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Found 109 results
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    In this article they use this case to highlight the importance of analysing errors using a systems approach. James Reasons 'Swiss cheese model of medical errors' is explained and put into context.
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    This project will involve an action research, whole team approach to effective management of fatigue in theatre and labour ward teams during the night shift. The interventions will involve educating night shift workers about the impact of fatigue on work performance, and holding focus groups to explore experiences of fatigue, and suggested ways of mitigating night shift tiredness. Ideas will then be tested out, before the strategy is finalised and implemented. During the testing, staff will use wearable activity monitors and an app, which will help demonstrate the impact of new processes. This participatory approach and the interventions should improve team working at night, with breaks and powernaps built into the work schedule. This may improve decision-making, the management of emergencies, patient and staff safety, and staff morale. This project is currently underway and will be completed in March 2020.
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    This document is accompanied by: general advice and advice for hospital inpatients supporting information for healthcare staff including background and findings posters in English and Welsh Health and Safety Laboratory report FS/06/12 ‘Fire hazards associated with contamination of dressings and clothing by paraffin based ointments’ examples of products containing paraffin warning / hazard stickers for products a patient safety video leaflets in English and Welsh. Although the deadline for actions has passed, this guidance remains best practice. It should be followed to prevent future patient safety incidents.
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    In this short film, Dr Peter-Marc Fortune discusses the role of human factors in the recognition, response and escalation of the deteriorating child.
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    Working in healthcare has never been so demanding. The demand outweighs capacity in most services. There is a constant need for patients to be ‘flowing’ through the system. So much so, that there is little capacity for deviation from pathways that we have set up for certain groups of patients to enable their care to be ‘safer’. Our staffing templates and bed occupancy has no wiggle room for the ebbs and flows within the system at different times. Winter pressures now span from mid-summer to late spring – it just feels like the status quo. Having a busy day used to be every now and again, it seems that busy days are just the norm now. It is relentless. The huge machine that is ‘the acute Trust’ keeps turning. If you slow up due to covering staff sickness, a swell in emergency department admissions, a swell in ‘failed discharges’ you will tumble around this machine and be spat out at the end of the day with a little less resilience to when you started. There are times when we get sent an email from Comms. "We are experiencing high volumes of admissions and a low number of discharges – this is an internal critical incident". I often read this email a week later. Staff who are doing the clinical work often have no access to a computer at work as the computer is used for looking at clinical results or used by the ward clerk. Plus, when will there be time? An email telling us to work harder and be more efficient by people in their Comms room is as helpful as an ashtray on a moped. At times, us frontline staff feel as if we are being told to ‘work harder, discharge more patients, be quicker, be more efficient and while you are fighting the fire... innovate and give safer care. Innovation is rife within the healthcare system. I see it on a daily basis. Small pockets of great people doing amazing things. How are these people implementing their innovative ideas in an environment where there is little room for a full lunch break? Good will. Often, these people have been driven to innovate in their area due to an unforeseen circumstance. They may have been involved in a safety incident, a never event, bullying or just wanting to make their job easier. Ideas often start small, then grow. What was a seemingly 'simple fix’ has now turned into a beast. A band 5 nurse may introduce a new way of working. They do this alongside their full-time clinical role, often in their own time. They stay late, they come in early, they send emails on their day off, they read up on the theory behind their initiative. Great ideas and solutions are made everyday in our healthcare system by dedicated, passionate people. It is in our nature to ‘fix’ something that is broken: bones, wounds, people… healthcare? Is this pressure cooker of a place producing the ‘right type’ of solution? Or are we just papering over the big issues such as bullying, poor leadership, pay and conditions, management of long-term conditions, staffing… the list goes on. It feels as if we are putting sticking plasters over gaping cracks; it may work for a while, for that ward, that department, that Trust – but it needs to be more robust than that. We can not rely on the goodwill of our front-line clinicians to come up with the solutions.
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    This poster was created by the Royal Free Nursing team on the intensive care unit. It demonstrated how they reduced turnover of staff on the unit by implementing 'Joy in Work'.
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    In two studies, researchers found that doctors with high levels of burnout had between 45% and 63% higher odds of making a major medical error in the following three months, compared with those who had low levels. To ensure well-being and motivation at work, and to minimise workplace stress, people have three core needs, and all three must be met. A - Autonomy/control – the need to have control over our work lives, and to act consistently with our work and life values. B - Belonging – the need to be connected to, cared for, and caring of others around us in the workplace and to feel valued, respected and supported. C - Competence – the need to experience effectiveness and deliver valued outcomes, such as high-quality care. The review identified inspiring examples of organisations that meet these three core needs for doctors. An integrated, coherent intervention strategy will transform the work lives of doctors, their productivity and effectiveness, and thereby patient care and patient safety.
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    The museum is curated by Dr. Samuel West, licensed psychologist, PhD in Organisational Psychology.
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    Why is there more chance we'll believe something if it's in a bold type face? Why are judges more likely to deny parole before lunch? Why do we assume a good-looking person will be more competent? The answer lies in the two ways we make choices: fast, intuitive thinking, and slow, rational thinking. This book reveals how our minds are tripped up by error and prejudice (even when we think we are being logical), and gives you practical techniques for slower, smarter thinking. It will enable to you make better decisions at work, at home and in everything you do.
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    Presented by Sidney Dekker, Safety Differently: The Movie tells the stories of three organisations that had the courage to devolve, de-clutter, and decentralise their safety bureaucracy. It is a story of hope; of rediscovering ways to trust and empower people and of reinvigorating the humanity and dignity of actual work.
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