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This resource is intended to help leaders guide conversations with colleagues to: Provide and elicit needed information and problem-solving to ensure staff well-being and the best care possible Use this time during the COVID-19 pandemic to break unnecessary rules and build more robust systems Tap into creative solutions identified by staff for both immediate needs and in an ongoing way Promote joy in work through healthy relationships and environments that support teams and personal growth while diminishing, as much as possible, current and future stress In using this guide, leaders are encouraged to use any opportunity to frequently communicate with team members — using brief in-person huddles, electronic methods, or other approaches — to promote staff well-being.

Patient Safety Tool Box Talks© Theme 1 talks - Person centred care and supportre and Support Patient Safety Tool Box Talks© Theme 2 talks - Effective care and support Patient Safety Tool Box Talks© Theme 3 talks - Safe care and support Patient Safety Tool Box Talks© Theme 5 talks - Leadership, governance and management Patient Safety Tool Box Talks© Theme 8 talks - Use of information

In an editorial for the World Journal of Surgery, Gogalniceanu et al. describe five concepts that can help surgical institutions adapt and create a crisis control plan in dynamic circumstances: Command Communications Capacity and resource management Contingency planning Clinical knowledge

Allow me to start this essay with a real personal story: more than a decade ago, while I was doing my Transplant & Hepato-Biliary Surgery fellowship in the USA, I had to have elective orthopaedic surgery. The good news was the hospital where I was about to have the surgery was the number one in the US News Ranking for Orthopedics that year. The bad news was that I was literally ‘terrified’ while I was in the pre-op holding area, just before I was wheeled into the operating room! How could that be? Me: the surgeon, terrified of having a straightforward orthopaedic procedure in the number one orthopaedic surgery hospital in the US? The answer was yes. It was precisely for this reason – that I am a surgeon who knew what could go wrong in a clinical unit like the OR and that I was terrified of becoming just another casualty of a medical error! Back in 2016, in their book 'Safer Healthcare', Charles Vincent and Rene Amalberti beautifully articulated the safety levels in hospitals where they classified five levels of care: Level 1: The care envisaged by standards. Level 2: Compliance with standards / ordinary care with imperfections. Level 3: Unreliable care / poor quality, but the patient escapes harm. Level 4: Poor care with probable minor harm but overall benefits. Level 5: Care where harm undermines any benefit obtained. As a practicing healthcare professional (a surgeon), I can, unfortunately, say that the majority of clinical units in hospitals are performing around Level 3 (unreliable care / poor quality, but the patient escapes harm) with fluctuations towards Level 4 (poor care with probable minor harm but overall benefits) for below-average performers or Level 2 (compliance with standards / ordinary care with imperfections) for a very few leading medical centres... sometimes! Patient safety was defined as the absence of harm. I believe it is time to define patient safety using a patient-centric approach where patient safety can be defined as the absence of harm for each patient, by the right person(s), at the right time(s) and the right place(s). Such definition would help us think about a systemic and individual framework to safety, where safety is customised to every patient, all the time, in the backdrop of a safe clinical unit. Last year marked the 20th anniversary of the landmark paper 'To Err is Human'. Although the past 20 years have seen much progress in the understanding of the healthcare safety which helped bridge the knowledge gap in this significant field, we still have a significant implementation and structural gap, which continues to contribute to the ongoing inherently weak safety conditions for patients. The main reason for writing this essay is to say that 20 years after To Err is Human, the majority of hospitals are treading around Level 3 (mediocre patient safety conditions to use layman’s terms!). Such a situation is entirely unacceptable for high-reliability industries like aviation, nuclear, and oil and gas. Fifty to sixty years ago, these industries were not as safe as they are today but reached their watershed moments (tipping point) and had to transform their safety practices. This essay is a call for action to highlight the following: Healthcare continues to be structurally weak when it comes to the safety conditions. This lack of resilience leads to ongoing medical errors and harm to patients. There is an urgent need for us to have a paradigm shift in the way we think about patient safety and how we implement it while providing healthcare. As healthcare systems are complex adaptive systems, the only way to do that is to build resilience in the system. Here are my practical solutions: Adopting co-production principles: co-design, co-delivery and co-assessment. Introducing complementary checklists for both patients and healthcare professionals throughout the patient journey. Safety reconciliation: transition of care or any patient transfer carries potential patient harm – e.g., fall, tubes or IV dislodgement, communication failure with new staff members, such as radiology department technicians, etc. Hence, it is vital that a safety reconciliation is performed by both the patient/families and healthcare professionals (co-production) using checklists. Leveraging implementation science: by introducing safety principles into the day to day clinical practices at the bedside (undergraduate, postgraduate, and board-certified practitioners). Human Factors Engineering (HFE): introducing HFE principles into bedside clinical practice – e.g., effective communication, situational awareness, flat hierarchy and team-based simulated learning – will introduce resilience into the system and help reduce potential harm to patients.

To help frame their conversation, they use the paper How Does Audit and Feedback Influence Intentions of Health Professionals to Improve Practice? Topics include: Our feelings about audits Feedback from the audit process The format of a cluster-randomised trial Lab vs. field results How to act on audit results Analysing the study’s results Final takeaways.

The resources on this web page include past webinars on: What is appreciative inquiry? Appreciative conversations The 5D cycle SOAR analysis.

This document aims to achieve the following: ➤ Outline the data received, the severity of reported patient harm and the timing and source of reports ➤ Provide feedback to reporters and encourage further reports ➤ Provide vignettes for clinicians to use to support learning in their own Trusts and Boards ➤ Provide expert comments on reported issues ➤ Encourage staff to contact SALG in order to share their own learning.