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Found 1,320 results
  1. Content Article
    The National Institute for Health and Care Research (NIHR) Evidence Collections draw together evidence from important NIHR-funded and wider research. They aim to help people in policy and practice understand recent important research in a topic area. The most recent Collection is Maternity services: evidence for improvement. In this blog, one of the Collection's authors, Candace Imison, describes how it was framed by the findings from a recent investigation into failings in East Kent Hospitals’ maternity services. She focuses on some key messages from evidence on how to identify poor performance and provide effective board governance and oversight.
  2. Content Article
    In England, the NHS National Breast Screening Programme (NHSBSP) offers routine breast screening to all women, some trans men and non-binary people, between the ages of 50 years and up to their 71st birthday, every 3 years. The unfolding Covid-19 pandemic in early 2020 was understandably a time of great anxiety and concern. Culturally we were seeing strong behavioural shifts such as social distancing and a general change in all our daily life patterns. Conceptually, and as leaders, we understood the vulnerability we observed, but felt that we did not have the 'right language' and in fact lacked the relevant experience of how to address and communicate with staff and clients during this crisis. A semiotic, observational research project was utilised that aimed at providing insight how cultural behaviour was being shaped and expressed during the early onset of the Covid-19 pandemic in England. The recommendations of the project were then integrated and implemented into an action plan and subsequent practice. Semiotic analysis revealed that several factors (positive and negative) impacted on peoples' confidence and had practical and emotional implications. Eleven main codes which are belief systems about oneself and others were identified and expressed in a multitude of different ways revealing three main themes or needs i.e. Reassurance, Trust and Clarity. An action plan was developed in response to the project findings and recommendation were implemented. Effective leadership relies on situational awareness. This semiotic project enabled the authors to find the 'right' language and communication style so that they could connect with staff at the time of crisis.
  3. Content Article
    Burnout is a workplace syndrome characterised by three core attributes: 1) energy depletion or exhaustion, 2) a cynical or negative attitude toward one’s job, and 3) reduced professional efficacy. That second attribute, workplace cynicism, may be the least-understood aspect of burnout in part because of its complexity. In contrast to exhaustion and diminished efficacy, whose causes and effects are relatively straightforward, cynicism can be caused by a number of workplace factors, and it can be expressed in a broad range of emotional states and behaviours. Cynicism is dangerous to both individual and organisational health and can also spread rapidly throughout teams through a phenomenon known as “emotional contagion.” It’s possible to improve even deep-seated cynicism — and better yet, to prevent it from infecting your organization in the first place. The author of this Harvard Business Review article offers strategies to help reverse existing cynicism and to create an anti-cynical culture at work.
  4. Content Article
    The NHS in England has largely relied on a human resources trilogy of policies, procedures and training to improve organisational culture. Evidence from four interventions using this paradigm—disciplinary action, bullying, whistleblowing and recruitment and career progression—confirms research findings that this approach, in isolation, was never likely to be effective. Roger Kline proposes an alternative methodology, elements of which are beginning to be adopted, which is more likely to be effective and to positively contribute to organisational cultures supporting inclusion, psychological safety, staff well-being, organisational effectiveness and patient care.
  5. Content Article
    Standardised data and integration of systems are vital for full traceability, improving patient safety, and enabling swift action in healthcare incidents. The PIP breast implant scandal was not the first and transvaginal mesh will not be the last. In fact, the next national patient safety scandal is likely manifesting today. “There needs to be better processes to ‘track and trace’ patients who have received a device when a problem arises,” says Professor Sir Terence Stephenson, Nuffield professor of child health at UCL Great Ormond Street Institute of Child Health and chair of the Health Research Authority for England, in the Scan4Safety 2020 report. “Clear strategies and channels are needed to inform patients, the public and clinical professionals to help improve safety.” One common denominator among such incidents is the lack of traceability – limited visibility of the devices used, when and where they are used and, most importantly, in or on which patients. This is where standardised data comes into play. There is no shortage of data in the NHS. However, the ability to standardise and share that data between systems and organisations is something the health service as a whole still lacks. Today, achieving full traceability remains a key challenge for the NHS, with repercussions that continue to have a detrimental effect on patient care.
  6. Content Article
    NHS Impact ‘improving patient care together’ is the term NHS England is using for the new single, shared NHS improvement approach. This includes the five components which form the ‘DNA’ of all evidence-based improvement methods, which underpin a systematic approach to continuous improvement: Building a shared purpose and vision. Investing in people and culture. Developing leadership behaviours. Building improvement capability and capacity. Embedding improvement into management systems and processes. When these 5 components are consistently used, systems and organisations create the right conditions for continuous improvement and high performance, responding to today’s challenges, and delivering better care for patients and better outcomes for communities.
  7. Content Article
    This blog by Operations Insider looks at the Gemba Walk approach to problem solving in systems. Gemba Walks involve looking at problems where they occur and discussing them on site, in the real world. The blog includes a series of questions to consider when using the Gemba Walk approach,
  8. Content Article
    The Bucharest Declaration is the outcome of a World Health Organization (WHO) high-level regional meeting on health and care workforce in Europe that took place in Bucharest 22-23 March 2023. It makes 11 statements relating to the workforce crisis facing countries across Europe about retention, recruitment and staff safety.
  9. Content Article
    In 2002, a dedicated group from Pennsylvania passed the Medical Care Availability and Reduction of Error (MCARE) Act, the most robust state-level legislation of its kind. Its legacy remains 21 years later. In this interview with the journal Patient Safety, Pennsylvania's Patient Safety Authority chair, Dr Nirmal Joshi, discusses ways care has improved, what challenges persist, and how to achieve the unachievable—true culture change.
  10. Content Article
    Partha Kar, National Specialty Advisor for NHS England, has led work that has had an enormous impact for patients and for patient safety. In this video podcast, Steph O'Donohue from Patient Safety Learning talks to Partha about his leadership style and how it has helped him drive forward significant change in an often challenging context.  Partha talks about the power of the patient community, workforce morale, sharing failures and leading with honesty. 
  11. Content Article
    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.
  12. Content Article
    This is part of our series of Patient Safety Spotlight interviews, where we talk to people working for patient safety about their role and what motivates them. Stephen talks to us about his time as turnaround Chair of Mid Staffordshire NHS Foundation Trust, how NHS boards can ensure they live their values and why creating a safe space to share concerns improves patient safety.
  13. Content Article
    Compassionate leadership builds connection across boundaries, ensuring that the voices of all are heard in the process of delivering and improving care. In order to nurture a culture of compassion, organisations require their leaders – as the carriers of culture – to embody compassion and inclusion in their leadership. Where leaders model a commitment to high-quality and compassionate care, this impacts everything from clinical effectiveness and patient safety to staff health, wellbeing and engagement. The King's Fund's work, through courses, blogs and articles, explores the role of, and supports, leaders in creating a culture of compassion and inclusion.
  14. Content Article
    Primary care, like many parts of the NHS and health systems globally, is under tremendous pressure – one in five people report they did not get through or get a reply when they last attempted to contact their practice. The Fuller Stocktake built a broad consensus on the vision for integrating primary care with three essential elements: streamlining access to care and advice; providing more proactive, personalised care from a multidisciplinary team of professionals; and helping people stay well for longer.  The joint NHS and Department for Health and Social Care (DHSC) plan is an important first step in delivering the vision set out in Dr Claire Fuller’s Next steps for integrating primary care.
  15. Content Article
    Helen Vernon explains why the role of director of safety and learning at NHS Resolution can make a lasting difference to the safety of NHS patients.
  16. Content Article
    On 23–24 February 2023, the 5th Global Ministerial Summit on Patient Safety in Montreux, Switzerland, marked the first convening of global leaders to discuss patient safety for more than 3 years. The summit provided the opportunity to reimagine the way safe care is delivered using learnings from the COVID-19 pandemic. In this correspondence in the Lancet, Shaw et al. hopes we will look back at the Montreux summit as a turning point in patient safety: the catalyst for moving from plans to actions, so that at future summits we can discuss shared learning and evaluation of health systems that deliver safe care to all.
  17. Content Article
    NHS and social care continues to have significant challenges. This blog cannot change that but it offers food for thought on how to stay afloat. 
  18. Content Article
    Social care in England entered the pandemic in a fragile state. With much already written about the government’s response to the Covid-19 pandemic in the social care sector, this new report from the Nuffield Trust in collaboration with the Care Policy and Evaluation Centre analyses the structural and systemic factors that influenced that initial national response. Covid had far-reaching impacts on social care and exacerbated many longstanding issues. This work seeks to highlight progress and identify where action is needed to create a more resilient system.
  19. News Article
    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
  20. News Article
    The government has promised to build more surgical and community diagnostic hubs in England and to give patients greater control over their healthcare provider as part of its long awaited recovery plan for elective care to reduce the NHS backlog and tackle waiting times. But the targets set out on 8 February will not be met without the staff to run the expanded services, health leaders have warned. Andrew Goddard, president of the Royal College of Physicians, said that the plan depended on the “recovery of urgent and emergency care, as the two are intimately entwined both with respect to workforce and estate.” He added, “We will also need to build on it with a full plan for recruiting enough new staff to meet patient demand and the steps we’ll take to retain existing staff, including flexible and remote working for those returning to practice." Read full story (paywalled) Source: BMJ, 8 February 2022
  21. News Article
    Public figures accused of wrong-doing announce they are “sorry if” people have been offended, outraged, confused etc by their words or actions. The implication is that it is people’s reactions that have inspired the sorrow, not shame about the actions themselves – and often that those reactions are disproportionate to whatever perceived wrong has occurred. Nearly as common is the “sorry but” tactic in which the public figure expresses sorrow, but adds some qualification that effectively absolves themselves of blame and, again, perhaps suggests the concern is disproportionate. Sometimes, of course, the non-apology is just that - ‘I’ve done nothing to feel sorry about’. This is again, often followed by, ‘which is more than can be said for…’ It now appears as if the non-apology is being adopted by some NHS leaders. In the space of seven days we have seen: The Christie react to a report saying it had been “dismissive” of whistleblowers by – appropriately – dismissing the report as inaccurate and out of date. The leadership of Walsall Healthcare Trust and Royal Wolverhampton Trust deploy the “sorry if” defence against accusations of “poor behaviour” by implying they needed to bang some heads together to drive improvement. The chief executive of University Hospitals Birmingham express irritation about his referral to the General Medical Council, stating that he could “live with” the “admin error” which he said had sparked it. Read full story (paywalled) Source: HSJ, 4 February 2022
  22. News Article
    An 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
  23. News Article
    There is no significant relationship between the number of managers or the amount spent on management and the quality of NHS hospital services, research has concluded. Researchers at the London School of Economics studied the performance of all 129 non-specialist acute trusts between 2012-13 and 2018-19. They measured hospital performance on five indicators covering financial position, elective and emergency waiting times, level of admissions and mortality. This was then compared to the number of managers each trust employed and the amount spent on management staff. The researchers also attempted to measure the quality of management based on answers given to relevant questions in the annual NHS staff survey. Reviewing the evidence they analysed, the LSE team state: “We find no evidence of an association between our measures of quantity of managerial input and quality of management… Furthermore, we find no associations between our measures of quantity of management input and five measures of hospital performance.” They add: “This holds, irrespective of how we define managerial input, whether by number of managers or expenditure on management. These results are generally robust to how we account for variation between hospitals and within hospitals over time.” This leads the researchers to conclude: “Hospitals hiring more managers do not see an improvement in the quality of management leading to better performance, and increasing the numbers of managers does not appear to improve hospital performance through any other direct or indirect mechanism.” Read full story (paywalled) Source: HSJ, 17 January 2022
  24. News Article
    A hospital rated inadequate by inspectors two years ago has been praised for making improvements. The Care Quality Commission (CQC) has welcomed changes in urgent and emergency care at Stepping Hill Hospital in Stockport, Greater Manchester. The trust said the report was a "testament" to its staff's hard work. The CQC's unannounced inspection in November was carried out to check improvements had been made since a previous visit in August 2020. Among the concerns highlighted previously were patients left at high risk of harm during periods of heavy demand, staff shortages and staff who were "not competent for their roles". The new report said inspectors found urgent and emergency care had improved from inadequate to good overall and for being safe and well-led. "It has gone from requires improvement to good for being effective and caring. Responsive has gone from inadequate to requires improvement," the report said. Karen Knapton, CQC's head of hospital inspections, said: "We acknowledge the efforts of the emergency care team at Stepping Hill Hospital. We found staff provided good care and treated people with compassion and kindness." "They gave patients, their families and carers help, emotional support and advice when they needed it. Also, the service has been tailored to meet individual needs, including those living with dementia or a learning disability. " Read full story Source: BBC News, 12 January 2022
  25. News Article
    NHS leaders have been accused of downplaying the impact of the Covid crisis and putting hospitals under scrutiny for declaring critical incidents and postponing surgeries. A leaked email urges hospitals to use the “correct terminology” and make NHS leaders aware when declaring their status. Sources said the message was a “thinly veiled threat” and that there was “subtle pressure” amid rapid spread of Omicron. At least 24 trusts have declared critical incidents this week, including one in Northamptonshire on Friday afternoon, while new figures show a 59% rise in staff absences in just seven days. Trusts in London were told hospitals will be scrutinised for declaring a critical incident if there is “doubt” over the decision, according to an internal email sent from NHS England on Wednesday. In light of media coverage, it would be “valuable” to “raise awareness of the key terminology and encourage you to ensure that you are clear ... when considering a declaration,” it said. “National scrutiny on the declaration on incidents has heightened ... and [senior managers] will need to make additional enquiries where there is doubt as to the status of an organisation’s incident.” Shadow health secretary Wes Streeting said: “We know that the NHS is under enormous pressure and it is important that local trusts are able to be honest and open with parliament and the public about the challenges they’re facing. We are increasingly concerned that ministers are more interested in covering up problems than solving them.” Daisy Cooper, the Lib Dem Health spokesperson, said: “This is an insult to every health worker who has given their all, and every patient with cancelled appointments and delayed surgeries. Read full story Source: The Independent, 9 January 2022
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