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Showing results for tags 'Organisational Performance'.
Found 275 results
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Content ArticleQuality improvement and patient safety have been important topics on the agenda in the Danish health care system for >20 years. Over the years, Denmark has developed an array of national quality and patient safety initiatives. This paper aims to describe how quality improvement and patient safety initiatives have been organised in the Danish health care system and highlight how accountability has been achieved.
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EventuntilThis unique 1-day distance-learning course from Medled is delivered via Zoom by our expert trainers in a format designed to maximise learning retention and application of knowledge. You'll learn to: Understand the concept of systems thinking and models of safety – looking beyond the individual and the flawed concept of ‘Human Error’. Gain an introduction to human capabilities & limitations & how those influence quality and safety of care – how humans can be heroes and hazards. Be able to unpick the nature of human fallibility and why practice does not always make perfect. Have the knowledge to proactively contribute to the safety culture in your organisation. Be able to recognise error-provoking conditions and influence your systems of work. Understand the relationship between stress and performance/risk of error. Take away a tangible model for understanding the relationship between our physiological needs and performance – do we set ourselves up to fail? Understand strategies to optimise high-performance teamworking with ad hoc teams. Evidence-based, utilising cutting edge safety & performance science this course is suitable for all Healthcare Professionals, both clinical and non-clinical; it is applicable to all departments and multi-disciplinary teams. Accredited by Chartered Institute of Ergonomics & Human Factors, you'll take part in interactive actitvities and leave with practical tools to take away. Registration
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Content Article
Letter from America: “We got trouble my friends”
lzipperer posted an article in Letter from America
In her latest Letter from America, Lorri Zipperer explores the lack of coordination that is undermining the current US response to the COVID-19 crisis and preparation for the next phase. Letter from America is the latest in a Patient Safety Learning blog series highlighting new accomplishments and patient safety challenges in the United States. -
Content ArticleThe highly publicised crashes of two Boeing 737 Max aircraft quickly triggered pointed questions about the company’s commitment to safety versus profits. As we near the twentieth anniversary of the landmark Institute of Medicine (IOM) report on medical error, To Err is Human, that same level of scrutiny should apply to hospitals. Cost-benefit analysis is both a legitimate and crucial management function. But the criteria used in those calculations can range from appropriate to appalling. It’s long past time to examine how the “business case for safety” can sometimes represent a serious threat to patients’ lives. Michael L. Millenson discusses the dangers in the "business case" for patient safety in his blog in Health Affairs.
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News ArticleA quiet revolution in the NHS has happened. After decades of an internal market, NHS England has outlined new changes tying financial allocations and incentives to system-level performance instead. Over the past six months, providers had been allocated block funding based on activity from 2019/20 with top-ups and retrospective funding to support covid pressures, ensuring they financially break even during the crisis. Now, in a letter accompanying funding envelopes for Integrated Care Systems and Sustainability and Transformation Partnerships around the country, NHSE outlined how health service finances will be system managed for the remainder of the year. Systems will have not only control of the kitty (with all system costs to be met from its allocation) but funding will be linked to the performance of their member organisations, with some incentive payments or penalties for over/under performance at a system level. Glen Burley, the chief executive of a group of three acute trusts in the West Midlands, branded the move “very risky” and suggested a more traditional tariff performance would drive performance. Highlighting another of his concerns he said: “We have very little experience of doing so at system level, so this is a very risky tactic in a very risky year.” How systems will manage the shortfalls will hinge on elective delivery, system co-ordination, how to reduce forecast costs and recover income, set, of course, against the threat of a second wave of COVID-19. Read full story Source: HSJ, 17 September 2020
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Content ArticleThis overview considers how the NHS has performed over the current parliament in relation to patient safety. It looks at data relating to reported incidents and harm, episodes of care free of certain types of harm, and patient and staff perceptions of safety.
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Content Article
The challenge of culture change in the NHS
Claire Cox posted an article in Culture
Connection, inclusion and compassion are certain, unchanging, and provide a safe refuge to deal with what feels frightening and isolating for so many. The challenge set by the Francis Inquiry Report – to create a compassionate, inclusive organisational culture – is now amplified in the COVID-19 era, which the NHS entered with pre-existing record levels of staff stress and chronic excessive workloads. This workshop from the University of Manchester, explores the problems and opportunities associated with changing healthcare organisation cultures. -
News ArticleA GP practice serving one of Greater Manchester’s most deprived communities has been banned from operating for four months after regulators uncovered a catalogue of basic failures - including failing to follow up on a child reporting breathing difficulties for three days. Jarvis Medical Practice in Glodwick has had its registration with the Care Quality Commission (CQC) suspended after ‘serious concerns’ passed to the body led to a snap inspection last month. Inspectors found the practice, based at Glodwick Primary Care Centre, was failing 20 separate standards, many of them relating to patient safety. It noted ‘poor quality’ and conflicting records that were sometimes impossible to properly understand and urgent home visits delayed or not carried out at all. In one case a patient with a lump apparently received no physical examination and was not referred for tests or scans ‘due to Covid-19’. Inspectors also found examples of patients with breathing difficulties, including a child, who were not dealt with for days after they got in touch. In one case no further contact was made for 11 working days, with no explanation provided in the patient's notes. The practice, which serves more than 5,000 patients in the Oldham neighbourhood of Glodwick, has now been suspended by the CQC until October 11. Read full story Source: Manchester Evening News, 17 July 2020
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News ArticleDaniel Mason was born half a century ago without hands, with missing toes, a malformed mouth and impaired vision. From an early age, he and his family had to deal with people asking about his disabilities. The impact on his life has been considerable. Daniel’s mother Daphne long suspected the cause of his problems was a powerful hormone tablet called Primodos that was given to women to determine whether they were pregnant. But when she raised her concerns with doctors, they were dismissed. Now, at last, Daphne has been vindicated with official confirmation this week that her fears were right, in the landmark review by Baroness Cumberlege into three separate health scandals that has exposed a litany of shameful failings by the NHS, regulatory authorities and private hospitals. This damning report shows again the danger of placing a public service on a pedestal, with politicians happy to spout platitudes but scared to tackle systemic problems or confront the medical establishment. But how many more of these inquiries must be held? How many more disturbing reports and reviews must be written? How many more times must we listen to ministerial apologies to betrayed patients? How much more must we hear of ‘lessons being learned’ when clearly they are largely ignored? Read full story Source: Mail Online, 9 July 2020
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Content ArticleThe Lilypond is a new conceptual model to describe patient safety performance. It radically diverges from established patient safety models to develop the reality of complexity within the healthcare systems as well as incorporating Safety II principles. There are two viewpoints of the Lilypond that provide insight into patient safety performance. From above, we are able to observe the organisational outcomes. This supersedes the widely used Safety Triangle and provides a more accurate conceptual model for understanding what outcomes are generated within healthcare. From a cross-sectional view, we are able to gain insights into how these outcomes come to manifest. This includes recognition of the complexity of our workplace, the impact of micro-interactions, effective leadership behaviours as well as patterns of behaviour that all provide learning. This replaces the simple, linear approach of The Swiss Cheese Model when analysing outcome causation. By applying the principles of Safety II and replacing outdated models for understanding patient safety performance, a more accurate, beneficial and respectful understanding of safety outcomes is possible.
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Content ArticleMany people sense that the way organisations are run today has been stretched to its limits. In survey after survey, business people make it clear that in their view, companies are places of dread and drudgery, not passion or purpose. Organisational disillusionment afflicts government agencies, nonprofits, schools, and hospitals just as much. Further, it applies not just to the powerless at the bottom of the hierarchy. Behind a facade of success, many top leaders are tired of the power games and infighting; despite their desperately overloaded schedules, they feel a vague sense of emptiness. In this article, Frederic Laloux discusses and gives examples of 'teal' organisations.
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Content ArticleThis month’s Letter from America looks at perspectives examining collective responses to the COVID-19 pandemic through a systems analysis lens. Letter from America is the latest in a Patient Safety Learning blog series highlighting new accomplishments in patient safety from the United States.
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Content ArticleChallenges to the status quo present leaders with the opportunity and responsibility to not only respond but to learn and transform the system. This article from Slotkin et al. shares the experience of leaders at a large health system to design an emerging COVID response to effectively innovate to sustain improvement.
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Content ArticleNorth Tees and Hartlepool NHS Foundation Trust has achieved more than double its medicines savings target, delivering the best value for the North Tees and Hartlepool region and the wider NHS. The Trust’s Pharmacy and Medicines Optimisation team together in collaboration with the multidisciplinary medical and nursing teams, finance department and commissioners developed several work streams for medicines efficiencies and quality improvement initiatives. Getting best value for medicines is one of the core business priorities for the Pharmacy & Medicines Optimisation team, through significant collaboration with the multidisciplinary teams of senior medical, nursing, finance, and wider commissioning teams. The project has significantly benefited the organisation and the wider system, through exceeding the expectation of efficiency target, it has contributed directly to improving the quality of patient care and experience as well as ensuring the financial sustainability of the organisation.
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Content ArticleThis essay in The New Yorker summarises known weaknesses in US healthcare visible long before COVID-19—and discusses others more specific to the pandemic. The author suggests that efforts to change the system be informed by the COVID-19 experience. The work should not seek to return to the pre-pandemic state but instead aim to making changes based on what was revealed to improve health care delivery overall.
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Content ArticleThis is the YouTube Channel for the UCSF School of Medicine in the USA. Here you are able to listen and watch webinars on the latest 'grand rounds' on COVID-19. These webinars cover: paediatrics shape of the pandemic, digital innovation epidemiology, science & clinical manifestations of COVID-19 research general updates.
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Content Article
NHS: Specialty guides for patient management
Claire Cox posted an article in Guidance
Speciality guides for patient management during the coronavirus pandemic. -
Content ArticlePresentation slides for topic 5 of the WHO Multi-professional Patient Safety Curriculum Guide. The learning objective from this topic is to understand the nature of error and how healthcare providers can learn from errors to improve patient safety.
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News Article
Revealed: The trusts which will struggle most to deliver quality care in 2020
Patient Safety Learning posted a news article in News
The trusts which are likely to face the fiercest struggle to deliver quality care in the immediate future have been identified through an analysis carried out exclusively for HSJ. Analyst company Listening into Action has taken data from the NHS Staff Survey 2019 to produce “a set of ‘workforce at risk’ numbers that point to the likelihood (or not) of workforce stability and continuity challenges adversely affecting the care a trust’s key assets are able to deliver in the year ahead”. The analysis shows a strong correlation between staffs’ perceptions of how well they are supported, and care quality — and therefore reveals which trusts face the toughest challenge to improve performance. Read full story (paywalled) Source: HSJ, 9 March 2020 -
Content ArticleThe purpose of this guidance from the Royal College of Obstetricians and Gynaecologists (RCOG) is to urge all maternity units to consider the use of the Maternity Dashboard to plan and improve their maternity services. It serves as a clinical performance and governance score card to monitor the implementation of the principles of clinical governance on the ground. This may help to identify patient safety issues in advance so that timely and appropriate action can be instituted to ensure a woman-centred, high-quality, safe maternity care.
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Content ArticleImagine if hospitals could fly? Would they be safer for patients? Before you say to yourself, what a silly question. Please hear me out… Abdulelah M. Alhawsawi is Director General at the Saudi Patient Safety Center.
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Content ArticleAuthor 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."
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Content ArticleHuman 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.
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Content ArticleThis report from the King's Fund looks at the reality of caring for acutely ill medical patients at the NHS front line and asks how care in hospitals can be improved. It comprises a series of essays by frontline clinicians, managers, quality improvement champions and patients, and provides vivid and frank detail about how clinical care is currently provided and how it could be improved. The essays are introduced and summarised by Chris Ham and Don Berwick and the report serves as the starting point of an ongoing appreciative inquiry into improving care processes, particularly for acutely ill medical patients.
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News Article
NHS Staff Survey 2019
Patient Safety Learning posted a news article in News
Today the results of the National NHS Staff Survey 2019 are out. This is of the largest workforce surveys in the world with 300 NHS organisations taking part, including 229 trusts. It asks NHS staff in England about their experiences of working for their respective NHS organisations. The results found that 59.7% of staff think their organisation treats staff who are involved in an error, near miss or incident fairly. While an improvement on recent years (52.2% in 2015) work is needed to move from a blame culture to one that encourages and supports incident reporting. It also found that 73.8% of staff think their organisation acts on concerns raised by patients/service users. It is vital that patients are engaged for patient safety during their care and there is clear research evidence that active patient engagement helps to reduce unsafe care. Patient Safety Learning has recently launched a new blog series on the hub to develop our understanding of the needs of patients, families and staff when things go wrong and looking at how these needs may be best met.
