Search the hub
Showing results for tags 'Safety culture'.
Found 535 results
-
Content Article
In this blog, Patient Safety Learning reflects on a recent letter by Keith Conradi to the Secretary of State for Health and Social Care, highlighting concerns about a lack of interest and attention in the activities of the Healthcare Safety Investigation Branch (HSIB) at the highest levels of the Department of Health and Social Care (DHSC) and NHS England.- Posted
- 2 comments
-
1
-
- (and 3 more)
-
Content Article
In this blog, student midwife Sophie Dorman describes some of the issues that have led to a chronic shortage of midwives, including a culture of fear, poor pay and conditions and a lack of basic facilities for maternity staff. She highlights the impact this is having on the safety of maternity services and argues that valuing and looking after midwives will make pregnancy and childbirth safer and better for everyone. -
Content ArticleIn this blog, nurse Carol Menashy describes her experience making an error in theatre fifteen years ago, and the personal blame she faced in the way the incident was dealt with at the time. She talks about how a SEIPS (Systems Engineering Initiative for Patient Safety) framework can transform how adverse incidents are dealt with, allowing healthcare teams to learn together and use incidents to help make positive changes towards patient safety. She describes the progress that has been made towards organisational accountability and systems thinking over the past fifteen years, and talks about the importance of staff support to allow for healing from adverse events.
-
Content ArticleHealthcare is traditionally a hierarchical industry. This structure can foster a culture of division amongst staff that is sometimes made worse by significant differences in background and training. However, in order to make sure care is safe and of a high quality, healthcare teams must develop good teamwork and communication. This is only possible if every member of the team feels respected and is free to speak up when they think something is wrong. In this podcast, host David Feldman speaks to Michael Brodman, Professor and Chair Emeritus in the Department of Obstetrics, Gynecology, and Reproductive Science at the Icahn School of Medicine at Mount Sinai in the US. They discuss how mutual respect is essential for any institution developing a culture of safety and how the problems presented by medical hierarchy can be overcome.
-
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. Annie talks to us about her work training teams in safety behaviours, why productivity and safety must go hand-in-hand, and how working on patient safety is like running a marathon. -
Content ArticleThe COVID-19 pandemic has made it more difficult to maintain high quality in medical education. As online formats are often considered unsuitable, interactive workshops and seminars have particularly often been postponed or cancelled. To meet the challenge, Angelina Müller and her colleagues converted an existing interactive undergraduate elective on safety culture into an online event. In this article, they describe the conceptualisation and evaluation of the elective.
-
Content ArticleThe emotion of the team is a sum-total of emotions and feelings that members of the team experience. Left unnoticed, unexpressed, and unattended, these emotions can grow toxic to harm relationships or grossly undermine team’s potential. Leaders have a choice of either noticing those emotions intentionally and intervening constructively when needed or just ignore the emotions to focus only on the outcomes and the process. Tuning into team emotions, fostering productive relationships, building trust, and a conducive environment within the team is the constant work of leadership.
-
Content ArticleThe NHS in England has introduced a range of policy measures aimed at fostering greater openness, transparency and candour about quality and safety. This study looks at the implementation of these policies within NHS organisations, with the aim of identifying key implications for policy and practice.
-
Content ArticleOver the past few years, concerns have been raised about the level of funding and intervention regulators have received from the pharmaceutical industry. In this article for The BMJ, investigative journalist Maryanne Demasi examines whether regulators of medical devices and medications have enough independence from the companies they are meant to regulate. She asked six of the world's biggest regulators about their funding and transparency and found that industry money permeates the world's leading regulators. This casts doubt on their ability to provide effective regulation, especially in the wake of a string of drug and device scandals.
-
Content ArticleThis article in the Journal of Interprofessional Care highlights the challenges experienced by programme leaders and healthcare professionals as they work to improve patient safety. It discusses the complexities of translating organisation-wide speaking-up policies to local practices and settings.
-
Content ArticleThis improvement tool is designed to help NHS organisations identify strengths their leadership team and organisation, and any gaps that need work, in seeking to create an environment where people feel safe to speak up with confidence. It should be used alongside Freedom to speak up: A guide for leaders in the NHS and organisations delivering NHS services, which provides full information about the areas addressed in the statements, as well as recommendations for further reading.
-
Content Article
Deference to expertise: Making care safer (2017)
Patient Safety Learning posted an article in Good practice
Since the seminal report by the Institute of Medicine, To Err Is Human, was issued in 1999, significant efforts across the health care industry have been launched to improve the safety and quality of patient care. Recent advances in the safety of health care delivery have included commitment to creating high-reliability organisations (HROs) to enhance existing quality improvement activities. This article will explore key elements of the HRO concept of deference to expertise, describe the structural elements that support nurses and other personnel in speaking up, and provide examples of practical, evidence-based tools to help organizations support and encourage all members of the health care team to speak up. -
Content ArticleKrista Haugen is National Director of Patient Safety for US-based emergency and patient relocation services provider Global Medical Response. In this interview, she describes how her 25-year career as an emergency medicine nurse has influenced her approach to safety and patient care. She discusses her personal experience of being involved in an accident as an air-ambulance flight nurse, and how this caused her to look at safety and risk management from a systems perspective, focussing on building a just culture where safety is optimised through organisational reflection and learning.
-
Content ArticleOne box of chemicals mistaken for another. Ingredients intended to be life-sustaining are instead life-taking. Families in shock, healthcare providers reeling and fingers starting to point. A large healthcare system’s reputation hangs in the balance while decisions need to be made, quickly. More questions than answers. People have to be held accountable – does this mean they get fired? Should the media and therefore the public be informed? What are family members and the providers involved feeling? When the dust settles, will remaining patients be more safe or less safe? In this provocative true story of tragedy, the authors recount the journey travelled and what was learned by, at the time, Canada’s largest fully integrated health region. They weave this story together with the theory about why things fall apart and how to put them back together again. Building on the writings and wisdom of James Reason and other experts, the book explores new ways of thinking about Just Culture, and what this would mean for patients and family members, in addition to healthcare providers. With afterwords by two of the major players in this story, the authors make a compelling case that Just Culture is as much about fairness and healing as it is about supporting a safety culture.
-
Content ArticleMedical error is a serious issue in hospitals in Jordan. This study from Suliman et al. explored Jordanian nurses' perceptions of the culture of safety in their hospitals. The Hospital Survey of Patient Safety Culture translated into Arabic was administered to a convenience sample of 391 nurses from 7 hospitals in Jordan. The positive responses to the 12 dimensions of safety culture ranged from 20.0% to 74.6%. These are lower than the benchmarks of the Agency for Healthcare Research and Quality. Jordanian nurses perceive their hospitals as places that need more effort to improve the safety culture.
-
Content ArticleThis study in the journal Health and Social Care Delivery Research mapped interventions aimed at reducing restrictive practices in children and young people’s institutional settings around the world. It also assessed which process elements led promising behaviour change techniques, and compared the results with a companion review of adult psychiatric inpatient settings. In the first evidence review of its kind, the authors found that interventions tend to be complex, reporting is inconsistent and robust evaluation data are limited. But they did find some behaviour change techniques that warrant further research. They argue that better evidence could help address the urgent need for effective strategies.
-
Content Article
Safety Chats: Part 2 – Safety as measured
Gina Winter-Bates posted an article in Good practice
In a series of blogs, Gina Winter-Bates, Associate Nurse Director Quality and Safety at Solent NHS Trust, shares her experience of implementing Safety Chats. In her first blog, Gina explained what motivated her to introduce Safety Chats into her Trust. In part 2, Gina reflects on how we know we are safe and the safety measures her Trust has put in place. -
Content ArticleMaternity services shouldn’t be waiting for whistle-blowers or inquiries to alert them to problems, says Dr Mark Ratnarajah, a practising paediatrician and managing director of C2-Ai. Instead systematic transdisciplinary reviews and real-time data should support a culture of shared learning, that helps ensure patient safety is everybody’s responsibility.
-
Content Article
Questions & answers: World Hand Hygiene Day 2022
Patient Safety Learning posted an article in WHO
The 5 May is World Hand Hygiene Day. This year's theme is focused on recognising that we can add to a facility's climate or culture of safety and quality through cleaning our hands but also that a strong quality and safety culture will encourage people to clean hands at the right times and with the right products. See the World Health Organization's questions and answers about World Hand Hygiene Day. -
Content Article
Safety Chats blog series: Part 1
Gina Winter-Bates posted an article in Good practice
In a series of blogs, Gina Winter-Bates, Associate Nurse Director Quality and Safety at Solent NHS Trust, shares her experience of implementing Safety Chats. In this first blog, Gina explains what motivated her to introduce Safety Chats into her Trust. -
Content ArticlePresentation from Professor Mark Brinell, Vice Chair and Global Healthcare Expert at KMPG, on lessons we can learn from integrated care systems across the globe.
-
Content ArticleThis article in the journal Implementation Science aims to offer a system for classifying implementation strategies. The article recommends that authors not only name and define their implementation strategies, but also specify who enacted the strategy, and the level and determinants that were targeted.
-
Content ArticlePolypharmacy refers to the prescription of many medicines to one patient. As more people live longer with multiple long-term conditions, the number of medicines they take often increases. This can have a significant burden on the person managing and trying to adhere to multiple medicines regimes, and can also be harmful. The Academic Health Science Networks (AHSN) Network's Polypharmacy Programme aims to support healthcare professionals to identify patients at potential risk from polypharmacy, and to support better conversations about medicines. Based on the recommendations of the National Overprescribing Review (NOR) published in September 2021, the programme aims to achieve the following outcomes: A national network of Polypharmacy Communities of Practice, all working to address the system-wide challenges of problematic polypharmacy in their geographies. Routine use of the NHSBSA Polypharmacy Prescribing Comparators to identify and prioritise patients for a shared decision-making Structured Medication Review. Increased confidence amongst the primary care prescribing workforce to safely stop medicines identified to be inappropriate or unnecessary. A change in patient expectations – to anticipate having a shared decision-making conversation about their medicines regularly, especially as they get older. A contribution to the evidence base around how to help patients to feel more empowered to open up about their medicines issues. A contribution to the evidence base around how to tackle problematic polypharmacy.
-
Content ArticleThe purpose of the NHS England and NHS Improvement's Safety Culture Implementation group (SCIG) is to support and enable NHS organisations to improve their safety culture, in support of the The NHS Patient Safety Strategy, through embedding a continuous cycle of understanding the issue, developing a plan, delivering the plan and evaluating the outcome. Attached is SCIG's terms of reference.
-
Content ArticleThe Safety culture programme group (SCPG) was a virtual task and finish group established in July 2021 for six sessions to provide recommendations to support and enable organisations to improve their safety culture through embedding a continuous cycle of understanding the issue, developing a plan, delivering the plan and evaluating the outcome with an underpinning foundation of inequalities reduction. This report contains an overview of the discussions undertaken by the Safety culture programme group (SCPG) in 2021. It also includes their recommendations so that safety culture continues to be developed as one of the foundations that underpins the NHS patient safety strategy.
