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Showing results for tags 'PSIRF'.
Found 212 results
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Content ArticleIn this blog, Melanie Ottewill, National Investigator and Senior Investigation Science Educator at the Healthcare Safety Investigation Branch (HSIB), explains how HSIB's work is supporting the NHS to adopt a systems approach to local safety investigations through the Patient Safety Incident Response Framework (PSIRF). She looks at how PSIRF promotes a proportionate response to patient safety incidents, highlights the importance of organisations developing patient safety incident response plans and explores how PSIRF promotes compassionate involvement in patient safety incidents. She also highlights guidance to support staff in planning PSIRF implementation.
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Content ArticleIf you want to find out what the new Patient Safety Incident Response Framework is all about, and how it will support the NHS to learn and improve, this video provides a helpful introduction.
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Content ArticleThis NHS England podcast examines how the application of system-based approaches to learning from patient safety incidents will be vital to the success of the Patient Safety Incident Response Framework (PSIRF). Guests Darren Thorne from the consultancy Facere Melius, Jane Carthey, a Human Factors and Patient Safety Consultant and Laura Pickup from the Healthcare Safety Investigation Branch (HSIB) discuss NHS England's learning response toolkit.
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Content ArticleA thematic review can identify patterns in data to help answer questions, show links or identify issues. Thematic reviews typically use qualitative (e.g, open text survey responses, field sketches, incident reports and information sourced through conversations and interviews) rather than quantitative data to identify safety themes and issues. Thematic reviews can sometimes use a combination of qualitative data with quantitative data. Quantitative data may come from closed survey responses or audit, for example. These top tips support health and social care staff to carry out thematic reviews, but organisations may take different approaches, depending on the purpose and scope of their review.
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Content ArticleA themed review may be useful in understanding common links, themes or issues within a cluster of investigations or incidents. It will seek to understand key barriers or facilitators to safety using reference cases (e.g. individual datix incidents or previous investigations).
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Content Article
This is part of our series of Patient Safety Spotlight interviews, where we talk to different people about their role and what motivates them to make health and social care safer. Judy talks to us about the power of After Action Reviews (AARs) to promote learning and bring about lasting improvements in healthcare. She also discusses the opportunity that the new Patient Safety Incident Response Framework (PSIRF) offers to take a more people-focused approach to learning from patient safety incidents. -
Content ArticleIn this blog, Melanie Ottewill, National Investigator and Senior Investigation Science Educator at HSIB, shares some key messages from a recent seminar delivered by Tracey Herlihey, Head of Patient Safety Incident Response Policy and Lauren Mosley, Head of Patient Safety Implementation at NHS England. The seminar looked at the new Patient Safety Incident Response Framework (PSIRF) published in August 2022. PSIRF fundamentally shifts how the NHS responds to patient safety incidents for learning and improvement, promoting a proportionate approach to responding to patient safety incidents. It focuses on ensuring resources allocated to investigating and learning are balanced with those needed to deliver improvement. Melanie describes the cultural shift needed to implement PSIRF so it really makes a difference, and talks about the important of compassionate engagement.
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Content ArticleSerious incidents not only have a considerable human impact, but they are also detrimental to NHS reputations and finances. The current Serious Incident Framework (SIF) is a reactive, bureaucratic process, where opportunities to reduce the recurrence of a harmful incidence is often missed. With a ‘Get It Right First Time’ mentality, the new PSIRF framework was road-tested by a number of nationally appointed ‘early adopter’ Trusts and commissioners working to implement it during the course of 2021. Now a wider implementation across the NHS is planned, starting spring 2022, with guidance informed by the early adopter pilots. This blog was written by Sian Williams, NHS Team Lead & Managing Consultant, and Paul Binyon, who in a recent assignment has worked with an NHS Trust contributing to an early adopter PSIRF pilot rollout.
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Content ArticleOrganisations should uphold the patient safety incident response standards to ensure they meet the minimum expectations of the Patient Safety Incident Response Framework (PSIRF). The standards cover the following aspects of PSIRF: policy, planning and oversight competence and capacity engagement and involvement of those affected by patient safety incidents proportionate responses. This document provides the complete list of patient safety incident response standards, and where relevant refers to specific PSIRF documentation.
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Content ArticleThe NHS Patient Safety Incident Response Framework (PSIRF) promotes a range of system-based approaches for learning from patient safety incidents. These national tools and guides have been developed to incorporate the well-established SEIPS framework (Systems Engineering Initiative for Patient Safety) to help support organisations implementing PSIRF.
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Content ArticleIn partnership with the Healthcare Safety Investigation Branch (HSIB) and Learn Together, NHS England has published its Guide to engaging and involving patients, families and staff following a patient safety incident alongside the Patient Safety Incident Response Framework (PSIRF). This guide sets out expectations for how those affected by an incident should be treated with compassion and involved in any investigation process. In this podcast, the speakers introduce the guide, discuss how it was developed, and talk about future plans in the area of work. Speakers: Tracey Herlihey, Head of Patient Safety Incident Response Policy, NHS England National Patient Safety Team Lauren Mosley, Head of Patient Safety Implementation, NHS England National Patient Safety Team Lou Pye, Head of Family Engagement, HSIB Jane O’Hara, Learn Together research team, Professor of Healthcare Quality and Safety, University of Leeds and Deputy Director of the Yorkshire Quality and Safety Research Group.
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Content Article
NHS England Learning Handbook: After action review
Patient Safety Learning posted an article in NHS Improvement
First used by the US army on combat missions, the after action review is a structured approach for reflecting on the work of a group and identifying strengths, weaknesses and areas for improvement. This NHS Improvement document explains what an after action review and when and how to use it.
