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Found 1,089 results
  1. 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.
  2. Content Article
    Recently, there has been a concerning increase in the number of deaths of pregnant women, especially from Black, Asian and deprived backgrounds. In addition, there have been several investigations into safety issues in maternity services, such as the Ockenden, East Kent, and Shrewsbury and Telford report. This National Institute for Health and Care Research (NIHR) Collection highlights evidence in priority areas, identified in the East Kent report, to support high-quality care and avoid safety issues in maternity services.
  3. Content Article
    This policy paper from the Department of Health and Social Care sets out the Government’s response to the recommendations of the investigation into the death of Elizabeth Dixon in respect of the failures of care she received from the NHS.
  4. 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.
  5. 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.
  6. 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. 
  7. News Article
    Nearly 150 doctors have been disciplined for sexual misconduct in the last five years, as surgeons call for action on the “systemic” and “cultural” problem of sexual assault within healthcare, The Independent can reveal. Doctors campaigning for the UK’s healthcare services to address widespread problems with sexual harassment and assault in medicine have warned that people do not feel safe to come forward with allegations amid deep-seated “hierarchies” within healthcare. The Royal College of Surgeons’ Women in Surgery chair has said the issues are “widespread” across the health services and improvements to protecting whistleblowers needed to be made nationally. Last year, surgeons Becky Fisher and Simon Fleming wrote an academic paper exposing the problem of sexual assault, harassment and rape in surgery and surgical training. In interviews with The Independent, both have warned the “institutional” problem goes beyond surgery and across all of the healthcare services. Mr Fleming said the figures from the GMC were the “the very tip of the iceberg” in terms of actual levels of sexual assault within healthcare. Talking about the role of the GMC, Mr Fleming said he’d been told “by more than one person” that when they’ve reached out to the GMC over sexual assault or misconduct they were “failed” by the regulator and were “either not helped, abandoned or told to deal with it locally”. Read full story Source: The Independent, 15 February 2022
  8. News Article
    Allowing staff enough rest has been ‘the key’ to elective recovery for an acute trust which has the lowest number of 52-week waiters in England, it has said. Maidstone and Tunbridge Wells (MTW) Trust currently has just one patient who has waited 52 weeks or more on its lists, compared with a high of 976 at one point in April 2021. MTW is one of a handful of trusts with very few long waiters. All are relatively small trusts – and are not regional centres for specialist/tertiary patients – but their 52-week-waiters also represent less than 1% of their total list. MTW chief of service for the surgery division Greg Lawton told HSJ its success in tackling long waiters was down to “attention to detail” in tracking each patient, and not expecting staff to run too many extra sessions. “Any problems patients are having getting through their pathways are identified early and addressed,” he said. "Treatment had been prioritised on the grounds of clinical need, he added, with cancer treatments still going ahead and cancer targets being met." The trust, in the South East, has put on extra operating sessions to clear some of its backlog of patients but these had been limited in number, Dr Lawton said. “What we have never done is try to run too many and I think that may be the key. If you try to do too much you will burn staff out,” he said. The trust had “been mindful that staff need a break,” he added. “Morale is very important.” Read full story (paywalled) Source: HSJ, 16 February 2022
  9. News Article
    The leadership of a prominent cancer trust acted in a ‘defensive and dismissive’ manner when serious concerns were raised about bullying behaviours and multiple failings in the handling of a major research contract, an external review has found. As previously revealed by HSJ, NHS England commissioned the review into events at The Christie Foundation Trust after whistleblowers raised numerous concerns over a research project with pharmaceutical giant Roche, and about the way they were treated as a result of speaking out. The NHSE review, which was led by Angela Schofield, chair of Harrogate and District FT, was published earlier today within trust board papers. It described the trust’s research division as “ineffective” and said it had “allowed inappropriate behaviours to continue without challenge”. The review added: “It may… be thought to be surprising that NHSE/I found it necessary to commission an external rapid review to look into concerns which had been raised by colleagues within the research and innovation division." “The root cause of this seems to be an apparent failure by those people in leadership positions who were aware of the concerns that had been raised, in the circumstances covered by the review, to listen to and take notice of a number of people who have some serious issues about the way they are treated and wish to contribute to an improvement in the culture." It also summarised the experiences of 20 current and former staff members who said they suffered “detriment as a result of raising concerns”, although it did not make a clear judgement on whether their claims were justified. They said: “An experience of bullying, harassment and racial prejudice was described along with lack of respect at work… Patronising behaviour, humiliation and verbal aggression by managers and clinicians in public and private spaces contributed to the perception that working environments were emotionally unsafe.” Read full story (paywalled) Source: HSJ, 27 January 2022
  10. News Article
    One of the NHS’ most high-profile mental health trusts has ‘multiple’ corporate governance problems and ‘deep-seated’ cultural issues, according to an external review. Tavistock and Portman NHS Foundation Trust, which provides mental health, educational and training services in London, commissioned an external firm to look into its leadership amid a period of intense public scrutiny in the latter half of 2021. Among cultural issues identified at the trust, which reviewers described as “deep seated”, was a reluctance of staff to speak up about concerns. Assessors said a recent employment tribunal, which ruled the trust’s treatment of a whistleblower had damaged her professional reputation and “prevented her from proper work on safeguarding”, had impacted the ability of staff to raise concerns. They urged leaders to review their Freedom to Speak Up and whistleblowing procedures. And while reviewers commended board members for commissioning an external review of race equality, they said it had “yielded an outpouring of emotion” which suggested many staff from minority ethnic groups do not feel consistently supported, respected or valued. Read full story Source: HSJ, 25 January 2022
  11. News Article
    More than £100 million has been paid out in damages by one hospital trust over 10 years after its maternity units were accused of being responsible for dozens of deaths and stillbirths, Channel 4 News has revealed. From April 2010 to March 2021, £103,097,198 was paid out by the Mid & South Essex NHS Foundation Trust involving 176 obstetrics claims, according to NHS Resolution figures obtained by a freedom of information request. Of those claims made against the trust, 36 related to mothers and children dying, 27 referred to stillbirths and 55 concerned babies born with brain damage or cerebral palsy. Gabriela Pintilie died in Basildon University Hospital, which is run by the trust, in 2019 after losing six litres of blood giving birth, and a coroner said there were “serious failings” in her care. Basildon University Hospital’s maternity unit was twice rated inadequate in 2020, following two separate inspections, with a report saying the service “did not always have enough staff to keep women safe”. The report also criticised “longstanding poor staff culture” which had “created an ineffective team”. In August 2020, the Care Quality Commission (CQC) issued a warning notice to the hospital as inspectors found six serious incidents occurred between March and April that year in which babies were born in a poor condition starved of oxygen and at risk of brain damage. Read full story Source: Channel 4 News, 14 January 2022
  12. News Article
    East of England Ambulance Service Trust has launched an ‘independent investigation into the circumstances’ surrounding the death of a staff member, its chief executive told a board meeting today. Nick Lee, 46, from Ovington in west Norfolk, died on 3 December. The cause of death is yet to be officially established. He was a leading operations manager for west Norfolk, and hospital ambulance liaison officer at Queen Elizabeth Hospital King’s Lynn Foundation Trust and had worked for the ambulance trust for nearly 20 years. This is not the first time the trust, which has faced significant cultural problems in recent years, has been required to investigate the circumstances surrounding the deaths of members of their workforce. The trust launched an investigation into the “underlying factors associated with” the sudden deaths of three of its employees in November 2019, HSJ exclusively revealed in January 2020. A whistleblower alleged in 2019 that staff at the ambulance provider were at risk of suicide because of its “completely toxic culture”. A month after the allegations were reported in October, three young staff members died suddenly in 11 days. The deaths happened while the trust was transitioning to a new staff welfare provider. The staff who died were ambulance dispatcher Luke Wright, aged 24, and paramedics Christopher Gill, from Welwyn Garden City, and Richard Grimes, from Luton. Read full story (paywalled) Source: HSJ, 13 January 2022
  13. News Article
    A Christian nurse who claimed she was discriminated against for wearing a cross at work has won her case for unfair dismissal. Mary Onuoha, a theatre practitioner at Croydon University Hospital in London, said she was bullied and harassed for refusing to remove her necklace in 2018. But an employment tribunal has ruled Croydon Health Services NHS Trust discriminated against and harassed Ms Onuoha over her refusal to remove the jewellery. The trust told her the necklace was a safety risk and must not be outwardly visible. Ms Onuoha, supported by Christian Legal Centre, said she had worked at the hospital for 13 years before being asked to remove the symbol. The tribunal found the employer’s uniform policy arbitrary, with many staff allowed to wear necklaces and other religious symbols were permitted. Following the ruling, Christian Legal Centre chief executive Andrea Williams said the trust’s interpretation of uniform guidance had led to a campaign of harassment against a devoted, experienced, and highly professional nurse, who was in effect hounded out of the NHS. Ms Onuoha said she was investigated and suspended from clinical duties when she refused to remove the item and she was demoted to receptionist duties. In June 2020, she went off work with stress and said she felt she had no alternative but to resign. Read full story Source: Nursing Standard, 6 January 2022
  14. News Article
    NHS England has set out 10 priorities for 2022-23 in its annual planning guidance. NHSE chief executive Amanda Pritchard makes clear in an introduction that many of its goals remain contingent on covid, stating: ”The objectives set out in this document are based on a scenario where covid-19 returns to a low level and we are able to make significant progress in the first part of next year.” The 10 priorities are: Workforce investment, including “strengthening the compassionate and inclusive culture needed to deliver outstanding care”. Responding to COVID-19. Delivering “significantly more elective care to tackle the elective backlog”. Improving “the responsiveness of urgent and emergency care and community care capacity.” Increasing timely access to primary care, “maximising the impact of the investment in primary medical care and primary care networks”. Maintaining “continued growth in mental health investment to transform and expand community health services and improve access”. Using data and analytics to “redesign care pathways and measure outcomes with a focus on improving access and health equity for underserved communities”. Achieving “a core level of digitisation in every service across systems”. Returning to and better “prepandemic levels of productivity”. Establishing integrated care boards and collaborative system working, and “working together with local authorities and other partners across their ICS to develop a five-year strategic plan for their system and places”. Read full story (paywalled) Source: HSJ, 24 December 2021
  15. News Article
    West Suffolk Foundation Trust’s investigation to find a whistleblower was “intimidating…flawed and not fit for purpose”, according to a damning review which is highly critical of the organisation’s leadership. The long-awaited review, published today, was triggered by ministers back in January 2020 following allegations that trust directors had ordered staff to give fingerprints and handwriting samples during a “witch hunt” for a whistleblower. The review, led by Christine Outram, has corroborated many of the allegations. It concluded trust leaders’ investigation to uncover the identity of the author of an anonymous letter sent to a patient’s family was “intimidating, flawed and not fit for purpose… impractical and unwise.” It said: “The decision to use fingerprinting and handwriting analysis in an NHS hospital, in the context of an anonymous letter and where no crime has been committed, was highly unusual and without doubt extremely ill-judged.” Read full story (paywalled) Source: HSJ, 9 December 2021
  16. News Article
    Efforts to end health inequalities should be ‘in the mix’ of metrics used to determine the NHS’ progress against key performance targets, say race inequality experts. In an exclusive interview with HSJ, NHS Race and Health Observatory (RHO) director Habib Naqvi said organisations’ performance on the issue should be scrutinised by an external body to ensure they are held accountable and “not marking their own exam answer”. It comes as the RHO publishes a report that warns the appointment of health inequalities leads across the NHS risks becoming “tokenistic” if they are not adequately supported and held accountable. The report by The King’s Fund think tank has recommended several actions to prevent the introduction of board-level leads from becoming a “hollow gesture”. In August 2020, NHS England asked all NHS organisations to have a named executive board member responsible for tackling inequalities by October that year. The RHO estimates there to be more than 450 of these named leads across the country. The report welcomed this but added “frameworks” of support and accountability should exist to “empower individuals and motivate change”. The recommendations include putting inequalities on an “equal footing” with key performance metrics, as well as a long-term policy focus that puts addressing inequalities “at the heart of system development”. Read full story (paywalled) Source: HSJ, 1 December 2021
  17. News Article
    Frontline staff are being ‘triggered’ by ministers playing down the ‘overwhelming’ pressures facing the health service with “a ‘move along, no story here’-type attitude”, a royal college president has warned. The Royal College of Emergency Medicine’s Katherine Henderson said the intentions of those making such comments may be “well meaning” but that it was important ministers and NHSE leaders were “humble and transparent about the scale of the problem [facing the NHS] at the moment”. Katherine Henderson said: “The scale of the problem feels quite overwhelming, and the kind of ‘move along, no story here’-type attitude I think is not great for the people working in healthcare. They need to feel heard.” Read full story (paywalled) Source: HSJ, 24 November 2021
  18. News Article
    ‘Unprofessional’ behaviours, a lack of compassion, and tension among staff and managers are all contributing to pockets of ‘poor culture’ at an acute trust. A Freedom to Speak Up report presented to the board of Buckinghamshire Healthcare Trust found there had been an increase in bullying and reports of staff members being “humiliated” during the last three months. The report, which covers the first two quarters of 2021-22, highlighted a “lack of compassion, kindness, and understanding” between colleagues and noted “increasing levels of frustration” that people are not being held to account for “unprofessional” poor behaviours. The report added the findings were not surprising due to the pressures of the pandemic experienced by staff. It found: “There appears to be an increase in the proportion of concerns around interpersonal behaviours and communication issues as well as levels of frustration and tension amongst staff and managers.” Read full story (paywalled) Source: HSJ, 24 November 2021
  19. News Article
    A ‘culture of distrust’ between consultants and the use of incident reporting as a tool of ‘reprisal’ impacted patient care at a trust’s cardiology department, a review has concluded. An external review undertaken for Hull University Teaching Hospitals Trust has made a series of recommendations after looking into allegations of bullying and several examples of poor care within its cardiology services. In a report published in the trust’s board papers, the Royal College of Physicians reported a “perceived tendency to downplay clinical incidents, and, to undermine those who wanted to raise patient safety issues”. It added: “We met a group of individual consultants who did not work well as a team. There is a culture of distrust, a lack of departmental cohesion and allegations of bullying in the department. All of which reinforce a clear divide between the interventional and non-interventional consultant cardiologists." “There have been a number of allegations of belittling, intimidation and undermining…The review team heard accounts of a culture where datix has been used as a tool for possible personal reprisal along with ignoring/downplaying incidents that have been raised.” The review concludes: “This behaviour is impacting on patient care and therefore, all medical staff should be reminded of good medical practice as the [General Medical Council] code of conduct of how doctors must work collaboratively with colleagues.” Read full story (paywalled) Source: HSJ, 16 November 2021
  20. News Article
    A major trust’s Freedom To Speak Up Guardian has warned that a failure to address staff concerns about alleged bullying and long-standing ‘dysfunctional behaviours’ is damaging confidence and resulting in the loss of high-quality staff. Professor Julian Bion, presenting a half-yearly report to University Hospitals Birmingham Foundation Trust’s board, revealed that the majority of the 41 reports to the FTSU service between April and October this year had expressed a “fear of detriment” when raising concerns. Just under half (44%) of 34 concerns raised by the contacts related to “problematic attitudes and behaviours”, ranging from reports of micro-aggressions to overt bullying. Professor Bion, UHB’s FTSU guardian since 2019, told HSJ such concerns are always “complex and sensitive issues” and recognised that the trust is handling them during “difficult circumstances” for the NHS. UHB has seen very large numbers of covid patients throughout much of the pandemic. But he warned the board that several “common themes” were emerging in UHB’s complaints process – including a fear of detriment, “problematic” delays to cases being resolved, and a lack of response from divisional departments. Suggesting there is a “disinclination” within the trust to address concerns, he said: “Very often, these dysfunctional behaviours are known about for a long time but they haven’t been addressed.” Read full story (paywalled) Source: HSJ, 2 November 2021
  21. News Article
    Senior managers at an NHS trust are facing calls to resign from local councillors after criticism of the trust’s culture and widespread bullying. The chair of Nottinghamshire County Council's health scrutiny panel has called for the chair of Nottingham University Hospitals Trust Eric Morton to step down along with Keith Girling, the trust’s medical director. Councillor Sue Saddington, chair of the council’s scrutiny committee, said she would be writing to health secretary Sajid Javid over concerns about leadership at the trust. An investigation by The Independent and Channel 4 News earlier this year uncovered dozens of cases of negligent baby deaths and injuries costing millions of pounds in compensation. Families have accused the trust of trying to cover-up mistakes and not learning from errors. More than 30 babies have died at the trust in the past decade with 46 children left with brain damage. Read full story Source: The Independent, 13 October 2021
  22. News Article
    A hospital for men with learning disabilities has been placed in special measures after the Care Quality Commission (CQC) identified “serious risks to patient safety”. The CQC said it had also suspended its current rating of “good” for caring for Cygnet Woodside, Bradford, West Yorkshire, following an inspection in September. The commission said it carried out the unannounced inspection following allegations of abuse by staff towards a patient, which are subject to an ongoing police investigation. The hospital said it was “disappointed” with the CQC’s assessment, stressing that the inspection was triggered by its own management notifying the commission of a concern it had identified. It said the report “does not provide an entirely accurate representation” of the hospital. Dr Kevin Cleary, the CQC deputy chief inspector of hospitals and lead for mental health, said: “Our latest inspection of Cygnet Woodside found that the hospital was not ensuring its patients’ safety.” Cleary added: “The service showed warning signs that increased the likelihood of a closed culture developing. This would have put people at serious risk of coming to harm if we didn’t take action.” He said care was compromised because there was not always the right number or skill level of staff looking after patients. Read full story Source: Guardian, 23 December 2020
  23. News Article
    Strong leadership, challenging poor workplace culture, and ringfencing maternity funding are key to improving safety. That’s the message from two leading Royal Colleges as they respond to the independent review of maternity services at Shrewsbury and Telford NHS Trust led by Donna Ockenden. The RCOG and the Royal College of Midwives (RCM) have today welcomed the Ockenden Review and its recognition of the need to challenge poor working relationships, improve funding and access to multidisciplinary training and crucially to listen to women and their families to improve learning and to ensure tragedies such as those that have happened at Shrewsbury and Telford NHS Trust never occur again. The Colleges have said that the local actions for learning and the immediate and essential actions laid out in this report must be read and acted upon immediately in all Trusts and Health Boards delivering maternity services across the UK. Commenting, Dr Edward Morris, President of the Royal College of Obstetricians and Gynaecologists, said: “This report makes difficult reading for all of us working in maternity services and should be a watershed moment for the system. Reducing risk needs a holistic approach that targets the specific challenges of fetal monitoring interpretation and strengthens organisational functioning, culture and behaviour." Read press release Source: RCOG, 10 December 2020
  24. News Article
    The NHS is under pressure to publish a delayed review into a bullying scandal at Matt Hancock’s local hospital that involved senior clinicians being asked to provide fingerprint samples in a “witch-hunt” for a whistleblower. The “rapid review” into West Suffolk hospital, which Hancock had to recuse himself from because of his friendship with the boss at the trust, was ordered in January and had been due for completion in April. Its publication was put back to this month because of the coronavirus pandemic. But it is now not expected until spring. The Doctors’ Association UK suspects the conclusions are being sat on because they make embarrassing reading for the trust’s chief executive, Steve Dunn, described by Hanock as a “brilliant leader”. A consultant who chairs the hospital’s medical staff committee wrote to the NHS’s regional director for the east of England, Ann Radmore, last week warning that senior medics felt the hospital could not move on until the review was published. The NHS East insists the review will be published as soon as possible, but a source confirmed this is likely to be “spring next year”.
  25. News Article
    Trusts have been urged to reflect on their disciplinary procedures, and review them annually where required, following the death of a senior nurse who took his own life after being dismissed. NHS England’s chief people officer Prerana Issar has written to trust leaders to highlight Imperial College Healthcare Trust’s new disciplinary procedures, which were put in place following Amin Abdullah’s suicide. Mr Abdullah, a senior nurse at Charing Cross Hospital in west London, was suspended in September 2015 before being let go from his job that December. He died in February 2016 after setting himself on fire. An independent investigation criticised both the trust and its staff and concluded he had been “treated unfairly”. The summary report produced by the trust was labelled a “whitewash”, which “served to reassure the trust that it had handled the case with due care and attention”, and the delay of three months between the events and hearing were “troubling”. The report, which also criticised the delays as “excessive” and “weak” in their justification, said Mr Abdullah found the delay “stressful” and caused him to become “distressed”. In the letter sent on Tuesday, seen by HSJ, Ms Issar said: “The shared learning from Amin’s experience has demonstrated the need for us to work continuously and collaboratively, to ensure that our people practices are inclusive, compassionate and person-centred, with an overriding objective as to the safety and wellbeing of our people… our collective goal is to ensure we enable a fair and compassionate culture in our NHS. I urge you to honestly reflect on your organisation’s disciplinary procedure…" Read full story (paywalled) Source: HSJ, 3 December 2020
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