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Found 525 results
  1. Content Article
    Author Hugh MacLeod host's this fourth episode in the ISQua Podcast series. "We do not make stuff in healthcare, we deliver care to people through people. When the relationship patterns between people are connected and healthy quality and patient safety magic happens, when they are not connected nor healthy, things fall through the cracks and patient harm and death occurs."
  2. Content Article
    Patient and family advisory councils (PFAC) are groups of patients, family members, community members, and hospital staff who work together to bring the unique perspectives of patients and families to a hospital’s operations, especially its efforts to improve care. According to one estimate, more than 2,000 hospitals in the United States have PFACs. They are also slowly becoming more common in outpatient settings. Massachusetts is the only state that mandates all hospitals (acute care, rehabilitation, and long-term acute care) to have a PFAC. Five years on, this is a review of how the mandate came about, how the implementation process has gone, what PFACs in Massachusetts are doing now and what other states, healthcare organisations and consumer advocacy groups can learn from the Massachusetts experience.
  3. Content Article
    Steve Turner's blog look at a workshop session delivered jointly by a facilitator and a user of mental health services. The aims of the session were to discuss adherence to medicines and treatments, relate this to practice through group work and discuss this with a user of mental health services
  4. Content Article
    Helen Hughes, Patient Safety Learning's Chief Executive, shares her insight from a three day World Health Organisation (WHO) meeting and the development of its Global Patient Safety Action Plan for 2020-2030.
  5. Content Article
    Human factors are of pivotal importance to both patient safety and doctors’ wellbeing, says Peter Brennan and Tista Chakravarty-Gannon in this BMJ Opinion article. In this article they highlight what the General Medical Council (GMC) and other organisations are doing to support doctors to deliver good care for their patients through educational and support programmes, including the GMC’s new Professional Behaviours and Patient Safety Programmes (PBPS) being piloted across the UK. These programmes are designed to help improve doctors’ skills and confidence in addressing unprofessional behaviours. These initiatives should reduce medical error, improve patient safety and professional welfare, as well as enhancing team working.
  6. Content Article
     The Jeddah Declaration on Patient Safety is founded on the principles that guided the 4th Global Ministerial Patient Safety Summit 2019, Jeddah, Kingdom of Saudi Arabia. It is a call for action on many fronts, and for many actors, at all levels of healthcare provision and delivery – from frontline, to organisational and policy arenas. The Declaration is founded on the underlying spirit that it is imperative to reflect on the effectiveness of current practices in light of the now mature patient safety evidence base of 20 years and to collectively move forward with a vision to sustainable and scalable implementation of patient safety solutions known to improve care delivery systems, patient outcomes and safety culture. The Declaration signals a strong collective and global commitment to shape truly safer systems for generations to come.
  7. Content Article
    In The Silo Effect, the author uses an anthropological lens to explore how individuals, teams and whole organisations often work in silos of thought, process and product. With examples drawn from a range of fascinating areas - the New York Fire Department and Facebook to the Bank of England and Sony - these narratives illustrate not just how foolishly people can behave when they are mastered by silos but also how the brightest institutions and individuals can master them.
  8. Content Article
    This article by Abdulelah M. Alhawsawi, from the Saudi Patient Safety Center, first appeared on the G20 Health & Development Partnership news stream. It is copied below verbatim.
  9. Content Article
    This short video, by Understanding Patient Data,  shows people talking about why it's important to use patient data, and why we need to better explain the benefits and safeguards.
  10. Content Article
    Resilience in the context of anaesthesia and intensive care medicine is the ability to manage the breadth, depth, intensity and chronicity of the demands of the work. The concept of resilience is often misunderstood: it is a dynamic, contextual process that goes beyond the narrow conceptions of individual ‘toughness’ that it can be reduced to. Resilience is important for those working in anaesthesia and intensive care medicine, and indeed staff throughout healthcare, as it is inevitable that difficult cases and situations will be encountered during our working lives. In addition, the way in which we respond to these events is critical to our own welfare and competence at work.
  11. Content Article
    This white paper explores the significance of safety strategies in healthcare settings and how these practices influence the patient and clinician experience. The Experience of Safety in Healthcare: A Call to Expand Perceptions and Solutions, reflects on the integrated nature of safety and service and how they interact to create the overall experience of patients, families and clinicians.
  12. Content Article
    I had been away from the hospital for a week and I was reluctant to go back in, fearful of what I would face, but I am amazed at how much has been achieved in 7 days.
  13. Content Article
    At Patient Safety Learning we believe that sharing insights and learning is vital to improving outcomes and reducing harm. That's why we created the hub; to provide a space for people to come together and share their experiences, resources and good practice examples. We’ve selected twelve useful resources about diabetes. Self-management is perhaps the most important aspect of treating diabetes effectively, so we've included some resources aimed at helping patients manage their diabetes too. Diabetes is a condition that causes the amount of glucose in a person's blood to be too high. When you have type 1 diabetes, your body can’t make any insulin at all, whereas with type 2, you either can’t make enough insulin, or it can’t work properly. There are also other types of diabetes including gestational diabetes, which some women develop during pregnancy, maturity onset diabetes of the young (MODY) and latent autoimmune diabetes in adults (LADA). It is important that people with diabetes are supported to maintain good blood glucose control through diet, insulin and other diabetes medications, to prevent both acute and long-term complications,
  14. Content Article
    This guide developed by Learn Together and Bradford Teaching Hospitals NHS Foundation Trust has been designed to help patients and families understand what to expect from patient safety investigations and how they can be involved in the process. It includes quotes and advice from patients who have been through patient safety investigations and spaces to record experiences, questions and reflections. The guide provides an outline of the investigation process, broken down into five stages: Understanding you and your needs Agreeing how you work together Giving and getting information Checking and finalising the report Next steps
  15. Content Article
    Melanie Whitfield, Associate Director of Patient Safety at Kingston NHS Foundation Trust, and Helen Hughes, Chief Executive of Patient Safety Learning, recently ran a workshop for Patient Safety Partners (PSPs) at the Kingston Trust. Here is a summary of the workshop.
  16. Content Article
    An NHS-Led Provider Collaborative is a group of providers of specialised mental health, learning disability and autism services who have agreed to work together to improve the care pathway for their local population. They will do this by taking responsibility for the budget and pathway for their given population. The Collaborative will be led by an NHS Provider who remains accountable to NHS England and NHS Improvement for the commissioning of high-quality, specialised services. These Collaboratives aim to ensure that people with specialist mental health, learning disability and autism needs experience high quality, specialist care, as close to home as appropriately possible. They seek to enable specialist care to be provided in the community to prevent people being in hospital if they don’t need to be, and to enable people to leave hospital when they are ready. This webpage explains the role of NHS-Led Provider Collaboratives and includes case studies that demonstrate how they are helping to transform specialised mental health services.
  17. Content Article
    This blog describes No Wrong Door (NWD), an adult community mental health transformation programme being rolled out across Hampshire, Southampton, Isle of Wight and Portsmouth. The NWD model takes a partnership approach and recognises that mental health is affected by quality of housing, employment, family and personal contacts, leisure and cultural activities, technological solutions and other community resources such as green spaces. Mental health services will work together with the community to ensure that care can be provided locally, and that support can be received in several settings for multiple aspects of a person’s life.
  18. Content Article
    The Serenity Integrated Mentoring (SIM) model is described as "an innovative mental health workforce transformation model that brings together the police and community mental health services, in order to better support 'high intensity users' of Section 136 of the Mental Health Act (MHA) and public services." The SIM model is part of a 'High Intensity Network' (HIN) approach, which is now live in all south London boroughs. In this hub post, Steve Turner highlights the benefits and risks of this approach and seek your views on it.
  19. Content Article
    The objective of this piece of work was to try and create a different way of navigating through the various themes in mental health. There are a huge range of posts on mental health and related areas on the hub. Seemingly endless information, and so little time to absorb it. I know from experience, and from the learning I have undertaken and delivered on information mastery, that there is so much material available it is difficult to find the time to discover, and then read fully, what is most relevant to the work in hand. As a result I have created a diagram (below - click on it to enlarge it) and an interactive pdf (attached), which has a number of topics and subtopics links to existing hub content to help people to do exactly that. In doing this, the focus has been on including patients/users of services, avoiding medical jargon, taking a holistic view. I am really interested in everyone’s views on this. Is this a useful approach and a helpful model? Will it help you post and find what matters to you? I would love to gather people's ideas and potentially improve the model further.
  20. Content Article
    Published annually, the 'Lancet Countdown on health and climate change' is an international, multidisciplinary collaboration, dedicated to monitoring the evolving health profile of climate change, and providing an independent assessment of the delivery of commitments made by governments worldwide under the Paris Agreement. 
  21. Content Article
    The Royal Society of Psychiatry are conducting a scoping and design exercise to identify the key actions that mental health providers can make to improve the use of the Mental Health Act (MHA) in preparation for the proposed MHA reforms, and to design two interventions to help mental health providers implement the identified actions.  The broad aims of the exercise are to: Understand the experience of people currently and recently detained under the MHA  Identify which aims identified in the Reforming the Mental Health Act White Paper (PDF) should be prioritised for a QI programme and intervention.  Identify the key actions that mental health providers can make to improve use of the MHA. Design a QI programme and one other intervention in collaboration with staff and agencies involved in MHA treatment and detention.
  22. Content Article
    In 2016, 18 year-old Oliver McGowan died after being inappropriately prescribed antipsychotic medications. Oliver had high functioning autism, mild hemiplegia and epilepsy, and had experienced previous well-documented adverse reactions to these medications. On admission to hospital, both Oliver and his parents had been clear about the fact that he should not be given any form of antipsychotic. In this interview for Woman's Hour, Oliver's mum Paula talks about Oliver and the events that led to his death, as well as discussing new mandatory training for all health and social care staff that was passed into law as part of the Health and Care Act 2022 - The Oliver McGowan Mandatory Training in Learning Disability and Autism. This will ensure that all staff working health and social care receive learning disability and autism training appropriate for their role, which will in turn improve outcomes for people with learning disabilities. The interview can be found at 34 minutes 10 seconds into the programme.
  23. Content Article
    Many people with learning disabilities are not getting their annual health check, facing increased risk factors to a number of diseases as a result. This article, by Jim Blair and published by the British Journal of Family Medicine, considers what more can be done to help those most at risk
  24. Content Article
    In June 2023 the AHSN Network published a refreshed Patient Safety Plan, reflecting progress made across focus areas including managing deterioration in care homes; maternity and neonatal health; medicines safety; mental health; and system safety. In this podcast episode, Caroline Kenyon talks to four leaders responsible for delivering the plan across the country, Tasha Swinscoe, Alison White, Katie Whittle and Jodie Mazar.
  25. Content Article
    This review covers the impact the Eastern AHSN has delivered throughout the East of England and beyond in 2022/23, including an increased focus on fostering an innovation culture, tackling health inequalities, and supporting innovators to turn their ideas into positive health impact.
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