help guide personal reflection, conversations between board members and in quality committees, with staff and with partners locally. This list does not cover everything you may wish to or need to ask, but is intended to help provide a starting point and overview of important aspects to consider. -
Content ArticleWhen was the last time your board discussed procurement and its role in your strategy for improving health outcomes? It’s been four months since Heather Tierney-Moore took over as interim chair of NHS Supply Chain and in this blog she reflects on the world of NHS procurement, where it has come from and where it might be going.
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News Article
Why America needs a National Patient Safety Board
Patient Safety Learning posted a news article in News
Within hours of the catastrophic Fern Hollow bridge collapse in Pittsburgh, USA, the National Transportation Safety Board was on the scene, finding answers to “Why?” and “How can we keep this from ever happening again?” What could be more obvious than the value of having a team of experts on the alert — and empowered with the authority — to provide promising solutions to dangerous situations? Transportation industries embraced the recommendations because they know what its corporate mission and obligation to the public is: to get people from place to place as efficiently and safely as possible. Sadly, we cannot say the same for health care, says Karen Wolk Feinstein. There is no single federal agency entrusted with a sole mission: to make health care as safe as possible by investigating solutions to major threats. Therefore, there has been comparatively little progress to protect patients from medical mistakes. We don’t understand well enough the preconditions and root causes of adverse events, making it difficult to prevent harm before it happens; we haven’t deployed the safety technology and analytics we have available; and we often don’t share existing lessons learned or actionable solutions, says Karen. That’s why a coalition of US experts, including leaders from hospitals, insurers, patient safety groups, consumer advocates, foundations, universities, technology companies and employers has formed to promote the establishment of an independent, nonpunitive federal agency dedicated to finding data-driven solutions to the problem of medical error. A National Patient Safety Board, modelled after the National Transportation Safety Board, would identify patient safety events, study the root causes of these events and issue recommendations to prevent future lapses. More than 80% of the NTSB’s recommendations are acted upon. Imagine if this occurred in health care: How many lives could be saved? How much needless suffering could be prevented? Read full story Source: Pittsurgh Post-Gazette, 10 February 2022 -
News ArticleAn NHS England review into the behaviour of high-profile senior leaders who took over a Midlands trust has concluded that the interim CEO “behaved poorly and inappropriately” while its chair was “complicit with” and failed to address problems. NHS England had commissioned an independent probe into allegations about the behaviour of new executives, who had recently been appointed to the board of Walsall Healthcare Trust. David Loughton and Professor Steve Field, who hold the same roles at the Royal Wolverhampton Trust, were brought in as interim chief executive and chair respectively in spring 2021. Walsall has faced care quality concerns for some years and it was hoped the pair from neighbouring Wolverhampton would bring improvements. Dr McLean wrote in her review: “Leadership changes can, understandably, represent a period of anxiety for those affected but this can be minimised if changes are made in line with appropriate values and processes. “Whilst I conclude that the joint chair and interim CEO were motivated to act in the best interests of patients, I was saddened by much of what I heard. ”In the narratives I heard, there was a consistent lack of compassion or respect for people.” She concluded: “The interim CEO, while motivated by the safety and care of patients, has behaved poorly and inappropriately … the joint chair has been complicit with and failed to address this behaviour.” Read full story (paywalled) Source: HSJ, 2 February 2022
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Content ArticleIn 2020, all NHS organisations were instructed to name a single executive board member as their senior responsible person for tackling health inequalities. Across the NHS, there should now be over 450 dedicated health equality named leads in healthcare organisations. This report published by the independent NHS Race & Health Observatory in collaboration with The King’s Fund sets out recommendations to help ensure senior NHS officials responsible for improving health inequalities are able to make a difference.
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Content ArticleThe composition and background of members of state medical boards, including public or citizen members, can impact the functionality and public perception of medical boards in the United States. This study from Doug Wojcieszak analysed the number of public members on each state medical board and their professional backgrounds or expertise to regulate the medical profession. The findings show that for nearly half of state medical boards public members comprise at least a quarter of their voting members; however, more than half of public members for all state medical boards have no measurable medical experience or background, including in patient safety. The need for public members to have medical expertise or background – especially in patient safety -- is discussed along with potential policy recommendations.
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Content ArticleThis maturity matrix from the Good Governance Institute is a resource designed to support organisations to self-assess whether they are appropriately applying the key principles of good governance practice in relation to quality assurance.
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Content ArticleTrusts that embed trust-wide improvement successfully throughout their organisations embrace accountability for that improvement and have boards that offer space to leaders at all levels to identify, shape and drive that improvement. They have a consistent and coherent approach. Perhaps most critically, they support their staff to engage in and lead improvement efforts by enabling them to both develop improvement skills and capabilities, and by focusing on relationships and culture. Staff in these organisations come to work to deliver and improve services. But how do boards support this evolution to happen? In our first three virtual webinar sessions as part of our trust-wide improvement programme, supported by The Health Foundation, NHS Providers delved into what it really means to have a systematic approach to improvement and what learning we can draw from the experiences of COVID-19. It explored diverse experiences of organisation-wide improvement, with differing investment levels, and type and rigour of method used. Trust leaders shared practical, actionable insights for peers to consider, with a number of common principles emerging that could help sustain the gains made as a result of the pandemic and respond to the scale of the challenges ahead. This briefing highlights what has been learnt so far
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Content ArticleThe NHS is in the process of changing the way it embraces patient safety, moving from a focus on individual incidents and issues to a more comprehensive look at system learning. The changes are set out in NHS England/Improvement’s Patient Safety Strategy, released in July 2019 and updated in February 2021. This was followed by the Patient Safety Investigation Framework in March 2020, due for full implementation by Spring 2022. They are important not just in relation to incident management but also because of the implications they have for strategy and board responsibilities in relation to patient safety. So they need careful attention at all levels of NHS organisations. This article from the Good Governance Institute highlights the safety roles and responsibilities of organisations and moving to a proactive approach to safety management.
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Content ArticleThis guide from Leading for Health is to help those interested in developing and enhancing boards and top teams.
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Community PostIt's #SpeakUpMonth in the #NHS so why isn't the National Guardian Office using the word whistleblowing? After all it was the Francis Review into whistleblowing that led to the recommendation for Speak Up Guardians. I believe that if we don't talk about it openly and use the word 'WHISTLEBLOWING' we will be unable to learn and change. Whistleblowing isn’t a problem to be solved or managed, it’s an opportunity to learn and improve. So many genuine healthcare whistleblowers seem to be excluded from contributing to the debate, and yes not all those who claim to be whistleblowers are genuine. The more we move away for labelling and stereotyping, and look at what's happening from all angles, the more we will learn. Regardless of our position, role or perceived status, we all need to address this much more openly and explicitly, in a spirit of truth and with a genuine desire to learn and change.
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News ArticleNearly half of trust chairs fail to “effectively deal with non-performing board members” according to a major study of the role of NHS non-executive directors seen by HSJ. The Henley Business School conducted in-depth research over a two-year period for its report 'The Independent Director in Society: Our Current Crisis of Governance & What to Do About It' which is published later this month. The research included a survey of NHS non-executive directors, which reveals that they have a broadly positive view about their contribution but also reveals significant areas of concern. Only 55% of respondents agreed with the statement that NHS trust chairs “effectively deal with/remove non-performing and/or disruptive board members”. Just 47% said chairs had “positive relations with the media.” The survey was undertaken before the onset of the pandemic, but nearly a third of the respondents disagreed with the statement that NHS chairs were “effective in a crisis”. However, almost every survey respondent claimed trust chairs had “high moral values” which were “aligned with those of the organisation.” All but 2% of respondents backed the idea that non-executive directors “have a sense of duty to see things are done both ethically and morally”, while 94% claimed they were “truly independent”. However, a fifth claimed it was impossible for non-executive directors to be effective “given the mandate of the NHS”. Read full story (paywalled) Source: HSJ, 1 October 2020
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Content ArticleSince the Institute of Medicine’s 1999 report To Err is Human, it has been known that upwards of 100,000 deaths due to preventable medical errors occur each year. In the twenty years since then, little progress has been made in the way of reducing the number of these deaths and estimates now suggest between 200- 440,000 Americans are dying preventably each year. One major component many believe is lacking in the United States is a national agency that focuses on responsibility and accountability for patient safety. The Patient Safety Movement Foundation has published a white paper assessing the feasibility of creating a National Patient Safety Board to reduce preventable medical errors in facilities across the country.
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Content ArticleThe NHS Leadership Academy recognises the crucial importance of effective, engaged, accountable board leadership and has commissioned this refreshed edition of ‘The Healthy NHS Board 2013 - Principles for Good Governance’. This guidance supports the NHS Leadership Academy’s mission to develop outstanding leadership in health in order to improve people’s health and their experience of the NHS.
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Community PostWay back in March I applied to re-join the NHS to help with COVID-19. I am a mental health nurse prescriber with an unblemished clinical record. I have had an unusual career which includes working in senior management before returning to clinical work in 2002. I have also helped deliver several projects that achieved nation recognition, including one that was highly commented by NICE in 2015, and one that was presented at the NICE Annual Conference in 2018. Several examples of my work can be found on the NICE Shared Learning resource pages. Since applying as an NHS returner. I have been interviewed online 6 times by 3 different organisations, all repeating the same questions. I was told that the area of work I felt best suited to working in - primary care/ community / mental health , specialising in prescribing and multi-morbidity - was in demand. A reference has been taken up and my DBS check eventually came through. I also received several (mostly duplicated) emails. On 29th June I received a call from the acute trust in Cornwall about returning. I explained that I had specified community / primary care as I have no recent acute hospital experience. The caller said they would pass me over to NHS Kernow, an organisation I had mentioned in my application. I have heard nothing since. I can only assume the backlisting I have suffered for speaking out for patients, is still in place. If this is true (and I am always open to being corrected) it is an appalling reflection on the NHS culture in my view. Here is my story: http://www.carerightnow.co.uk/i-dont-want-to-hear-anything-bad-whistleblowing-in-health-social-care/
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