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Showing results for tags 'Safety culture'.
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News Article
The NHS should act now to avoid a worse crisis next winter
Clive Flashman posted a news article in News
Action must be taken now if the NHS is to avoid an even worse winter crisis next year, the chief inspector of hospitals has warned. The Care Quality Commission (CQC) said the use of corridors to treat sick patients in A&E was “becoming normalised”, with departments struggling with a lack of staff, poor leadership and long delays leading to crowding and safety risks. Professor Ted Baker said: “Our inspections are showing that this winter is proving as difficult for emergency departments as was predicted. Managing this remains a challenge but if we do not act now, we can predict that next winter will be a greater challenge still. “We cannot continue this trajectory. A scenario where each winter is worse than the one before has real consequences for both patients and staff.” Read full story Source: The Independent, 18 February 2020 -
Content ArticleDespite dealing with biomedical practices, infection prevention and control (IPC) is essentially a behavioural science. Human behaviour is influenced by various factors, including culture. This paper by M.A. Borg, published in the Journal of Hospital Infection, analyses the cultural determinants of infection control behaviour.
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News Article
Report reveals the impact of Freedom to Speak Up
Patient Safety Learning posted a news article in News
A new report published by the National Guardian’s Office reveals that the perception of the speaking up culture in health is improving. An annual survey, conducted by the National Guardian’s Office, asked Freedom to Speak Up Guardians, and those in a supporting role, about how speaking up is being implemented in their organisation. The results reveal details about the network’s demographics and their perceptions of the impact of their role. Headlines from the survey include a measure of whether those in speaking up roles think their work is making a difference, with 76 per cent agreeing or strongly agreeing – compared to 68 per cent last year. They also reported that awareness of the guardian role is improving. “It’s really important we listen to guardians in order to understand the impact Freedom to Speak Up is making,” said Dr Henrietta Hughes OBE, National Guardian for the NHS. “The report we are publishing today will help organisations better understand how to work with their guardians to improve their speaking up cultures.” Read full story Source: National Freedom to Speak Up, 30 January 2020 -
Content Article
Freedom to Speak Up Guardian survey 2019
Patient Safety Learning posted an article in Speak Up Guardians
A new report published by the National Guardian’s Office reveals that the perception of the speaking up culture in health is improving. An annual survey, conducted by the National Guardian’s Office, asked Freedom to Speak Up Guardians, and those in a supporting role, about how speaking up is being implemented in their organisation. The results reveal details about the network’s demographics and their perceptions of the impact of their role. This infographic highlights some of the findings. -
Content ArticleWhile there is growing awareness of the risk of harm in ambulatory health care, most patient safety efforts have focused on the inpatient setting. The Comprehensive Unit-based Safety Program (CUSP) has been an integral part of highly successful safety efforts in inpatient settings. In 2014 CUSP was implemented in an academic primary care practice. As part of CUSP implementation, staff and clinicians underwent training on the science of safety and completed a two-question safety assessment survey to identify safety concerns in the practice. The concerns identified by team members were used to select two initial safety priorities. The impact of CUSP on safety climate and teamwork was assessed through a pre-post comparison of results on the validated Safety Attitudes Questionnaire. CUSP is a promising tool to improve safety climate and to identify and address safety concerns within ambulatory health care.
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Content ArticleThe Comprehensive Unit-based Safety Program (CUSP) aims to improve the culture of safety while providing frontline caregivers with the tools and support that they need to identify and tackle the hazards that threaten their patients at the unit or clinic level. Developed by Johns Hopkins safety and quality researchers, the five-step programme has been used to target a wide range of hazards, including patient falls, hospital-acquired infections, medication administration errors, specimen labeling errors and teamwork and communication breakdowns. Notably, CUSP has been used in national and international quality improvement projects that have drastically reduced hospital-acquired infections. Whether your hospital has participated in such projects or is seeking to adopt CUSP, the Armstrong Institute provides resources to help you run a successful programme.
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Content ArticleThe appointment of a Freedom to Speak Up (FTSU) Guardian is a requirement of the NHS Standard Contract in England. The National Guardian’s Office (NGO) provides leadership, support and guidance to FTSU Guardians. Guidance on recording data was originally issued in January 2017 and guardians in trusts and foundation trusts have been asked to provide quarterly reports on the number of cases they have received since April 2017. These quarterly reports have been published on the NGO’s webpages. This end of year report represents a summary and analysis of the second year’s return and compares across the two years for which data is available.
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Content ArticlePatient Safety and Healthcare Improvement at a Glance is an overview of healthcare quality written specifically for students and junior doctors and healthcare professionals. It bridges the gap between the practical and the theoretical to ensure the safety and well-being of patients. Featuring essential step-by-step guides to interpreting and managing risk, quality improvement within clinical specialties, and practice development, this highly visual textbook offers preparation for the increased emphasis on patient safety and quality-driven focus in today's healthcare environment.
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Content ArticleSafety and Improvement in Primary Care: The Essential Guide is ideal for frontline clinicians, managers and healthcare administrators needing practical guidance on safety and is also highly recommended for improvement advisers, patient safety officers, clinical governance facilitators, risk managers and health services researchers wanting a critical review of theory and evidence. Primary care educators, too, will find much of interest in relation to designing and delivering training to help trainee doctors, established clinicians, managers and other colleagues meet the demands and obligations of specialty training, appraisal and revalidation, routine contractual requirements and continuing professional development. It provides reading for healthcare policy makers seeking implementation evidence on interventions for improving quality and safety at the professional, team and organisational levels.
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Content ArticleFollowing the traumatic death of an anaesthetic trainee who was returning home after a night shift, the Fatigue Group supported by the Association of Anaesthetists and RCoA have surveyed UK trainees about shift working and fatigue. With a 60% response rate, the survey highlights a wide variation in access to rest facilities, commuting distances and concerning effects of fatigue on trainees.
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Content ArticleSpeaking at the Domain Driven Design conference in 2018, Sidney Dekker talks about the complexity of pursuing and averting drift into failure.
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Content ArticleAs I mentioned in my previous blog (part 3), the number of staff using the SISOS calm zone as a safe space to take time out was surprising because of the sheer volume and also the average time it was used for (15 minutes). Certain factors contribute to the success of a safe space: management buy-in, location and, to a degree, ambiance. At Chase Farm Hospital, we have been fully supported locally and at a trust level. However, in any organisation there will always be people who are averse to change. In this blog I will share with you some of the negative experiences I encountered, because anyone thinking of setting up a similar initiative needs to be aware that it is not always plain sailing and unfortunately not everyone sees the need to support staff. I will also share with you how SISOS is evolving to meet our staff's needs.
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Content Article
Miles Sibley: Changing the culture of learning from deaths
Patient Safety Learning posted an article in Culture
In this BMJ Opinion article, Miles Sibley, Director for the Patient Experience Library, reflects on why there is still a failure to listen to patients and bereaved families when things go wrong. Instead we find that over and over again, when patients die avoidable deaths, their shocked and grieving relatives are locked out of investigations, refused access to information, and denied justice. -
Content Article
Planetree: International resource collection
lzipperer posted an article in Other countries and national agencies
The US-based Planetree organisation has long been a leader in establishing processes and mindsets that enable safe, patient-centred care. This resource collection includes a variety of tools, templates and instructions that help organisations and teams embed effective communication behaviours and activities into their daily work. Resources focus on tactics such bedside rounding, huddles, patient and family engagement council formation and physician interaction coaching. -
Content ArticleIn her blog, drawing on the Paterson Inquiry, Judy Walker discusses After Action Review (AAR) and the fear that exists around speaking up.
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Content ArticleShifting the mindset (2020), a report from Healthwatch, investigates how hospitals report on complaints and whether current efforts are sufficient to build public trust. In this bog, Sir Robert Francis QC explains how hospitals can cultivate public trust in complaints.
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Content ArticleHow are trauma-informed approaches being implemented by public services – and what are the barriers to embedding the approach more widely? Produced jointly by the Centre for Mental Health and the Agenda, the alliance for women and girls at risk, this reports explores how trauma-informed approaches are being implemented by public services including women’s centres, prisons and mental health services. Evidence has shown that there are strong links between traumatic experiences and poor mental health. The need for public services to be trauma-informed has been repeatedly demonstrated. A sense of safety summarises the findings of interviews and site visits to a range of public services for women, including substance misuse, homelessness, mental health, the criminal justice system, and domestic and sexual abuse and exploitation. It found that services taking a holistic approach to supporting women’s needs were best able to make the change to becoming trauma-informed. However, many organisations faced barriers including short-term and fragile funding.
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Content Article
CQC Podcast: Give feedback on care (14 January 2020)
Claire Cox posted an article in Care Quality Commission (CQC)
Episode 1 in this podcast series from the Care Quality Commission talks about the work they have been doing to collect people's experiences of care through the development of their 'Give Feedback on Care' service, their public campaigns work and the work of their national contact centre. -
Content ArticleThe aim of this study from Martinez et al. was to develop and test the psychometric properties of two new survey scales aiming to measure the extent to which the clinical environment supports speaking up about (a) patient safety concerns and (b) unprofessional behaviour.
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Content Article
Safety climate survey – are we getting better? (12 June 2019)
Patient Safety Learning posted an article in Culture
Organisations working towards a culture of safety need a reliable measure to monitor the success of their initiatives. A Safety Climate Survey was carried out during September 2017 in the Paediatric ward at Daisy Hill Hospital, as part of the S.A.F.E. (Safety Awareness for Everyone) initiative. -
Content ArticleThe aim of this project from Hollis et al. was to improve engagement with the incident reporting process and to encourage staff to raise issues and create a proactive culture of quality improvement. This project demonstrates that a relatively simple intervention can have effect significant positive cultural change in an organisation over a small period of time. By giving frontline staff a mechanism to record issues it is possible to develop a positive culture of grass roots change. Incident reporting can act as a vehicle not only to improve patient safety but more broadly to generate ongoing ideas for quality improvement within an organisation.
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Content ArticleCommunication and care delivery is enhanced when teams work together well. TeamSTEPPS® is a US government set of teamwork tactics and tools designed to help health care professionals work together safely and effectively.
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Content Article
The Patient Safety Learning hub has provided the vehicle through which I’ve shared my personal journey as I sought to establish and embed a second victim support initiative at the trust where I worked until my recent retirement. Four years ago SISOS was set up to ensure that colleagues affected by safety incidents received emotional support as soon as possible. A lot of lessons have been learned along the way and positive actions taken. These are my personal thoughts. -
Content ArticleVenous thromboembolism (VTE) is a condition in which a thrombus – a blood clot – forms in a vein. Usually, this occurs in the deep veins of the legs and pelvis and is known as deep vein thrombosis (DVT). The thrombus or parts of it can break off, travel in the blood system and eventually block an artery in the lung. This is known as a pulmonary embolism (PE). VTE is a collective term for both DVT and PE.
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Content ArticleBuilding on cultural dimensions of underperforming group homes, Bigby and Beadle-Brown analyses culture in better performing services. In depth qualitative case studies were conducted in three better group homes using participant observation and interviews. The culture in these homes, reflected in patterns of staff practice and talk, as well as artefacts differed from that found in underperforming services. Formal power holders were undisputed leaders, their values aligned with those of other staff and the organization, responsibility for practice quality was shared enabling teamwork, staff perceived their purpose as “making the life each person wants it to be,” working practices were person centered, and new ideas and outsiders were embraced. The culture was charactersed as coherent, respectful, “enabling” for residents, and “motivating” for staff. Though it is unclear whether good group homes have a similar culture to better ones the insights from this study provide knowledge to guide service development and evaluation.
