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Content ArticleBoards and leaders of healthcare organisations are legally responsible for the performance of their organisation and must take definitive responsibility for improvements, successful delivery and failures in the quality of care. Board effectiveness relies on the ways in which board members translate their knowledge and information into quality and safety plans with measurable goals, maintain oversight on progress towards these goals and hold the chief executive accountable for these goals. This resource by the Canadian Patient Safety Institute lists tools available to boards and board members to allow them to understand their legislative responsibilities for quality and safety, conduct self-evaluation and understand the competencies needed to lead on quality and patient safety.
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Content Article
Monitor: The role of boards in improving patient safety (2010)
Patient Safety Learning posted an article in Boards
Patient care inevitably raises issues of safety. Safety measures can never be failsafe, but they can always be improved. The aim of this publication is to offer guidance to boards on helping to bring about these improvements. The publication was developed by Monitor for NHS foundation trusts, though its principles apply equally to other NHS settings. It draws on evidence and best practices from UK pilot sites, and also taps the experience of healthcare providers in other developed countries who use similar principles and approaches. The field research and work with the UK pilot sites took place between October 2009 and March 2010. -
Content ArticleThis guide by the Health Foundation can be used to make the case for improvement to policy, executive, operational and front-line audiences, and to initiate and support conversations about the benefits of improvement approaches among key stakeholders. The guide is divided into four broad areas improvement approaches can benefit: the health and care workforce patients, service users and society organisations and system-level bodies. Specific examples are given for each area, illustrating the diverse and multi-faceted benefits that come from improvement approaches.
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Content ArticleLessons from service and system failures describe the pivotal roles played by governance and leadership in delivering high-quality, safe care. This 'Element' publication from Cambridge Core, sets out what the terms governance and leadership mean and how thinking about them has developed over time. Using real-world examples, the authors analyse research evidence on the influence of governance and leadership on quality and safety in healthcare at different levels in the health system: macro level (what national health systems do), meso level (what organisations do), and micro level (what teams and individuals do). The authors describe behaviours that may help boards focus on improving quality and show how different leadership approaches may contribute to delivering major system change. The Element presents some critiques of governance and leadership, including some challenges that can arise and gaps in the evidence, and then draws out lessons for those seeking to strengthen governance and leadership for improvement. This title is also available as Open Access on Cambridge Core.
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News Article
Record 420,000 patients in England had ‘more than 12 hour wait’ in A&E last year
Patient Safety Learning posted a news article in News
A record 420,000 patients had to wait more than 12 hours in A&E last year, analysis has shown. The latest NHS England figures revealed a 20% increase on 2022 in people facing lengthy delays after a decision to admit them to hospital from the emergency department. In 2023, 419,560 people – or one in 15 A&E patients – faced “trolley waits” of 12 hours or more, according to the Liberal Democrats, who compiled the analysis. It marks by far the highest number since records began in 2011, and amounts to an average of 1,150 patients a day. Ed Davey, the party leader, criticised the “appalling delays” and accused Rishi Sunak’s government of “ignoring the suffering of patients and driving our health service into the ground”. Significant waits in A&E have been linked to excess deaths and increased harm to patients, as their condition could deteriorate before they are admitted or given a bed on a ward. Davey said: “Every year A&E delays are getting worse and worse under this Conservative government as hospitals are starved of the resources and staff they need. These appalling delays are leaving often vulnerable and elderly patients waiting for hours on end in overcrowded A&Es." Read full story Source: The Guardian, 14 January 2024 -
EventThe Patient Advocacy Leadership Collective (PALC) is an innovative hub that provides connectivity, community resources, and tools focused on sustainable capacity building for patient advocates globally. Advocacy skills are necessary for patient organisations as these allow the patients to actively participate in their healthcare, improve communication with healthcare providers, access information and resources, and contribute to positive changes in the healthcare system. The PALC is an excellent platform that is focused on supporting the growth, development, and leadership of patient advocacy organizations and offers a NextGen Leadership, Mentorship, and Global Health Fellows program. The PALC has been developed by leading global patient advocacy leaders with support from Pfizer. The purpose of this webinar is to spread awareness and build capacities by taking all concerned through this very important tool for Patient Advocacy. Register
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EventuntilIntegrated care systems (ICSs) have the potential to radically transform health and care through collaboration, long-term thinking, and by pushing the boundaries of what is possible. In this summit, we give voice to innovative thinking and practices by hearing from senior leaders and partners from both within and outside of the health and care service, who have found ways to create meaningful impact by doing things differently. Be inspired by leaders who despite challenging circumstances and a backdrop of a 30% reduction in running costs have carved out opportunities for collaboration to create transformational change. Join us at this event to be at the forefront of discussions and debate on how ICSs can work differently to meet the needs of their local populations and fulfil their original purpose. Through keynote speeches, panel debates, case studies and interactive workshops, this summit will explore: how we meet the potential of ICSs to transform health and care the importance of focusing on prevention as a way of sustainably meeting the needs of local populations, and the role data has in it how provider collaboratives and Integrated Care Boards (ICBs) can work together differently and effectively to deliver integrated care services how reconvening community services so that care is moved closer to home can potentially transform the health and care system the value of working with patients and communities to provide better services how system-wide solutions can be utilised to tackle the workforce crisis what leading in uncertainty feels like and what can be learnt from it. Register
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News Article
Letby inquiry: Former nurse director among ‘core participants’
Patient Safety Learning posted a news article in News
The former nursing director at the hospital where Lucy Letby murdered seven babies will be among the 'core participants' of the Thirlwall Inquiry. The inquiry, chaired by Lady Justice Thirlwall, will investigate how Letby was able to commit the murders and attempt six others while she worked as a neonatal nurse at Countess of Chester Hospital NHS Foundation Trust in 2015 and 2016. This week, Alison Kelly, who was director of nursing and quality at the trust during the time of Letby's crimes, was announced as 1 of 10 core participants in the inquiry. Also named were former Countess of Chester chief executive Tony Chambers, former medical director Ian Harvey and former human resources director Sue Hodkinson. Ms Kelly and Mr Harvey were among the senior staff at the trust who were accused of failing to act when clinicians first raised concerns about Letby. How managers responded to such concerns is one of the areas due to be investigated by the Thirlwall Inquiry. A number of organisations are also on the list as core participants, including the Nursing and Midwifery Council (NMC), NHS England, the Royal College of Paediatrics and Child Health, the Department of Health and Social Care and Countess of Chester itself. Read full story Source: Nursing Times, 3 January 2024 -
News Article
Managers fear ‘unfair’ professional regulation
Patient Safety Learning posted a news article in News
More NHS managers support regulation of their roles than oppose it, despite many fearing its implementation will be unfair or disproportionate, a survey suggests. The trade union Managers in Partnership surveyed NHS managers working at Agenda for Change band 8a and above throughout the UK late last year, collecting 291 responses. Asked whether they “in principle… support professional regulation of NHS managers”, 49% said they supported or strongly supported it. Just 19% said they opposed or strongly opposed, while the remainder were neutral. However, respondents – 22% of whom said they were already covered by a professional regulator, and likely to be nurses, doctors or finance or legal professionals – appeared sceptical about the benefits. Asked whether they thought professional regulation of NHS managers would make processes for raising concerns/whistleblowing better or worse, only 26% said it would be better. 20% said these would get worse, and the remainder said it would be “about the same”. Read full story (paywalled) Source: HSJ, 9 January 2023 -
News Article
NHSE to catalogue ‘harm and near misses’ where BMA rejects derogations
Patient Safety Learning posted a news article in News
The NHS will start recording harm caused to patients during strike action where exemptions have been rejected by the British Medical Association (BMA). BMA council chair Phillip Banfield yesterday accused NHS England of the “weaponisation” of the strike “derogation” process, saying trusts had this week submitted more of the requests, which would permit some striking doctors to return to work, and were not providing information needed to determine if they were justified. NHS England wrote back to Professor Banfield, insisting it was only trying to prioritise safety, but also saying it would revise its own approach to derogation requests. This will include: asking trusts whose requests were rejected by the BMA “to compile a picture” of the impact on services; reinforcing requirements to report patient safety incidents during strikes and after mitigation requests, so “we can evidence harm and near misses which might have been avoided”. The letter says: “We have consistently asked local medical and other clinical leaders to consider applying to the BMA for patient safety mitigations where they have significant concerns for patient safety that cannot be mitigated through other options available to them, and where they can make a strong evidential case that the return of a limited number of junior doctors would address these risks. “We have done this, in part, because we have received a number of reports over previous periods of action that some teams have been put off seeking patient safety mitigations because of their prior experience of having applications rejected, or not receiving a response in time. We are sure you would agree that this is an unsatisfactory position, and that where patient safety concerns exist, these should always be escalated appropriately.” Read full story (paywalled) Source: HSJ, 4 January 2024 -
Content ArticleThe World Health Organization (WHO) has shared a list of key milestones in their Global Patient Safety Journey during 2023.
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News Article
NHSE trying to ‘undermine’ doctors strike, claims BMA
Patient Safety Learning posted a news article in News
NHS England has been accused of bowing to political pressure and trying to “undermine” the junior doctors strike. British Medical Association council chair Philip Banfield tonight wrote to NHSE chief executive Amanda Pritchard accusing her organisation of the “weaponisation” of the process used to agree minimum services level during the strike. Junior doctors walked out yesterday to begin a six day strike, the latest in their 10 month campaign and the longest in NHS history. Professor Banfield’s letter claims that NHSE is not respecting the terms of the voluntary agreement to provide “derogations”. These, says the letter, “allow for junior doctors to return to work in the event of safety concerns arising from ‘unexpected and extreme circumstances’ unrelated to industrial action”. The BMA accuses trusts of not providing the information the union needs to determine if the requests for derogations are justified. It said that the lack of information provided by trusts had led to it turning down 20 requests for derogations. The letter states: “We are increasingly drawing the conclusion that NHS England’s change in attitude towards the process is not due to concerns around patient safety but due to political pressure to maintain a higher level of service, undermine our strike action and push the BMA into refusing an increasing number of requests; requests, we believe, would not have been put to us during previous rounds of strike action. “The change in approach also appears to be politicisation and weaponisation of a safety critical process to justify the Minimum Service Level regulations.” Read full story (paywalled) Source: HSJ, 3 January 2024 -
Content ArticleThe BMA has sent a letter to Amanda Pritchard, Chief Executive of NHS England, highlighting the increasing concerns from their members about the protection of healthcare workers and patients from Covid-19, particularly in light of the rise in cases, hospitalisations and deaths that occurred in September and October.
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Content ArticleEfforts to increase physician engagement in quality and safety are most often approached from an organisational or administrative perspective. Given hospital-based physicians’ strong professional identification, physician-led strategies may offer a novel strategic approach to enhancing physician engagement. It remains unclear what role medical leadership can play in leading programmes to enhance physician engagement. In this study, Rotteau et al. explore physicians’ experience of participating in a Medical Safety Huddle initiative and how participation influences engagement with organisational quality and safety efforts. They found that The Medical Safety Huddle initiative supports physician engagement in quality and safety through intrinsic motivation. However, the huddles’ implementation must align with the organisation’s multipronged patient safety agenda to support multidisciplinary collaborative quality and safety efforts and leaders must ensure mechanisms to consistently address reported safety concerns for sustained physician engagement.
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Content Article
TED talk: Tribal leadership (Ted Logan, March 2009)
Patient-Safety-Learning posted an article in Leadership
David Logan talks about the five kinds of tribes that humans naturally form—in schools, workplaces, even the driver's license office. He argues that by understanding our shared tribal tendencies, we can help lead each other to become better individuals. -
Content ArticleThis rapid evidence review and economic analysis makes the business case for investing in the wellbeing of NHS staff. It was written by a team from the University of East Anglia, RAND Europe and the International Public Policy Observatory (IPPO) and includes a narrative review of data on the current state of the mental health and wellbeing of NHS staff. Data shows that nearly half of staff reported feeling unwell as a result of work-related stress in the most recent survey, that sickness absence has increased and that there are high vacancy and turnover rates in some trusts. Research also shows that patient care can be affected by poor healthcare staff wellbeing.
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Content ArticleIn a video and article published in Trends in Urology and Men's Health, Peter Duffy shares his experience of what it is to be a whistle-blower in the NHS, in the context of historical scandals of UK healthcare and whistleblowing, examining the roles of the NHS itself, the regulators and the law in the ensuing events.
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News Article
Half trust’s staff told CQC they had ‘no confidence’ in its leaders
Patient Safety Learning posted a news article in News
More than half of a trust’s staff told the Care Quality Commission (CQC) they did not have confidence in its executive leadership, with just 16% saying they did, the regulator has reported. The CQC surveyed staff as part of its inspection of East Kent Hospitals University Foundation Trust. Eighty-four per cent either said they disagreed with the statement “I have confidence in the executive team”, or neither agreed nor disagreed. That leaves just 16% who said they did have confidence. Some said they felt “traumatised”, “devalued” or “damaged” by a recent restructuring programme at the trust, which has been grappling major care quality and performance problems for several years. The CQC also revealed in a report today that it issued a warning notice to the trust after inspections at its two main sites in July. They ordered immediate improvements in its emergency departments, medical care and children and young people’s services. Read full story (paywalled) Source: HSJ, 20 December 2023 -
News ArticleThe national clinical director for older people has announced he is leaving NHS England and said a major government funding settlement will be needed to maintain progress and take community services to the ‘next stage’. Adrian Hayter joined NHSE in 2019 as NCD for older people and integrated person centred care. Dr Hayter, who is also a longstanding GP partner in Berkshire, said community services were now much more prominent at NHSE — and in its asks of the service – than they were four years ago. He said: “When I first came in, there wasn’t very much in planning guidance about what was happening in the community at all. Now that is different and we are expecting a range of initiatives in 2024. “But the future is that all of these things are not individual programmes - they’re all part of a particular approach to how we manage and support people for as long as possible in their own homes. “Urgent community response [where services are required to respond within two-hours to urgent needs, referred from a range of services] and virtual wards are a continuum of care. “And the growth of virtual wards have helped extend what happens in the community all the way through to the acute level care.” National long-term funding for several of the new services – badged in the 2019 long-term plan as “Aging Well” – is also now due to end, with integrated care boards instead asked to commission them locally. Dr Hayter warned that, as well as moving those services closer together, there needed to be a future government spending review settlement aimed at growing community services, to meet the needs of the rapidly ageing population. Read full story (paywalled) Source: HSJ, 18 December 2023
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Content Article
Who’s who at NHS England (updated 23 November 2023)
Patient Safety Learning posted an article in NHS England
This overview provides detail on the structure of NHS England’s executive group. -
Content ArticleThis toolkit from the Institute from Healthcare Improvement (IHI) equips patient safety and finance leaders with tools and a collaborative approach to make a compelling business case for organizational investments to advance patient and workforce safety initiatives.
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EventuntilThe health and care workforce continues to face profound challenges, with severe staff shortages and increasing financial pressures across health and care. While the NHS Long Term Workforce Plan aims to support the NHS’s future needs, it does not cover the social care workforce, resulting in a knock-on effect across the entire health and care system, particularly for those who rely on social care services. To resolve the challenges facing health and care, the sector needs to embrace positive disruption and its potential to change the nature of work and to improve recruitment, retention and the health and wellbeing of the workforce. This event from the King's Fund will explore the changing nature of work and how this can support the health and care system to adapt to future challenges. It will look at the different expectations between those already in the workforce and those joining it, and the challenges and opportunities this presents – whether it’s redesigning job roles, reforming education and training and providing different routes into health and care careers, developing a system that embraces flexible working, creating spaces for digital collaboration, or supporting moves to shift care out of hospital and into the community. Attendees will consider how those working in health and care can be supported to make the most of these opportunities against the backdrop of deep-seated cultural issues in the health and care system. Conference sessions will explore how to support the health and care workforce to succeed in their roles, and how organisations can be more responsive to the needs of people who work in them, whether through redesigning job roles to enable staff to deliver the best possible care, reforming regulation to support managers to succeed, or creating development opportunities to enable staff to work in a way that supports their health and wellbeing. Please join us to learn and share your leadership and workforce challenges. You will also have the opportunity to collaborate with experts and leaders from across the health and care system through keynote speeches, panel debates and interactive workshops. Register
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Content ArticleJames Titcombe, Melanie Leis, and Peter Howitt delineate the major themes of a roundtable to address challenges in improving patient safety, emphasising the need for data sharing nuances, cultural shifts, optimising limited resources, prioritising workforce plans, and staff well-being.
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News Article
Black Country doctors back vote of no confidence in management
Patient Safety Learning posted a news article in News
Doctors at a Black Country mental health trust have backed a vote of no confidence in their management team. Sources say that the Black Country Healthcare NHS Trust is not acting in the best interests of patients and they believe it wants to cut beds. They also have no confidence in the way that the trust has removed its chief medical officer, Mark Weaver. The NHS Trust said it was aware of concerns and had agreed to work on them going forward. The doctors wrote to the trust board following a meeting of the Medical Advisory Committee claiming that over the past two years the relationship with the board had become fractured. In the letter they claimed the voice of doctors was not being taken seriously by the board and that clinical priorities were secondary to financial performance. They also said they were seriously disturbed with the way in which Mr Weaver had been asked to step down and that the deputy chief medical officer Dr Sharada Abilash had not been asked to take over while due process occurred. Read full story Source: BBC News, 9 December 2023 -
Content ArticleLucy Letby was allowed to continue working with new-born babies despite her colleagues raising concerns about her for months. Her conviction highlighted how NHS executives put the reputation of the Countess of Chester NHS Trust ahead of patient safety. But what happened in Cheshire was far from a one-off. File on 4 hears from doctors with unblemished medical careers who were sacked after raising patient safety concerns. The programme follows one medic through an Employment Tribunal as he attempts to save his career, and hears the emotional, brutal toll the process takes on him. For the first time, a top doctor who won record damages talks about the extraordinary steps her managers took to undermine her. Their tactics included relocating her to an empty office with a broken chair and telling colleagues that she agreed with their assessment she was incompetent. And a former NHS executive tells the programme that trusts are more interested in “flying LGBT flags” than tackling concerns about patient safety. With widespread calls for NHS managers to be regulated, File on 4 asks who should take on the role, given the willingness of the NHS to redeploy managers found to have ignored patient safety concerns, or even punished those who dared to raise them.
