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Found 258 results
  1. Content Article
    A case study on how Healthier Lancashire and Cumbria have been driving forward their digital strategy. This strategy includes how they are standardising and redesigning digital systems to improve patient safety (see Theme 4 - Manage the system more effectively).
  2. Content Article
    Potentially preventable adverse events remain a formidable cause of patient harm and health care expenditure despite advances in systems-based risk-reduction strategies. This quality improvement study from Suliburk et al., published in JAMA Network Open, analysed the incidence of human performance deficiencies during the provision of surgical care to identify opportunities to enhance patient safety.
  3. Content Article
    The NHS Long Term Plan highlighted several safety issues that need to be addressed: the fear of blame and retribution which curtails reporting and learning, lack of staff understanding of patient safety matters and workforce issues. This short article summarises what I have learnt about how After Action Review (AAR) can directly address the first two of these and indirectly impact on the third. 
  4. Content Article
    Policy to date has mostly focused on the role of 'whistleblowers' in raising concerns about quality and safety of patient care in healthcare settings. However, most opportunities for personnel to identify and act on these concerns are likely to occur much further upstream, in the day-to-day mundane interactions of everyday work. Using qualitative data from over 900 hours of ethnographic observation and 98 interviews across 19 English intensive care units (ICUs), Tarrant et al., in a paper published in Social Science & Medicine, studied how personnel gave voice to concerns about patient safety or poor practice.
  5. Content Article
    PatientSafe Network in Australia has been promoting the theatre cap challenge across the world. By wearing your name on your theatre cap it can improve team work and patient safety. The PatientSafe Network is a registered non for profit charity. It has been developed by front line healthcare staff and is for anyone to use – patients, relatives, doctors, nurses, pharmacists, healthcare managers, equipment and system developers, insurers – who wants to improve patient safety.
  6. Content Article
    This short animation from the University of Western Australia highlights the importance of a multidisciplinary team briefing within the operating theatre environment.
  7. Content Article
    Designed and tested by the Institute of Healthcare Improvement (IHI)’s world-renowned safety experts, the Patient Safety Essentials Toolkit can help you improve teamwork and communication, understand the underlying issues that can cause errors, and create and maintain reliable systems. IHI's Vice President, Frank Federico, helped develop the contents of the new toolkit. In the following interview, he provides an overview of how to put the toolkit to good use.
  8. Content Article
    A video introducing Clinical Service Accreditation (CSA), how it can improve clinical care, how your hospital can become involved, and the resources, support and guidance available through the Healthcare Quality Improvement Partnership (HQIP). Presented by HQIP CSA Clinical Lead, Roland Valori. 
  9. Content Article
    This document provides guidance for nurses, midwives and nursing associates on raising concerns (which includes ‘whistleblowing’). It explains the processes you should follow when raising a concern, provides information about the legislation in this area, and tells you where you can get confidential support and advice.
  10. Content Article
    Back in January 2019, we started a regular team newsletter. Initially this was aimed at only the critical care unit (CCU) team; however, very quickly it developed into an all trust audience.  In this post I discuss the multiple benefits the newsletter has offered as well as the challenges I came across. I want to share my experience on developing the newsletter to encourage other teams to consider writing a regular newsletter if they don’t already have one. This followed on from several outreach teams contacting me personally for assistance in writing their own newsletters. 
  11. Content Article
    Trent Simulation & Clinical Skills Centre has developed this short cartoon to introduce healthcare staff to human factors and ergonomics. The cartoon particularly focuses on individuals, teams and the wider system with sign-posting to find out more about Human Factors and the Trent Simulation and Clinical Skills Centre.
  12. Content Article
    In 2016, Merseycare NHS Foundation Trust embarked on a journey towards a just and learning culture. Since then, they have made great progress and achieved significant results. They have produced an excellent interactive online presentation for anyone who wishes to improve the culture of the healthcare organisation in which they work. It describes why they started on the journey, what they did and the kinds of results they have obtained. It is an overview of a substantial programme, and demonstrates that while changing from a retributive 'blame' culture to a restorative 'just' culture may be challenging, it can be done - to the benefit of patients and staff.
  13. Content Article
    The Institute for Healthcare Improvement (IHI) has published a White paper: Framework on Improving Joy in Work and a series of related videos. Clinician burnout has been well-documented and is at record highs. The same issues that drive burnout also diminish joy in work for the healthcare workforce. Healthcare leaders need to understand what factors are diminishing joy in work, nurture their workforce, and address the issues that drive burnout and sap joy in work. The most joyful, productive, engaged staff feel both physically and psychologically safe, appreciate the meaning and purpose of their work, have some choice and control over their time, experience camaraderie with others at work, and perceive their work life to be fair and equitable.
  14. Content Article
    This article looks at encouraging better workplace cultures by encouraging people to be active bystanders. With a few simple facilitated sessions, many organisations have given their workforce the tools to provide interventions when toxic behaviours are displayed.
  15. Content Article
    This study by Noble and Sweeney, published in Workplace Health & Safety, assessed barriers to the use of assistive devices in safe patient handling and mobility that contribute to health care worker injuries.
  16. Content Article
    The National Guardian’s Office (NGO) conducted a review of the handling of speaking up at Derbyshire Community Health Services Foundation Trust after receiving information that the trust might not have responded to one of its workers speaking up in accordance with good practice.  The review sought to identify learning on how support for speaking up could be improved, as well as to highlight existing good practice.
  17. Content Article
    The NHS Innovation Accelerator supports the uptake and spread of high impact, evidence-based innovations across England’s NHS, benefiting patients, populations and NHS staff. 
  18. Content Article
    This document provides information about NHS England’s and NHS Improvement’s funding in 2019/20. It sets out how NHS England and NHS Improvement will support The NHS Long Term Plan through distribution of funding, people and resources, to transform local health and care systems. 
  19. Content Article
    In this BMJ blog, Drs Blair Bigham and Amitha Kalaichandran discuss hospital culture of bullying and a culture of not speaking up. When hospitals fail to create a culture where doctors and nurses can speak up, patients pay the price.
  20. Content Article
    Report from NHS Resolution highlighting the need for the NHS to involve users of care services and staff in safety investigations. It draws on NHS Resolution’s unique dataset to explore best practice in response to incidents resulting from claims from across the system.
  21. Content Article
    This paper from Kneebone et al, published in BMC's Advances in Simulations proposes simulation-based enactment of care as an innovative and fruitful means of engaging patients and clinicians to create collaborative solutions to healthcare issues.
  22. Content Article
    The Director of Medical Education (DME) at Oxford University NHS Foundation Trust developed a range of forums for junior doctor engagement with the trust, via representative groups, which meet, individually, with senior executives 10-12 times a year. These forums include a foundation year group, core medical trainee group, medical registrar group and more recently a surgical and anaesthetic group. Each group is chaired by a junior doctor, who sets the agenda and is responsible for organising the meetings. This structure emphasises that the forum’s agenda is focused on the needs and concerns of trainees, and encourages attendance and discussion.
  23. Content Article
    In this video, the General Medical Council (GMC) discusses bullying and harassment and its impact on patient care. This is part of the Professional behaviours and patient safety training programme.
  24. Content Article
    This leadership model was produced by the NHS Leadership Academy. Aimed at all employees of healthcare, regardless of grade or role, it sets out how anyone can develop as a leader.
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