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Found 248 results
  1. Content Article
    Many diagnostic mistakes are caused by reasoning errors, but lack of feedback makes it difficult for healthcare providers to make improvements in this area. This paper, published in BMJ Quality & Safety, describes the reason for and process of developing 'The Diagnosis Learning Cycle', a new model for feedback and improvement in diagnosis. The model is based on theory and knowledge from both outside and within the field of healthcare. It proposes a standardised feedback mechanism that includes concrete measures of factors such as reasoning and confidence.
  2. Content Article
    A film about why Schwartz Rounds are needed.
  3. Content Article
    Hundreds of healthcare organisations around the world are Schwartz Center healthcare members and conduct Schwartz Rounds® to bring doctors, nurses and other caregivers together to discuss the social and emotional side of caring for patients and families. This video explains more.
  4. Content Article
    Attached is a list of research papers on Schwartz rounds that you might find useful.
  5. Content Article
    Providing high quality healthcare has an emotional impact on staff. Often they experience high levels of psychological distress, face increasing levels of scrutiny, regulation and demand, and have increasingly limited resources. Schwartz Center Rounds® (Rounds) were developed to support healthcare staff deliver compassionate care by providing a safe space where staff could openly share and reflect on the emotional, social and ethical challenges of their work. Rounds are a monthly staff forum (not attended by patients) where three to four employees (panellists) present short accounts of their experiences of delivering patient care. This organisational guide is based upon the findings from an evaluation of Rounds in the UK, undertaken between 2014 and 2016. The evaluation was commissioned by the National Institute for Health Research and led by Professor Jill Maben at King’s College London (now at the University of Surrey). The evaluation aimed to distil the findings and learning for practical application by organisations seeking to implement and/or sustain Rounds in their organisations.
  6. Content Article
    A glimpse of moving and powerful Rounds discussions that took place at the Massachusetts General Hospital Cancer Center and at Emerson Hospital in Concord, MA, USA
  7. Content Article
    This blog looks at how positive reporting of good practice and success can help support health systems and organisations in their journey to become highly reliable and improve patient safety. This is part of a joint series of blogs and video conversations exploring how we can improve patient safety through the application of principles of high reliability in healthcare, made collaboratively by Patient Safety Learning and RLDatix. 
  8. Content Article
    At the first Patient Safety Management Network (PSMN)* meeting of 2022, we were privileged to hear from a bereaved relative about her shocking experience, which reminded us all of why we do what we do.  Claire Cox, one of the PSMN founders, invited Susan (not her real name to protect her confidentiality) to share with us the causes of her relative’s untimely death and the poor and shameful experience when she and her GP started to ask questions. This kicked off a valuable and insightful discussion about how patients are responded to when things go wrong and about honesty and blame, patient and family engagement in decision making when patients are terminally ill, and how we need to ensure that the new Patient Safety Incident Response Framework (PSIRF) guidance embeds good practice informed by the real-life experience of patients and staff.
  9. Content Article
    In this blog, Patient Safety Learning’s hub Editor, Samantha Warne, summarises a recent Patient Safety Management Network (PSMN) session she joined to hear from James Munro, Chief Executive of Care Opinion, about how patients are using Care Opinion to share their experiences and how Trusts are using the feedback.
  10. Content Article
    In this opinion piece for The New York Times, David Brooks looks at the value of being 'at the edge of the inside'. He argues that being within an organisation, but not so close to the centre that you are subsumed by the 'group think', puts an individual in a good position to positively influence the organisation's culture and practice.
  11. Content Article
    Quality improvement initiatives take many forms, from the creation of standards for health professionals, health technologies and health facilities, to audit and feedback, and from fostering a patient safety culture to public reporting and paying for quality. For policymakers who struggle to decide which initiatives to prioritise for investment, understanding the potential of different quality strategies in their unique settings is key. This volume, developed by the Observatory together with OECD, provides an overall conceptual framework for understanding and applying strategies aimed at improving quality of care. Crucially, it summarises available evidence on different quality strategies and provides recommendations for their implementation. This book is intended to help policy-makers to understand concepts of quality and to support them to evaluate single strategies and combinations of strategies.
  12. Content Article
    In this opinion piece for the BMJ, David Oliver, a consultant in geriatrics and acute general medicine, draws lessons from the Grenfell Tower disaster and subsequent public inquiry. 72 people lost their lives in the fire that destroyed Grenfell Tower in 2017. Evidence to the public inquiry has shown that several residents had raised concerns about the building's safety over many years, and that architects, building contractors, and providers and fitters of cladding material had also expressed concerns about the safety of the exterior cladding used on Grenfell Tower. David Oliver highlights that had these concerns been listened to and acted on, the disaster could have been avoided and many lives saved. He draws parallels with concerns being raised by patients about the safety of the healthcare system and highlights the role of staff in repeatedly raising and keeping a record of concerns. He states that NHS leaders must create a culture where no one is afraid to speak out and act to mitigate safety issues. Leaders must expect to be held accountable for their response - or lack of response - to safety issues raised.
  13. Event
    until
    Online patient feedback, as mediated through the national platform Care Opinion, has turned out to be both information for, and intervention into, the healthcare system. As online feedback becomes normalised across health services, this raises a new question: is online feedback relevant only at an operational level, or also at a strategic and policy level? This webinar will explore what we already know from research about Care Opinion as information and as intervention, and explore how it is already being used to support system-level initiatives in Scotland and Northern Ireland. The webinar is hosted by the Person-centred Care Team in the Scottish Government, in partnership with the Northern Ireland Public Health Agency and Care Opinion. Who should attend This webinar will be of interest to anyone concerned with improving healthcare quality, safety, culture or transparency at an organisation or system level. Programme Download the webinar programme (Word) Register
  14. Event
    until
    The Health Research Authority is running its first ever research transparency week. They believe that keeping participants updated and informed as a study develops, as well as with the results at the end, should be the norm. When researchers work with patients and the public to plan individual studies, we hear that recruitment is easier, participants are better supported, and findings are more relevant to patient needs. Ongoing communication between researchers and participants throughout a study can offer further improvements. This strengthens relationships, and creates more opportunities for feedback and improvements to be made in the way findings are shared. This will be a two-hour online workshop, chaired by the co-Chairs of the Make it Public campaign group, Matt Westmore, Chief Executive of the HRA, and Derek Stewart, public contributor. The objective for attendees of this workshop will be to work together in facilitated small groups to explore this theme, and produce a set of 'top tips' to support best practice for those active in research. There will also be a short panel discussion, where attendees can hear directly from the study leads and research participants of studies working creatively and progressively in this area: UCL Covid-19 Social Study The INHALE Project Covid Voices Register for the workshop
  15. Event
    until
    In this research chat, Care Opinion welcomes back Dr Lauren Ramsey of Leeds University to discuss her recent paper: Exploring the sociocultural contexts in which healthcare staff respond to and use online patient feedback in practice: In-depth case studies of three NHS Trusts. Research chats are informal and friendly and last 30 minutes. For the first 15 minutes, Care Opinion CEO James Munro discusses the paper with Lauren and then invite comments and questions via the chat box (or in person if you prefer!). Anyone can come along—you don't need to be academic and you don't even need to read the paper beforehand. So do join us! Register
  16. Event
    Frontline staff often perceive event reporting as a black hole where no information exits once it enters. Join Andy Moyer, BSN, RN-BC, patient safety informatics specialist at Penn State Health Milton S. Hershey Medical Center, where he will help you tackle this perception by providing reporters better feedback. Moyer will also demonstrate ways to increase the quantity and quality of reported events. Register
  17. Event
    This conference will focus on measuring, understanding and acting on patient experience insight, and demonstrating responsiveness to that insight to ensure patient feedback is translated into quality improvement and assurance. Through national updates and case study presentations the conference will support you to measure, monitor and improve patient experience in your service, and ensure that insight leads to quality improvement. For further information and to book your place visit https://www.healthcareconferencesuk.co.uk/conferences-masterclasses/patient-experience-insight or email nicki@hc-uk.org.uk hub members receive 20% discount. Email info@pslhub.org for discount code. Follow on Twitter @HCUK_Clare #PatientExp
  18. Event
    until
    This participatory event, concerning research undertaken on patient safety, will consist of a 45 minute talk followed by a Q&A/interactive discussion about how hospital care can be improved and how the public can be empowered to be involved in their care. The talk will specifically draw upon Dr Elizabeth Sutton's recent research, which explored how patients understood patient safety, and how this affected the ways that they were involved in their care when hospitalised. The Head of Patient Safety at University Hospitals of Leicester NHS Trust will be participating in the event and there will be a screening of an animated video based upon Dr Sutton's research on patient perceptions and experiences of involvement in their safety. What’s it about? We are all likely to receive hospital care at some point in our lives or have relatives who have experienced hospital care. This makes it vitally important that we are well informed about what patients experience when hospitalised and how best to improve that care. This event aims to highlight what patient safety means to patients, why it matters and to find ways of empowering the public to be involved in their hospital care. I want to find out whether these experiences resonate with you. How could patient safety be improved? What would you like to see happen? How can we best help patients to speak up about their care when hospitalised? As an attendee, you will hear about research on this topic and have the opportunity to ask questions and put across your point of view. This event will be led by Dr Elizabeth Sutton, Research Associate, University of Leicester. It will be of particular interest to anyone who has experience of hospital care or whose relative has received hospital care and patient groups. Book a place a the event
  19. Event
    until
    This participatory event, concerning research undertaken on patient safety, will consist of a 45 minute talk followed by a Q&A/interactive discussion about how hospital care can be improved and how the public can be empowered to be involved in their care. The talk will specifically draw upon Dr Elizabeth Sutton's recent research, which explored how patients understood patient safety, and how this affected the ways that they were involved in their care when hospitalised. The Head of Patient Safety at University Hospitals of Leicester NHS Trust will be participating in the event and there will be a screening of an animated video based upon Dr Sutton's research on patient perceptions and experiences of involvement in their safety. What’s it about? We are all likely to receive hospital care at some point in our lives or have relatives who have experienced hospital care. This makes it vitally important that we are well informed about what patients experience when hospitalised and how best to improve that care. This event aims to highlight what patient safety means to patients, why it matters and to find ways of empowering the public to be involved in their hospital care. I want to find out whether these experiences resonate with you. How could patient safety be improved? What would you like to see happen? How can we best help patients to speak up about their care when hospitalised? As an attendee, you will hear about research on this topic and have the opportunity to ask questions and put across your point of view. This event will be led by Dr Elizabeth Sutton, Research Associate, University of Leicester. It will be of particular interest to anyone who has experience of hospital care or whose relative has received hospital care and patient groups. Book a place a the event
  20. Content Article
    Patients are increasingly describing their healthcare experiences publicly online. This has been facilitated by digital technology, a growing focus on transparency in healthcare and the emergence of a feedback culture in many sectors. The aim of this study was to identify a typology of responses that healthcare staff provide on Care Opinion, a not-for-profit online platform on which patients are able to provide narrative feedback about health and social care in the UK. The authors used framework analysis to qualitatively analyse a sample of 486 stories regarding hospital care and their 475 responses. Five response types were identified: non-responses, generic responses, appreciative responses, offline responses and transparent, conversational responses. The key factors that varied between these response types included the extent to which responses were specific and personal to the patient story, how much responders' embraced the transparent nature of public online discussion and whether or not responders suggested that the feedback had led to learning or impacted subsequent care delivery. Staff provide varying responses to feedback from patients online, with the response types provided being likely to have strong organisational influences. The findings offer valuable insight and have both practical and theoretical implications for those looking to enable meaningful conversations between patients and staff to help inform improvement. The authors suggest that future research should focus on the relationship between response type, organisational culture and the ways in which feedback is used in practice.
  21. Content Article
    Diagnostic error research has largely focused on individual clinicians’ decision making and system design, largely overlooking information from patients. This article in the journal Health Affairs analysed a unique data source of patient- and family-reported error narratives to explore factors that contribute to diagnostic errors. The analysis identified 224 instances of behavioural and interpersonal factors that reflected unprofessional clinician behaviour, including ignoring patients’ knowledge, disrespecting patients, failing to communicate and manipulation or deception. The authors concluded that patients’ perspectives can lead to a more comprehensive understanding of why diagnostic errors occur and help develop strategies for mitigation. They argue that health systems should develop and implement formal programs to collect patients’ experiences with the diagnostic process and use these data to promote an organisational culture that strives to reduce harm from diagnostic error.
  22. Content Article
    The UK Government is seeking the views of members of the public on an interim delivery plan to improve experiences and outcomes of people with myalgic encephalomyelitis (ME)/chronic fatigue syndrome (CFS). The consultation asks for views on: research attitudes and education living with ME/CFS language used in relation to ME/CFS The responses will be used to help the Government understand:how well the plan identifies and addresses the issues most important to the ME/CFS community and where further action may be required. This consultation closes at 11:59pm on 4 October 2023.
  23. Content Article
    In January 2023, NHS England’s Delivery plan for recovering urgent and emergency services committed the health service to ease the growing pressure on hospitals by scaling up the use of ‘virtual wards’. Also known as ‘hospital at home’, virtual wards allow people to receive treatment and care where they live, rather than as a hospital inpatient, while still being in regular contact with health professionals. This article by The Health Foundation looks at how NHS staff and the UK public feel about the use of virtual wards, based on the results of a survey of 7,100 members of the public and 1,251 NHS staff members. The survey aimed to assess how supportive these groups are of virtual wards and what they think is important for making sure they work well.
  24. Community Post
    I've been searching for a definition of "Lessons Learned", to inform some internal discussion and a policy review. However, I cannot seem to find one anywhere - I've tried as much NHSI and old NPSA documentation as I can get my hands on, Googled some Trust policies, and done some other searches. The closest I can find is some wording on Knowledge for Healthcare: This seems to be a start, but not necessarily specific to incidents and learning from investigations. I'm also keen to use wording from an organisation which already carries a bit of weight and gravitas, rather than developing our own, if possible. Is anyone aware of anything I might have missed?
  25. Content Article
    The NHS Long Term Workforce Plan 2023 is crucial to the long term sustainability of the health service. The National Centre for Rural Health and Care is concerned that the plan has not been 'rural proofed' and makes very few references to rural issues. They are preparing a response and are looking for views about the plan through this survey. The closing date for responses is 4 August 2023.
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