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Showing results for tags 'Organisational culture'.
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Content ArticleThe National Guardian's Office and the role of the Freedom to Speak Up Guardian were created in response to recommendations made in Sir Robert Francis QC’s 2015 report The Freedom to Speak Up. The office leads, trains and supports a network of Freedom to Speak Up Guardians in England and conducts speaking up reviews to identify learning and support improvement of the speaking up culture of the healthcare sector. This annual report shares intelligence and learning collated by the National Guardian’s Office, including data about the cases Freedom to Speak Up Guardians receive. Over 20,000 speaking up cases were brought last year, meaning cases remain at the record level set in 2020/21. The report also features case studies from different healthcare providers across England, sharing the experiences of people who have spoken up about a wide range of issues, and demonstrating the ways in which organisations have improved staff confidence in being able to speak up.
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Content ArticleIn this article for NHS Confederation, Sir Chris Ham reflects on progress made against his recommendations on the conditions ICSs need to succeed and on next steps for the Hewitt review. He argues that progress has been made in acting on some of the recommendations in the report Governing the Health and Care System in England. This can be seen in plans to create a new NHS England (NHSE), reduce staffing at the centre and regions and co-produce the operating framework. However, he highlights that more work is needed to reduce the number of national NHSE programmes, ensure greater consistency in how these programmes work and bring an end to constant bidding for funds tied to specific priorities. He recommends that high priority be given to an organisational development (OD) programme to support the development of collaboration, mutual respect and trust and determine how peer support, shared learning and improvement collaboratives can play a bigger part in improving performance in future. Sir Chris highlights that the Hewitt review offers an opportunity for these and other issues to be addressed with priority being given to ensuring that planning guidance for 2023/24 is short and focused on a small number of national priorities, leaving scope for ICSs to add local priorities. Leaders in the DHSC and NHSE must recognise the exceptional pressures facing the health and care system and set out what a realistic set of medium-term objectives for ICSs looks like under current circumstances.
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Content ArticleAppreciative Inquiry (AI) is a transformational change methodology grounded in theories from the disciplines of human sciences and philosophy. It invites people to see themselves and the world through an appreciative or valuing eye. This article by AI strategist Robyn Stratton-Berkessel aims to provide an overview of AI for beginners, and covers: What is Appreciative Inquiry How it is a strengths-based, positive framework What it can achieve through collaborative conversations The 4-D process of Appreciative Inquiry – known as the Appreciative Inquiry Model How it can be applied personally and professionally The guiding principles (Including the new addition of the five emerging principles) The importance of Appreciative Inquiry questions – affirmatively-framed questions The value of story-telling in Appreciative Inquiry
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Content ArticleIn this video published by Patient Safety Movement, Kimberly Cripe, CEO of the Children's Hospital of Orange County (CHOC), discusses how her hospital has incorporated Actionable Evidence-Based Practices to improve patient safety culture in a paediatric setting. She describes the many benefits of the approach including for staff morale and making financial savings.
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Content ArticleThis blog by Robert Otto Valdez, Director of the US Agency for Healthcare Research and Quality (AHRQ), outlines the setbacks to patient safety and the healthcare workforce caused by the Covid-19 pandemic. He highlights areas of concern including workforce burnout and an increase in healthcare associated infections (HAIs) since 2020. The issues faced by the US healthcare system are not felt equally, and Valdez draws attention to a report that demonstrates worsening health inequalities. The blog includes links to evidence-based research and initiatives developed by AHRQ aimed at improving current patient safety priorities. Toolkits to improve antibiotic use. These resources are based on a “Four Moments of Antibiotic Decision Making” model that has shown success in hospitals, long-term care facilities, and ambulatory care practices. Tools to engage patients and families in making healthcare safer. Patients and families are powerful partners in improving quality and safety in hospital settings, during primary care visits, or whenever a diagnosis is made. These resources help ensure that patients’ voices are heard. Surveys on patient safety culture. This family of surveys asks healthcare providers and staff about the extent to which their organisational culture supports patient safety. Each survey is designed to assess patient safety culture in a specific setting. Diagnostic Centers of Excellence. These grants establishing 10 centres of excellence are aimed at developing systems, measures, and new technology solutions to improve diagnostic safety and quality.
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Content Article
Dr Freya Smith, a Specialty Trainee in General Practice, reflects on the sinister and toxic side of medicine, using the recent Paterson and vaginal mesh scandals to demonstrate how patients have been let down by the system. In an honest and personal account, she shares with us the horror and sadness she felt at learning of these scandals and how she aspires to keep her future patients safe. -
Content ArticleIn December 2022, the All Party Parliamentary (APPG) for Whistleblowing heard evidence on the state of the NHS following the recent report on the avoidable deaths and life changing injuries caused to mothers and babies at the East Kent Trust. The culture at this hospital was described as one where “everyone knew the problems” and where whistleblowers were “thrown to the lions”. A culture attributed to 45 of the 65 baby deaths reviewed. This blog first appeared on the Whistleblowers UK website in December 2022.
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Content ArticleThis survey undertaken by SCATA and supported by the FightFatigue group is looking at rest facilities and culture in anaesthesia and intensive care. Aims: To describe the current situation regarding availability and quality of rest facilities in anaesthetic and intensive care departments in the UK and ROI, compared with current standards. To describe the current situation regarding rest culture in anaesthetic and intensive care departments in the UK and ROI, compared with current standards. To feedback to departments and provide a benchmarking of their practice as compared to current standards and peers nationally. If you would like to take part, please follow the link and enter the data into the data collection tool for each rota, in consultation with colleagues as you feel necessary. The data collected will be shared with partners in the FightFatigue group and used in line with the aims of the project as above and to produce a summary report. In this report, each Trust/Board will be able to identify their own data but not others. Please direct queries to fatigue@scata.org.uk.
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Content ArticleDr Mike Farquhar talks and writes a lot about the importance of healthcare professionals being able to look after themselves, both for their own wellbeing but also to improve the care we give to our patients. He has collated a Twitter thread of resources on the theme.
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Content ArticleProfessor Mary Dixon-Woods looks at improving the quality and safety of care in hospitals, and suggests that we need to take a three-pronged approach: ensuring we are collecting the right data and interpreting it intelligently, looking at the systems we work in and finally how culture and behaviour impact on quality of care.
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Content ArticleVideo recording and slides of a webinar presented by Mary Dixon-Woods, Professor of Medical Sociology and Wellcome Trust Investigator.
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Content ArticleIn this article, Roger Kline, Research Fellow at Middlesex University, explains what caused the sinking of the Herald of Free Enterprise ferry. The sinking of the Herald of Free Enterprise on March 6 1987 with the loss of 198 lives was an accident waiting to happen, highlighting the devastating consequences of abandoning safe working practices in the name of financial savings. Human factors science learned from the Herald disaster is widely applied in sectors as diverse as nuclear power stations and healthcare.
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Content ArticleNHS England has recorded two podcasts sharing insight and advice from organisations that have completed the transition from the National Reporting and Learning System (NRLS) to the new Learn from Patient Safety Events (LFPSE).
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Content ArticleIncident reporting is a crucial tool for improving patient safety, alongside an open culture that supports this. In the NHS the new Learn from Patient Safety Events (LFPSE) service is now being rolled out to replace the current National Reporting and Learning System (NRLS) and Strategic Executive Information System (StEIS). This article details correspondence between Patient Safety Learning and NHS England in relation to concerns raised by staff about the development and implementation of the LFPSE service
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Content ArticleThis cross-sectional study in BMJ Evidence-Based Medicine aimed to understand the relationship between financial conflicts of interest and recommendations for atrial fibrillation (AF) screening in the UK. The authors looked at whether the UK media recommend for or against screening for AF and the financial conflicts of interests of AF screening commentators. The authors found that the vast majority of UK media promotes screening for AF, in contrast to the position of the independent UK National Screening Committee, which recommends against screening. Most commentators, internal NHS organisations and UK charities promoting screening had a direct or indirect financial conflict of interest. Independent information was rare and the reasons for this are unknown. They recommend readers consider the potential impact of financial conflicts on recommendations to screen.
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Content ArticleRoyal Cornwall QI conference online book supporting the conference. The online brochure highlights all the quality improvement projects at Royal Cornwall Hospitals.
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Content ArticleIn this episode of the What the HealthTech? podcast, Radar Healthcare's Chief Product Officer Mark Fewster speaks to Helen Hughes, Chief Executive of Patient Safety Learning. to get the lowdown on NHS England's new Patient Safety Incident Response Framework (PSIRF). Helen talks about how PSIRF is going to drive an open and just culture, what can be expected after the transition and why the implementation process is key to PSIRF's success. Listen on Spotify Listen on YouTube
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Content ArticleOn 9 November 2022, The Professional Standards Authority hosted the Safer care for all conference to discuss questions and issues highlighted in the report Safer care for all – solutions from professional regulation and beyond. This webpage contains video summaries of the conference sessions. The conference provided an opportunity to hear experts’ views as well as consider and contest the themes raised in the report, including the PSA's main recommendation, the creation of a health and social care safety commissioner in all four UK countries. Speakers and delegates came from both professional and system regulators as well as patient organisations, the ombudsman, the NHS, health and care sector organisations and major healthcare inquiries.
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Content ArticleIn this HSJ article, Gemma Dakin and George Croft from the Health Innovation Network share their reflections on the HSJ Patient Safety Congress. They highlight key themes that emerged including the need to listen to patients, service users, and carers stories, and encourage their involvement to bring about a cultural change. They argue that humanity will be central to making progress in quality improvement and patient safety.
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Content ArticleAdam Tasker spent over a decade in the Royal Navy before starting medical training at the University of Warwick. In this article for BMJ Leader, he reflects on a near miss incident that he was involved in while working as a Helicopter Warfare Officer, examining his attitudes and those of his colleagues, and the practices and behaviours of the squadron’s leaders. He compares his experience in the Royal Navy to that of his experience as a medical student, and identifies lessons that are relevant to medical training, professional expectations and the management of clinical incidents. These lessons aim to support the implementation of a Just Culture within the NHS.
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Content ArticleRadar Healthcare has published its 'Incident Reporting in Secondary Care' whitepaper – an in-depth analysis of reporting within secondary care and its effects on patient safety. It has taken a look into the current state of incident reporting: the good work being done, the concerns across the sector, and how we can all aim to improve the situation. The report was conducted using a panel provided by SERMO from its database of UK Nurses and includes the views from 100 nursing staff members working in hospital wards across the UK. Those surveyed work with hospital in-patients daily and are responsible for reporting safety and regulatory incidents involving patients to senior colleagues.
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News Article
Eighteen deaths following Tees health trusts' safety lapses
Patient Safety Learning posted a news article in News
Eighteen people died at two Teesside hospital trusts following patient safety lapses over a 12-month period. Sixteen such deaths were recorded at the South Tees Hospitals NHS Foundation Trust, with two at the North Tees and Hartlepool NHS Foundation Trust. Examples of patient safety lapses include a failure to provide or monitor care, a breakdown in communication, an out-of-control infection in a hospital, insufficient staffing or a missed diagnosis. NHS England figures show that, between April 2021 and March this year, there were 16,557 incidents at the South Tees Trust, which operates James Cook University Hospital in Middlesbrough, and Northallerton's Friarage Hospital. Thirty-four resulted in "severe" harm. Middlesbrough MP Andy McDonald told the Local Democracy Reporting Service the figures were a concern and that he planned to take them up with the South Tees Trust's chief executive. He said NHS staff worked under "the most demanding of conditions" but added: "Every person going into hospital rightly expects to receive the best treatment. Patient safety is paramount and no family wants to see a loved one suffer." Dr Mike Stewart, the trust's chief medical officer, said: "We encourage an open and transparent culture and promote the reporting of all patient safety incidents, even when there is uncertainty over a direct link between any problems in care and incidents of severe harm or death. "In the last year there were no deaths graded as definitely preventable due to a problem in the care delivered by the trust. "While our reporting has increased consistently over the last three years, the number of serious incidents has not risen, which is strong evidence of a positive safety culture." Read full story Source: BBC News, 30 October 2022 -
News Article
Board to get anti-racism training as CQC orders cultural improvements
Patient Safety Learning posted a news article in News
Regulators have told the agency that supplies blood to the NHS to develop a more inclusive culture, after hearing multiple reports of ethnic minority staff being ‘disrespected’ and discriminated against. “Many staff” at NHS Blood and Transplant also expressed fear of reprisal for raising issues and concerns, the Care Quality Commission (CQC) said. The CQC carried out a “well-led” inspection of the agency over the summer, after receiving concerns about its culture and the behaviour of some senior leaders. Chief executive Betsy Bassis resigned after the inspection, although the CQC report does not refer to any specific allegations made against her. NHSBT has acknowledged it needs to improve its culture, particularly around diversity and inclusion issues. An internal memo sent to staff last week, seen by HSJ, said executives and board members would receive one-to-one training in “inclusive leadership and understanding racism”. Read full story (paywalled) Source: HSJ, 27 October 2022 -
News ArticleTrust chief executives risk becoming “prisoners” of organisations with poor cultures if they do not “step back and see the bigger picture”, a former chief inspector of hospitals has said. Ted Baker said he was “tired” of people getting angry about cultural problems in the NHS while doing nothing to change it, amid an appeal for “less anger and more thoughtful interventions”. He told HSJ’s Patient Safety Congress greater understanding was needed about what will change culture, and working to do so, rather than “rail against the culture in the way people do all the time”. Professor Baker said: “One of my real concerns is that we often end up criticising individuals in organisations because they, if you like, embody the ‘wrong’ culture. “But many individuals are often prisoners of the culture themselves, but we don’t see that. “You put a chief executive into an organisation with a poor culture, if they don’t have the wisdom and the vision to step back and see the bigger picture, they could become trapped in the culture themselves.” Read full story (paywalled) Source: HSJ, 24 October 2022
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News ArticleThe troubled agency that supplies blood to the NHS has a ’very serious problem’ with racism, a staff survey has revealed. Six hundred staff at NHS Blood and Transplant were surveyed and the results have been summarised in an internal memo, seen by HSJ. It said 55% of respondents felt the problem of racism at NHSBT is “extremely or very serious”, while half had little confidence in the organisation’s recent efforts to tackle racial inequality. When contacted for comment, a NHSBT spokeswoman said the results were “difficult to read” and added that “we are deeply sorry to those who have experienced negative behaviour”. The issues over race and leadership come at perhaps the most operationally challenging period in NHSBT’s history. It is struggling to find enough staff for its donation clinics, which meant it issued its first-ever “amber alert” over blood supplies recently. Read full story (paywalled) Source: HSJ, 21 October 2022
