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Found 536 results
  1. Content Article
    The Secretary of State asked NHS England and NHS Improvement to develop a new strategy for patient safety as a ‘golden thread’ running through healthcare. They consulted the UK on a set of ideas in December 2018. They received 527 contributions from organisations and individuals (staff, patients and carers). This strategy is the result of the consultation.
  2. Content Article
    The Institute for Safe Medication Practice shares key questions to help organisations assess their progress toward creating a Just Culture. They include results from the 2012 report on the Agency for Healthcare Research and Quality (AHRQ) Hospital Survey on Patient Safety Culture to provide a national snapshot of where hospitals stand regarding certain aspects of a Just Culture.
  3. Content Article
    Professor Sidney Dekker of Griffith University speaks about why things go wrong.
  4. Content Article
    Presentation by Andrew Brent (Sepsis Clinical Lead, Oxford AHSN & Oxford University Hospitals NHS Foundation Trust) and Bethan Page (Oxford AHSN) in collaboration with Dr Matt Inada-Kim (Wessex AHSN).
  5. Content Article
    This regulation has been put in place by the Care Quality Commission (CQC) in 2014. The intention of this regulation is to ensure that providers are open and transparent with people who use services and other 'relevant persons' (people acting lawfully on their behalf) in general in relation to care and treatment. It also sets out some specific requirements that providers must follow when things go wrong with care and treatment, including informing people about the incident, providing reasonable support, providing truthful information and an apology when things go wrong.
  6. Content Article
    Leadership must nurture a robust safety culture to manage crisis. This article from Foy and Mallory highlights the importance of formal and informal communication mechanisms, management empowerment and responsibility, and dialogue across silos to enhance the safety of teams and patients.
  7. Content Article
    This study from Landefeld et al., published in the Indian Journal of Community Medicine, looks at the perceptions of healthcare providers about barriers to improved patient safety in the Indian state of Kerala. Five focus group discussions were held with 16 doctors and 20 nurses across three institutions (primary, secondary and tertiary care centers) in Kerala, India and transcripts were analysed by thematic analysis.
  8. Content Article
    Is safety and a good experience two separate issues? This blog by Florence Wilcock, consultant obstetrician, discusses this issue.
  9. Content Article
    Safety culture can be described as our: 1. Values (what is important) 2. Behaviours (the way we do things around here) 3. Beliefs (how things work). Safety culture has been shown to be a key predictor of safety performance in several industries. It is the difference between a safe organisation and an accident waiting to happen. Thinking and talking about our safety culture is essential for us to understand what we do well, and where we need to improve. NHS Education for Scotland (NES) has adapted these safety culture discussion cards (designed by EUROCONTROL) to help us to do this. Follow the link below to download the cards.
  10. Content Article
    The Chartered Institute of Ergonomics & Human Factors has issued today their White Paper on Adverse Events. This report states what good practice should be in incident investigation across all industries, including health and social care. The White Paper is designed to: 1. Help organisations understand a human factors perspective to investigating and learning from adverse events. 2. Provide key principles organisations can apply to capture the human contribution to adverse events. How organisations learn, and fail to learn, from adverse events is discussed.
  11. Content Article
    This info-graphic by the Faculty of Pain Medicine is a safety checklist for Interventional Pain Procedures under local anaesthesia or sedation. This has been adapted from the World Health Organization surgical checklist.
  12. Content Article
    A significant number of people, who may or may not have been acutely unwell with COVID-19, are experiencing a prolonged and debilitating recovery at home. Symptoms and experiences of care seem to vary greatly among this group, sometimes known as the COVID-19 ‘long-haulers’. Many are finding comfort and reassurance through online communities, set up by and designed for patients who are struggling to get back on their feet.
  13. Content Article
    This article, published in Drug Safety, Robust, argues that active cooperation and effective, open communication between all stakeholders is essential for ensuring regulatory compliance and healthcare product safety; avoiding the necessity for whistle-blowing; and, most essentially, meeting the transparency requirements of public trust.
  14. Content Article
    This editorial, published by the Lancet, highlights that racism is the root cause of continued disparities in health and mortality rates between black and white people in the USA and a global public health emergency. It discusses what medical journals can and must do to help.
  15. Content Article
    I have been honest in my blogs during the pandemic. I have been apprehensive, scared and, at times, excited to work in the pandemic. So why do I feel so low at this moment? I am experiencing feelings that I have not had before. I have thoughts of leaving nursing. Surely, I can’t be the only one? Why now? Why am I feeling like this? This blog is to explore why this might be.
  16. Content Article
    Several factors can compromise patient safety, such as ineffective teamwork, failed organisational processes and the physical and psychological overload of health professionals. Studies about associations between burnout and patient safety have shown different outcomes. In this paper, published by Medicina (Kaunas), a team in Brazil analysed twenty-one studies, most of them demonstrating an association between the existence of burnout and the worsening of patient safety. High levels of burnout is more common among physicians and nurses and it is associated with external factors such as: high workload, long journeys and ineffective interpersonal relationships.
  17. Content Article
    Safety Differently are a safety news site, crafted by professionals and enthusiasts from various industries around the globe. They share innovative and critical safety ideas to empower a community of change-makers to make an impact and do safety differently.
  18. Content Article
    I wrote this editorial for the Journal of Surgical Simulation after delivering the keynote talk at the Homerton Hospital, London Surgical Simulation conference in 2018. It outlines how aviation approaches error and its use of simulation in training to deal with it safely and efficiently. Aviation Safety Management Framework and the extensive use of simulation is a safe, value for money tool.
  19. Content Article
    A brief summary produced by Frameworkhealth Ltd of the experiences aviation can share with healthcare from an author who has worked extensively in both. It outlines the three stage model used in Airline Safety Management Systems. Published in Northern Ireland Healthcare Review.
  20. Content Article
    This checklist from the Health and Safety Executive provides typical elements to score culture, particularly applicable for larger organisations.
  21. Content Article
    Dr Susan Whalley-Lloyd, Senior Lecturer in Human Factors/Ergonomics at Staffordshire University, discusses how the learning and research opportunities evolving from the coronavirus pandemic will add to our human factors knowledge base and gives us a unique opportunity to achieve new research in human factors and patient safety.
  22. Content Article
    Dr Susan Whalley-Lloyd, Senior Lecturer in Human Factors/Ergonomics at Staffordshire University, explains in this short video presentation why a human factors course is important for patient safety and what the course at Staffordshire University covers.  
  23. Content Article
    The Health & Safety Laboratory (HSL) Safety Climate Tool (SCT) measures the perceptions of the workforce on health and safety issues, offering a unique insight into the safety culture within an organisation. It can be applied across industries of all sizes, from SMEs to large complex organisations. Multi-site companies can also use it to look at the strengths and weaknesses of different sites or business units. The HSL SCT is delivered on a CD-ROM, which you install onto a suitable computer to allow you to produce a customised questionnaire that is then run across your organisation. Once the questionnaire survey has been run, the tool produces a series of automated charts that allow detailed analysis of the findings. (HSL is an agency of the Health and Safety Executive.)
  24. Content Article
    This is the letter from Monitor (now part of NHS Improvement) to all foundation trust chief executives about Sir Robert Francis’ Freedom to Speak Up review.
  25. Content Article
    Effective speaking up arrangements protect patients and improve the experience of NHS workers. The guidance set out by Sir Robert Francis in his Freedom to Speak Up review, was to develop a more open and supportive culture that encourages staff to speak up about any issues of patient care, quality or safety.  In this blog I want to explore why this hasn’t been happening in Trusts up and down the country, despite everyone wanting a safe culture to speak up, no more so than myself, a clinician who has a keen interest in patient and staff safety. Sir Robert Francis laid out six principles for Trusts to follow in his review of speaking up in NHS Trusts in 2015. I would like to reflect on the times when I have spoken up about patient safety issues and the responses I have had when I have raised them.  I will use Francis’ six principles to frame the blog. 
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