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Found 1,093 results
  1. Content Article
    When you are ready to implement measures to improve patient safety, this is the book to consult. Charles Vincent, one of the world's pioneers in patient safety, discusses each and every aspect clearly and compellingly. He reviews the evidence of risks and harms to patients, and he provides practical guidance on implementing safer practices in healthcare. The second edition puts greater emphasis on this practical side. Examples of team based initiatives show how patient safety can be improved by changing practices, both cultural and technological, throughout whole organisations. Not only does this benefit patients, it also impacts positively on healthcare delivery, with consequent savings in the economy. Patient Safety has been praised as a gateway to understanding the subject. This second edition is more than that it is a revelation of the pervading influence of healthcare errors and a guide to how these can be overcome.
  2. Content Article
    In this US based eMagazine Patient Safety: 20 Years after ‘To Err is Human,’ sees thought leaders from across the healthcare industry examine how shifting to patient-centred care has helped organisations across the country sustain a deeper culture of patient safety. By implementing strategies such as optimising health IT usability, advocating on behalf of patients and supporting healthcare workers, patient safety continues trending upward, leading to better outcomes.
  3. Content Article
    Amy Edmondson, PhD, Harvard professor and speaker at Learn Serve Lead 2019: The AAMC Annual Meeting, talks about how to create an interpersonal climate that encourages input from all members of the patient care team.
  4. Content Article
    Steve Turner is a healthcare professional, a nurse prescriber with experience in senior management in both the NHS and private sectors. He works as a clinician with vulnerable adults on the margins of society.  In this blog, published on Care Right Now, he reflects on the situation in England based on his experiences and those of the many people he has met as a result. All of whom experienced the backlash that can happen when organisational reputation trumps patient safety. One thing many of us have in common is that, put simply, we never intended to become known as ‘whistleblowers’ we were just trying to do our job to the best of our ability.
  5. Content Article
    John Dobbin is the editor of Thinking Digitally. Here he has written a blog on some of the barriers to psychological safety and why it is being ignored in the work place.
  6. Content Article
    Workplace incivility is low level and often not intended to cause harm. It can come from managers, colleagues and patients. Examples might include: eye rolling abrupt emails being interrupted, excluded or ignored hostile looks refusing to assist a colleague publicly criticising a colleague. See how incivility at work affects NHS staff and how that can impact negatively on patient safety. In this short film, join the staff of Epsom and St Helier University Hospitals NHS Trust on their journey as they reflect on the real-life effects of both incivility and active kindness. 
  7. Content Article
    In the past decade, hospitals and healthcare workers have become more familiar with medical errors and the harm they can cause. As a result, incident investigation has become a routine part of the hospital's response to an adverse event. Armed with the results of these investigations, research and quality improvement efforts are now taking on system improvements required to create a safer healthcare environment. There has also been increased attention paid to the appropriate handling of patients and families harmed by medical errors. There is developing recognition that disclosure of adverse events is necessary if hospitals are to learn from mistakes and improve patient safety outcomes. A growing number of accrediting and licensing bodies, as well as governmental entities and professional organisations, have stated the expectation that patients should be told about harmful medical errors. However, progress has been slower in translating policy into action at the level of the frontline clinician. Are these policies also beneficial to physicians and other healthcare workers, many of whom are already struggling just to get their work done? Wu and Steckelberg discuss this further in an Editorial published in BMJ Quality and Safety.
  8. Content Article
    Following the 'A New Strategy for Patient Safety - Insight, Involvement, Improvement' conference held in Manchester on the 16 October 2019, chaired by Helen Hughes of Patient Safety Learning, I am pleased to share the speaker presentations on the hub. A new London conference has been announced for 29 April 2020. Telephone: 0161 376 9007; Email: info@openforumevents.co.uk for further information.
  9. Content Article
    Speaking up, raising concerns, whistleblowing. However you describe it, we know it can be daunting. Supporting 'National Speak Up Month' , the General Medical Council (GMC) has provided advice and tools to help you.
  10. Content Article
    Rob Behrens talks to Dr Henrietta Hughes, the National Guardian for the NHS. Dr Hughes explains how her career as a GP has helped her in her national role and how NHS organisations can better support their Freedom To Speak Up Guardians.
  11. Content Article
    About one in ten patients are harmed during health care. Published on the OECD Library website, this paper estimates the health, financial and economic costs of this harm. Results indicate that patient harm exerts a considerable global health burden. The financial cost on health systems is also considerable and if the flow-on economic consequences such as lost productivity and income are included the costs of harm run into trillions of dollars annually. Because many of the incidents that cause harm can be prevented, these failures represent a considerable waste of healthcare resources, and the cost of failure dwarfs the investment required to implement effective prevention.
  12. Content Article
    In this blog post, Vince discusses the challenges registrants face when something goes wrong, and why employers and regulators should be doing more to reassure professionals that openness is best for everyone.
  13. Content Article
    Lubna Haq, Co-Founder/Director of Claridade, was one of the panelists at Patient Safety Learning's Annual Conference leading the discussions on why and how we need to professionalise patient safety. In this blog for the hub, Lubna continues the discussion and encourages us to have conversations about what makes the biggest difference in how we go about our jobs and to share examples of good practice.
  14. Content Article
    It is now accepted that healthy cultures in NHS organisations are crucial to ensuring the delivery of high-quality patient care. The Kings Fund developed a tool to help organisations assess their culture, identifying the ways in which it is working well, as well as the areas that need to change.
  15. Content Article
    Published in the BMJ journal Quality & Safety, the authors draw out high-level learning about culture and behaviour in NHS organisations; what influences culture and behaviour; and what needs to change to give effect to the vision of a safe, compassionate service in which patients and their families could have trust and confidence.
  16. Content Article
    This short video from the Derbyshire Community Health Services NHS Foundation describes the importance of speaking up, what the process is and how speaking up will improve patient safety.
  17. Content Article
    The National Guardian’s Office is an independent, non-statutory body with the remit to lead culture change in the NHS so that speaking up becomes business as usual. The office is not a regulator, but is sponsored by the CQC, NHS England and NHS Improvement. 
  18. Content Article
    Katie Evans-Reber, Head of People at Wonolo, shares her insights on how leaders can make frontline workers from all organisations feel part of the team and how to create a positive organisation culture.
  19. Content Article
    The Culture Change Toolbox is a collection of tools and interventions for changing culture. It’s full of ideas, examples, and exercises. For each tool there are tips on how to apply it and a description of which components of culture it helps to improve. This latest version includes: the latest evidence on culture change a refreshed format with an improved flow for learning new activities and resources for teams examples from across the continuum of care.
  20. Content Article
    PatientSafe Network in Australia has been promoting the theatre cap challenge across the world. By wearing your name on your theatre cap it can improve team work and patient safety.  Here, Rob Hackett discusses the challenges in trying to change the 'system'.
  21. Content Article
    "Looking back down the path of another person’s journey is not the same thing as making the trip yourself." What a great quote! It is so true. Henriksen and Kaplan discuss hindsight bias, outcome knowledge and adaptive learning in this paper published in BMJ Quality & Safety in 2003.
  22. Content Article
    There have been major healthcare failings in the UK NHS over many years. The persistent dysfunctional organisational culture, an inability to learn and the need for change has been identified within literature. The concept of organisational silence forms one aspect of the proposed model of organisational dysfunction in the NHS. Forty-three interviews and six focus groups have been conducted to test the model. From generalised evidence, it is suggested that the NHS is systemically and institutionally deaf, bullying, defensive and dishonest. There appears to be a culture of fear, lack of voice and silence. The cost of suppression of voice, reluctance to voice and the resulting ‘sea of silence’ is immense. There is a resistance to ‘knowing’ and the NHS appears to be hiding and retreating from reality. There is an urgent need for action to be taken to address this dysfunctional culture. The NHS needs to embrace the identity of being a listening, learning and honest organisation, with a culture of respect. It needs to choose to hear, see and speak for the benefit of patients and staff. There are implications for the wider UK society due to the apparent inability to learn and improve.
  23. Content Article
    The National Guardian’s Office is an independent, non-statutory body with the remit to lead culture change in the NHS so that speaking up becomes business as usual. The office is not a regulator, but is sponsored by the Care Quality Commission (CQC), NHS England and NHS Improvement.
  24. Content Article
    See how incivility affects all of us in the NHS and how that can impact patient safety. Join the staff of Epsom and St Helier University Hospitals NHS Trust on their journey as they reflect on the real-life effects of both incivility and active kindness.  This video was devised, filmed and produced by the Elena Power Simulation Centre.
  25. Content Article
    The fair treatment of staff supports a culture of fairness, openness and learning in the NHS by making staff feel confident to speak up when things go wrong, rather than fearing blame. Supporting staff to be open about mistakes allows valuable lessons to be learnt so the same errors can be prevented from being repeated. In any organisations or teams where a blame culture is still prevalent, this guide will be a powerful tool in promoting cultural change.
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