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Showing results for tags 'Organisational culture'.
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News Article
Nursing watchdog to miss target to cut soaring complaints backlog
Patient Safety Learning posted a news article in News
The nursing watchdog will miss its target to tackle a 5,500-case backlog of complaints as referrals hit a record high. The Nursing and Midwifery Council NMC has admitted it won’t hit its pledge to cut the number of unresolved complaints against nurses and midwives to 4,000 by March 2024. The news comes as it faces questions over the way it handles complaints after The Independent revealed a number of serious allegations, including poor investigations that have led to fears of rouge nursing going unchecked. The newspaper exposes have prompted two independent reviews. Details of the first two reviews have been revealed for the first time and will look at: The NMC’s response to whistleblower concerns, including whether they were treated fairly and whether it acted fairly and reasonably. Any evidence of cultural issues which may have impacted the NMC’s response to whistleblowing. Whether concerns raised are substantiated and indicate a decision-making process by the NMC which is insufficient in protecting the public. Evidence of shortcomings in guidance and training. The senior whistleblower whose evidence prompted the review said: “The NMC has refused to change its approach to the investigations into my whistleblowing concerns to allow me to share and explain my evidence without fear of reprisal. I don’t think it is possible to draw safe conclusions about either how I have been treated or the impact of our culture on case work from reviewing only 13 of our current 5,500 open cases, and 6 closed cases and a selection of my emails.” Read full story Source: The Independent, 16 November 2023 -
Content ArticleThe story behind Martha’s rule is depressingly familiar. A parent raising significant concerns about their daughter’s ongoing care only to be ignored with tragic consequences. Unfortunately, this feels like the latest in a long line of incidents where the NHS has failed to heed warnings from patients and their families about the quality of their care. This article by Dan Wellings looks at recent collaborative work by The King's Fund and the Heads of Patient Experience (HOPE) network to understand why the NHS is still too often not listening to people who use its services. He highlights that progress made since the early 2000s in improving how the health service listens to patients has stalled, with the proportion of patients feeling involved in decisions about their care or treatment falling in recent years. He also outlines how organisational cultures that focus disproportionately on the positive miss opportunities to hear and respond to stories that demonstrate serious patient safety and experience issues.
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Content ArticleDisruptive behaviour can have a significant impact on care delivery, which can adversely affect patient safety and quality outcomes of care. Disruptive behaviour occurs across all disciplines but is of particular concern when it involves physicians and nurses who have primary responsibility for patient care. There is a higher frequency of disruptive behaviour in neurologists compared to most other nonsurgical specialties. Disruptive behaviour causes stress, anxiety, frustration, and anger, which can impede communication and collaboration, which can result in avoidable medical errors, adverse events, and other compromises in quality care. Healthcare organisations need to be aware of the significance of disruptive behaviours and develop appropriate policies, standards, and procedures to effectively deal with this serious issue and reinforce appropriate standards of behaviour. Having a better understanding of what contributes to, incites, or provokes disruptive behaviours will help organizations provide appropriate educational and training programs that can lessen the likelihood of occurrence and improve the overall effectiveness of communication among the health care team.
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Content ArticleA substantial barrier to progress in patient safety is a dysfunctional culture rooted in widespread disrespect. Leape et al. identify a broad range of disrespectful conduct, suggesting six categories for classifying disrespectful behaviour in the health care setting: disruptive behaviour; humiliating, demeaning treatment of nurses, residents, and students; passive-aggressive behaviour; passive disrespect; dismissive treatment of patients; and systemic disrespect. At one end of the spectrum, a single disruptive physician can poison the atmosphere of an entire unit. More common are everyday humiliations of nurses and physicians in training, as well as passive resistance to collaboration and change. Even more common are lesser degrees of disrespectful conduct toward patients that are taken for granted and not recognised by health workers as disrespectful. Disrespect is a threat to patient safety because it inhibits collegiality and cooperation essential to teamwork, cuts off communication, undermines morale, and inhibits compliance with and implementation of new practices. Nurses and students are particularly at risk, but disrespectful treatment is also devastating for patients. Disrespect underlies the tensions and dissatisfactions that diminish joy and fulfilment in work for all health care workers and contributes to turnover of highly qualified staff. Disrespectful behaviour is rooted, in part, in characteristics of the individual, such as insecurity or aggressiveness, but it is also learned, tolerated, and reinforced in the hierarchical hospital culture. A major contributor to disrespectful behaviour is the stressful health care environment, particularly the presence of “production pressure,” such as the requirement to see a high volume of patients.
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Content ArticleNurse bullying has been an issue for decades and continued during the Covid-19 pandemic. Now, in the post-pandemic era, allegations of toxic behaviour are continuing to climb. Becker's spoke with Jennifer Woods, vice president and chief nursing officer at Baptist Health Hardin in Elizabethtown, Pennsylvania, and Jamie Payne, chief human resources officer at Saint Francis Health System in Tulsa, Oklahoma, to understand the increase in nurse bullying and how their health systems are working to address it.
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Content ArticleLearn from Patient Safety Events (LFPSE) is a centralised system that healthcare staff can use to record patient safety events and access data and analytics about patient safety events nationwide using the NHS database. It replaces the National Reporting and Learning System (NRLS) that was used to upload incidents to the NHS. LFPSE introduces improved capabilities for the analysis of patient safety events occurring across healthcare, and enables better use of the latest technology, such as machine learning, to create outputs that offer a greater depth of insight and learning that are more relevant to the current NHS environment. LFPSE fields can now integrated into Datix incident form, and the information is uploaded to the national database upon the completion of an incident report. After the reviewing manager’s and Patient Safety Team review, any changes are automatically re-uploaded and the information updated in the national database. CSH Surrey share their presentation slides on LFPSE and Datix.
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News Article
Don’t panic when staff leave, NHSE advises managers
Patient Safety Learning posted a news article in News
New NHS England guidance has advised line managers to ‘remain calm’, ‘not panic’, and ‘show kindness’ when handling staff resignations. The Expectations of Line Managers in Relation to People Management framework, published on the NHS England website, contains guidelines on several areas for line managers, including equality, diversity and inclusion, recruiting and flexible working. In the “managing exits” section, managers are told they are expected to: “Support your colleague by showing kindness to them, respect their decision, and wish them well for the future”; “Lead by example and remain calm, ie do not panic when key colleague leaves”; “Use opportunity to reflect and innovate, ie should services be redesigned?”; and “Be mindful that the colleague may have mixed emotions about leaving. Include them in planning any leaving event”. Managers are also told they should “undertake an exit interview, or ask another manager if appropriate, to understand the employee’s experience of working in your organisation” and “consider skills gaps and risks of someone leaving”. Read full story Source: HSJ, 9 November 2023 -
Content ArticleNHS England has launched this framework on the expectations of NHS line managers in relation to people management. The report contains a recommendation to create a clear view on the expectations of line managers in the service in relation to people management and the implications for provision of people services.
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News Article
Most foreign doctors in NHS face ‘racist microaggressions’, survey shows
Patient Safety Learning posted a news article in News
Three in five foreign doctors in the NHS face “racist microaggressions” at work, such as patients refusing to be treated by them or having their abilities doubted because of their skin colour. The widespread “thinly veiled, everyday instances of racism at work” experienced by medics trained overseas has been uncovered by a survey of more than 2,000 UK doctors and dentists. Almost three in five (58%) said they had encountered such behaviour, from colleagues as well as patients, although most did not report it because they thought that no action would be taken. Doctors affected can feel upset, humiliated, marginalised and not taken seriously as a result. The findings have raised fears that international medical graduates may choose not to work in the NHS, which is increasingly reliant on their skills given the service’s shortage of doctors. Dr Naeem Nazem, the head of medical at the medical defence organisation MDDUS, which acts for doctors accused of wrongdoing, said: “These findings show us that a worryingly large number of overseas-trained doctors working in the NHS face racist microaggressions in the course of their work, from both patients and colleagues, and that many do so regularly.” Read full story Source: The Guardian, 8 November 2023 -
Content ArticleMedical defence organisation MDDUS's latest annual member attitude survey has found that many have experienced or witnessed persistent racist microaggressions at work. Almost two-thirds of International Medical Graduate members report they’ve been subject to racist microaggressions and have little faith in being heard and the issue being taken seriously. MDDU's 'We hear you' campaign aims to be a catalyst for positive change and help rebuild confidence in the way such abuses can be reported.
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Content ArticleHigh reliability organisations are organisations that work in situations that have the potential for large-scale risk and harm, but which manage to balance effectiveness, efficiency and safety. They also minimise errors through teamwork, awareness of potential risk and constant improvement. This evidence scan collates empirical evidence about the characteristics of high reliability organisations and how these organisations develop within and outside healthcare.
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Content Article
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It was recently reported that NHS Finance Directors were ‘incensed’ that the Health Services Safety Investigations Body (HSSIB) should think that they could be working more closely with patient safety chiefs. Whereas medical staff and clinicians represent the sharp end of healthcare delivery, the administrative functions, including finance, are the blunt end. Removed in space and time from the action, it can be hard to see how their behaviour can directly influence workplace outcomes. To understand the issue, Norman MacLeod reflects on how systems behave and the decision-making hierarchy within healthcare organisations. -
Content ArticleThis study from Allan et al. investigates whether nurses working for a national medical telephone helpline show evidence of “decision fatigue,” as measured by a shift from effortful to easier and more conservative decisions as the time since their last rest break increases. The study found that for every consecutive call taken since last rest break, the odds of nurses making a conservative management decision (i.e., arranging for callers to see another health professional the same day) increased by 5.5% from immediately after 1 break to immediately before the next. Decision-making was not significantly related to general or cumulative workload (calls or time elapsed since start of shift). The authors concluded that every consecutive decision that nurses make since their last break produces a predictable shift toward more conservative, and less resource-efficient, decisions. Theoretical models of cognitive fatigue can elucidate how and why this shift occurs, helping to identify potentially modifiable determinants of patient care.
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Content ArticleHealthcare Organisational Culture (OC) is a major contributing factor in serious failings in healthcare delivery. Despite an increased awareness of the impact that OC is having on patient care, there is no universally accepted way to measure culture in practice. This study from Simpson et al. was undertaken to provide a snapshot as to how the NHS is currently measuring culture. Although the study is based in England, the findings have potential to influence the measurement of healthcare OC internationally.
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Content Article
Roger Kline's writings
Patient Safety Learning posted an article in Suggest a useful website
Roger Kline is a research fellow at Middlesex University Business School prior to which he held senior positions in eight UK trade unions. Roger has an extensive knowledge and experience of workplace culture, primarily in the public sector. On his web page you can find a selection of his published papers, books and blogs. -
Content Article"With every patient safety inquiry the lessons are the same. We owe the families affected by these repeated failures meaningful organisational change." Says Juliet Dobson, in this Editorial for the BMJ.
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Content ArticleChanges of all kinds can have a profound effect on us, both in terms of our wellbeing and performance. David Murphy has worked therapeutically with people, including front-line professionals, for over 20 years, helping them to change, and adapt to change. David talks to Steven Shorrock about dealing with traumatic events and more mundane changes.
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Content ArticleThe Thirlwall Inquiry has been set up to examine events at the Countess of Chester Hospital and their implications following the trial, and subsequent convictions, of former neonatal nurse Lucy Letby of murder and attempted murder of babies at the hospital. This document sets out the terms of reference for this inquiry, following an engagement process led by the inquiry’s independent chair, Lady Justice Thirlwall, with the affected families and other stakeholders.
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Content ArticleDrawing on his research and practice, Steven Shorrock explores the various barriers that we face when trying to make sense of Just Culture, inviting readers to refl ect on the intricate nature of justice and safety in our complex world
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News Article
Birmingham NHS trust sacks staff after sexual harassment claims
Patient Safety Learning posted a news article in News
A hospital trust has dismissed three members of staff following complaints of sexual harassment. The sackings by University Hospitals Birmingham (UHB) NHS Trust were revealed at the launch of its sexual safety charter on Monday. Sexual safety was one of the areas highlighted in a review of the trust's culture. UHB said sexism, misogyny and sexual harassment would not be tolerated in the workplace. The trust has been subject to three enquiries following a BBC investigation into its culture. The second of these investigations, by Prof Mike Bewick, identified a new line of inquiry into allegations of misogynistic behaviour and sexual harassment. Prof Bewick said the trust had begun formal investigations and there was a widening of the scope of the enquiry to accommodate the sensitive nature of these concerns. Read full story Source: BBC News, 19 October 2023 -
Content ArticleHealthcare is starting to embrace a shift towards Just Culture. In England, the new Patient Safety Incident Response Framework (PSIRF) prioritises respect, compassion, and systemic improvements. The potential benefits of this, and other initiatives, are significant, as Suzette Woodward reports
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News ArticleThousands of complaints made against nurses and midwives were rejected by the watchdog without investigation last year as it battles a huge backlog amid concerns rogue staff are being left unchecked. The Nursing and Midwifery Council has rejected hundreds more cases a year since 2018, including 339 where nurses faced a criminal charge, 18 for alleged sexual offences and 599 over allegations of violence in 2022-23, according to data shared exclusively with The Independent. The new figures come after The Independent revealed shocking allegations that nurses and midwives accused of serious sexual, physical and racial abuse are being allowed to keep working because whistleblowers are being ignored and that the NMC was failing to tackle internal reports of alleged racism. And now, a new internal document, obtained by The Independent, reveals more staff have come forward to raise concerns since our expose. Former Victims’ Commissioner Dame Vera Baird KC said the backlog of complaints was “worryingly high” and called for urgent action to tackle it. Read full story Source: The Independent, 19 October 2023
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Content ArticleIn this opinion piece, BMJ journalist Clare Dyer examines how the healthcare system is grappling with the question of how Lucy Letby was allowed to get away with killing babies in plain sight for so long. She looks at culture and governance issues that meant that concerns raised by consultants were not appropriately acted on.
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News Article
NMC ‘toxic culture’: regulator appoints barrister to investigate
Patient Safety Learning posted a news article in News
An employment and equality lawyer will lead investigations into claims of racism, sexism and toxic culture at the Nursing and Midwifery Council (NMC). The nursing regulator has appointed Ijeoma Omambala KC to review claims that fitness to practise cases have been mishandled, especially those involving racism, discrimination, sexual misconduct and child protection. She will lead a concurrent investigation into how complaints about allegations were handled. "I’m sorry anyone has concerns about our culture, and the regulatory decisions we take. We’re committed to a rigorous, transparent and independent response". Read full story (paywalled) Source: Nursing Standard, 17 October 2023 -
News Article
Be careful of celebrating staff as ‘heroes’, NHSE advises trusts
Patient Safety Learning posted a news article in News
Trusts haven been warned to be careful of “contentious” approaches to staff recognition, such as those that mimic the “clap for carers” initiative organised during the pandemic. NHS England has published a Staff Recognition Framework which stresses marking staff achievements is important. However, it also warns staff could also be demoralised by recognition they felt was derisory. The framework says: ”During the pandemic, studies suggested the weekly 8pm ‘clap for carers’ movement and use of the word ‘heroes’ were contentious approaches to staff recognition. The NHS is always in the media spotlight. Don’t let this put you off but do consider the broader political and economic context.” Recent strikes saw clinicians make the point that organised clapping was no substitute for increase-linked pay increases. The document for senior leaders recommends “developing a recognition strategy” which takes a triple track “formal, informal and everyday” approach to celebrating staff achievement. It said “evidence shows that pay alone will not influence staff wellbeing, engagement, and retention in the long-term – praise and social approval have also proved to be critical factors”. Read full story (paywalled) Source: HSJ, 12 October 2023
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