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Found 535 results
  1. Content Article
    This document outlines NHS England's approach to learning from safety culture best practice. It covers: Safety culture context within the NHS patient safety strategy Leadership Continuous learning and improvement Measurement and systems Teamwork and communication Psychological safety Inclusion, diversity and narrowing healthcare inequalities Case studies
  2. Content Article
    The Cambridge Elements series offers a comprehensive and authoritative set of overviews of different improvement approaches that can be applied to healthcare. Each publication explores the thinking behind them, examines evidence for each approach and identifies areas of debate. Publications available include: Design creativity Values and ethics Statistical process control Approaches to spread, scale-up, and sustainability Health economics Governance and leadership Workplace conditions Reducing overuse Simulation as an improvement technique Implementation science Operational research approaches Making culture change happen Co-producing and co-designing Collaboration-based approaches The positive deviance approach
  3. Content Article
    In December 2022, the All Party Parliamentary (APPG) for Whistleblowing heard evidence on the state of the NHS following the recent report on the avoidable deaths and life changing injuries caused to mothers and babies at the East Kent Trust. The culture at this hospital was described as one where “everyone knew the problems” and where whistleblowers were “thrown to the lions”. A culture attributed to 45 of the 65 baby deaths reviewed.  This blog first appeared on the Whistleblowers UK website in December 2022.
  4. Content Article
    In this video published by Patient Safety Movement, Kimberly Cripe, CEO of the Children's Hospital of Orange County (CHOC), discusses how her hospital has incorporated Actionable Evidence-Based Practices to improve patient safety culture in a paediatric setting. She describes the many benefits of the approach including for staff morale and making financial savings.
  5. Content Article
    Up to 30% of healthcare spending is considered unnecessary and represents systematic waste. While much attention has been given to low-value clinical tests and treatments, much less has focused on identifying low-value safety practices in healthcare settings. This study in the Journal of Patient Safety surveyed healthcare staff in the UK and Australia to identify safety practices perceived to be of low value. Staff who took part in a survey as part of the study frequently identified the following categories of practices as being low-value: paperwork, duplication and intentional rounding. Five cross-cutting themes (for example, 'covering ourselves') offered an underpinning rationale for why staff perceived these practices to be of low value. The authors conclude that in healthcare systems under strain, removing existing low-value practices should be a priority.
  6. Content Article
    This survey undertaken by SCATA and supported by the FightFatigue group is looking at rest facilities and culture in anaesthesia and intensive care. Aims: To describe the current situation regarding availability and quality of rest facilities in anaesthetic and intensive care departments in the UK and ROI, compared with current standards. To describe the current situation regarding rest culture in anaesthetic and intensive care departments in the UK and ROI, compared with current standards. To feedback to departments and provide a benchmarking of their practice as compared to current standards and peers nationally. If you would like to take part, please follow the link and enter the data into the data collection tool for each rota, in consultation with colleagues as you feel necessary. The data collected will be shared with partners in the FightFatigue group and used in line with the aims of the project as above and to produce a summary report. In this report, each Trust/Board will be able to identify their own data but not others. Please direct queries to fatigue@scata.org.uk.
  7. Event
    This one day masterclass will focus on improving patient safety through enhancing psychological safety and safety culture. It will look at effective ways to encourage health professionals to routinely embed high-quality clinical evidence into their everyday work. It will explore the characteristics of relatively successful behaviour change interventions. All Clinical Staff and Team Leads should attend. For further information and to book your place visit https://www.healthcareconferencesuk.co.uk/conferences-masterclasses/improving-psychological-safety-patient-safety or email aman@hc-uk.org.uk. hub members receive a 20% discount. Email info@pslhub.org for discount code.
  8. Content Article
    This paper asked healthcare workers who are considered to be theatre safety experts—theatre managers, matrons and clinical educators—to take part in the second round of a Delphi study. These individuals work at the coalface in operating theatres and deliver the surgical safety checklist daily. It addresses information raised as part of a Delphi study of NHS hospital operating theatres in England. The aim of the second Delphi study round was to establish the views of theatre users on the theatre checklist and local safety standards for invasive procedures. Likert scale responses and a combination of closed and open-ended questions solicited specific information about current practice and researched literature that generated ideas and allowed participants freedom in their responses of how the World Health Organisation’s (WHO's) Surgical Safety Checklist (SSC) is currently being used in the peri-operative setting as part of a strategy to reduce surgical ‘never events’. The paper is part of a literature review undertaken by the author towards a Doctor of Philosophy (PhD). Read the findings of round one of the Delphi study
  9. Event
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    Email rduh.qit@nhs,net to book a place.
  10. Event
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  11. Content Article
    This study in the journal Dove Press aimed to explore the experience of patient safety culture among South Korean advanced practice nurses in hospital-based home healthcare. 20 nurses involved in home healthcare were recruited from twelve hospitals located in three different cities throughout South Korea. The authors concluded that there were significant aspects of patient safety culture in hospital-based home healthcare, allowing for good continuity of care for patients. These aspects include communicating with caregivers, building community partnerships, understanding unexpected home environments and enhancing the safety of nurses.
  12. Content Article
    A culture of patient safety is essential for the continual improvement of service and reducing errors. This study in Risk Management and Healthcare Policy aimed to examine how the scores of patient safety culture items impact accreditation compliance percentages in primary care settings in Kuwait.
  13. Content Article
    Patient safety remains a global challenge for society today; in high income countries, it is estimated that one patient in ten is subject to adverse events while receiving hospital care. This article by Laís Junqueira, Quality, Patient Safety and Innovation Manager at Elsevier, in The Journal of mHealth looks at how enabling safer healthcare decision-making could reduce the burden of avoidable harm. Junqueira highlights the need to recognise that non-analytic and implicit decisions occur in healthcare systems, and that these have an impact on patient safety. He argues that as healthcare systems evolve, there must be an increased focus on the importance of an environment that fosters safe decision-making.
  14. Content Article
    The NHS Patient Safety Strategy aims to monitor and support the development of a strong patient safety culture within the NHS, creating an environment where individuals feel they will be treated fairly and compassionately if they speak up. In this publication, NHS England collates insights from focus groups held with NHS organisations that are rated by the Care Quality Commission as outstanding or good for its ‘Safe’ assessment domain. The insights reflect what they have done to support a patient safety culture within their organisations.
  15. Content Article
    Corey Adams, Researcher at the Australian Institute of Health Innovation, shares the impact of trauma on the patient experience. Corey shares his personal story of trauma and how we can alleviate the negative effects of trauma by building a culture of safety, kindness, trust, and respect.
  16. Content Article
    Safety conversations are an important step in building a proactive patient safety culture. They’re a respectful discussion about safety between two or more people involved in organising, delivering, and seeking or receiving care. This collection of tools and resources, from quick tip sheets to comprehensive reports and frameworks, aims to help healthcare professionals to have effective safety conversations and support safer care of older adults.
  17. Content Article
    Steven Shorrock is an interdisciplinary humanistic, systems and design practitioner interested in human work from multiple perspectives. In this blog, he reflects on what he has learned from 25 years as a human factors expert, highlighting that human factors is essentially about improving work, via design.
  18. Content Article
    In this study, Aniza Ismail and Norhani Mazrah Khalid assessed the baseline level and mean score of every domain of patient safety culture among healthcare professionals at a cluster hospital in Malaysia and identifed the determinants associated with patient safety culture. The study found that healthcare professionals at the cluster hospital showed unsatisfactory patient safety culture levels. Most of the respondents appreciated their jobs, despite experiencing dissatisfaction with their working conditions. The priority for changes should involve systematic interventions to focus on patient safety training, address the blame culture, improve communication, exchange information about errors and improve working conditions.
  19. Content Article
    This download is the second of three chapters of a book which complements the Chartered Institute of Ergonomics and Human Factors' Healthcare Learning Pathway and is intended as a practical resource for students.
  20. Event
    This one-day masterclass will focus on how to use behavioural insights and nudge theory to look at patient safety and safety culture. "Nudge Theory is based upon the idea that by shaping the environment, also known as the choice architecture, one can influence the likelihood that one option is chosen over another by individuals. A key factor of Nudge Theory is the ability for an individual to maintain freedom of choice and to feel in control of the decisions they make. " Nudge-type interventions have the potential for changing behaviours. We will look at examples of nudge theory use in healthcare and external organisations and how we can use these to improve patient safety and also to reduce inefficiency and waste. We will look at the type of interventions suitable for nudges and how to develop them. Key learning objectives: Behavioural insights. Nudge theory. Use of nudge theory to improve patient safety. Developing nudges. Opportunities for nudge-type interventions. Facilitated by Perbinder Grewal. Register hub members receive a 20% discount. Email info@pslhub.org for a discount code.
  21. Content Article
    Conversations that leaders have with their team members are the drivers of psychological safety. In this blog, Tanmay Vora looks at how to start conversations that build psychological safety in teams. He includes two infographics which highlight suggested conversation starters for team leaders and team members.
  22. Content Article
    This framework produced by the Royal College of Paediatrics and Child Health (RCPCH) aims to improve how healthcare organisations recognise and respond to children at risk of deterioration. A safer system can work in partnership with families and patients, develop a patient safety culture and support ongoing learning. The framework covers: Patient safety culture Partnership with families Recognising deterioration Responding to deterioriation Open and consistent learning Education and training
  23. News Article
    A hospital trust has been fined £200,000 for putting four babies at "serious risk"of harm. Staff at Rotherham Hospital failed to spot non-accidental injuries during admissions, Sheffield Magistrates' Court heard. District Judge Naomi Redhouse criticised failures in the hospital's systems and processes. Health watchdog, the Care Quality Commission (CQC), had earlier highlighted problems with safeguarding training at the trust prior to the babies' admissions between January 2019 and February 2020. The court was told how one eight-day-old baby was brought into the hospital on 23 December 2019 suffering from breathing difficulties and bleeding from the nose and mouth. It was only on the child's fifth visit to hospital - after a GP raised concerns - that a child safety examination took place, revealing rib and leg fractures that were deemed non-accidental. Ms Redhouse also heard how a month-old baby brought in with a mouth injury on 20 January 2019 was on a child protection plan but this was not spotted by the paediatric nurse who examined the baby. This child was twice released from hospital, with no safeguarding concerns, before a scan and other examinations revealed multiple fractures, the court heard. Prosecutor Ryan Donohue said failings had been identified in areas including policy implementation, training, reporting, auditing and governance. Eleanor Sanderson, mitigating for the trust, said: "The trust wishes to express to the court its deep regret for the circumstances which gave rise to these offences and the risk posed to those who required safeguarding." Read full story Source: BBC News, 26 October 2022
  24. Content Article
    The Health and Care Act 2022 will establish the Healthcare Safety Investigations Branch (HSIB) as the Health Services Safety Investigations Body (HSSIB) in April 2023, a fully independent arm’s-length body. This blog by Dr Sean Weaver, Deputy Medical Director at HSIB, outlines what HSSIB's new powers will be.
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