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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

What will I learn? Organisations who can support you. Practical tools and advice. Raising concern externally. Advice and reflections from the front line.

In this blog, David Naylor, a senior leadership consultant at The King’s Fund, reflects on ‘imposter syndrome’, considering its impact on third sector leaders and beyond.

What we did Sharon Mcloughlin, Ward Manager, Dott Ward: "The Innovation Agency gave us the dialogue to engage with staff and address concerns objectively, without staff taking anything personally. I was able to say this is an outside organisation, and with them we’re going to look at how our team could improve." “It’s been about empowering staff, and staff realising that change has to come from all of us. I’ve gained skills to help staff feel more empowered and get on board, and see it as their responsibility to improve things too." “Hopefully as a result we’ve improved safety for patients as well. I’m more confident now that I know everybody on the team knows which patients need turning, which patients are at risk of a fall, which patients are suffering from an infection – and if staff don’t know, they need to take some accountability for that now.” Kate Wallworth, Sister, Dott Ward: "After the Coaching Academy we've now got a structure in place – we’re organised, very organised. We introduced our Safety Huddle where all staff come in and listen while we run through all the main points on the ward. That’s before every shift. Going forward everyone is aware of what’s happening on the ward that day. If a visitor comes onto the ward, any member of staff would be able to answer their questions. We all know which patients are suffering from an infection, which patients are going into theatre. It just helps the running of the ward. It’s a more pleasant ward to work on.” Lisa Clark, Sister, Dott Ward: "We had to try and figure out a way to measure if teamwork was improving or not. We introduced a simple box where staff can post a smiley face or an unhappy face, or a comment card – it was just trying to make it as easy as possible. At the beginning we’d see a lot of sad faces going into the box and not many suggestions." “Now it takes me longer to type up because there’s so many suggestions. People mention staff who’ve really put themselves out to help out, just to say thank you. You can see a lot more positive feedback, and everyone who sees their name on the board gets a positive feeling." “I don’t think people realise how powerful and uplifting it is to hear how to be positive – that there is a way to think positively, and there are solutions to problems. That’s something we’ve tried here with the team – if things aren’t going in the right direction, why don’t you think of an idea? How could you fix it yourself?” The Coaching Academy The Innovation Agency’s Coaching Academy is a programme that enables health and care professionals to improve culture, quality and safety of health and care through structured, focused interactions. Coaching for a safe and continuously improving workplace culture is a one-year programme for clinical teams focused on developing safe, high-quality and compassionate services. The programme includes accredited coaching training for team leaders; a collaborative action learning programme with other teams, creating a community of practice; an accredited team culture diagnostic to identify key areas of focus; and quality improvement and innovation practical knowledge and skills.

This guide is designed to help people experiencing bullying and harassment at work. It covers: What is bullying? Examples of bullying What is harassment? What to do next The legal position Mediation and counselling Employer responsibilities Best practice for employers Students: being bullied whilst on placement Cyber bullying Sickness and work-related stress Been accused of bullying and/or harassment? Witnessed bullying? Further information

Our Critical Care Outreach Team (CCOT) work regular shifts within the CCU and our new high dependency unit (HDU). I believe we are not alone, but at times there is an element of divide across the teams and we wanted to limit the ‘them and us’ culture. Even when we are not working within the units, we need effective teamwork to maintain best practice and, ultimately, patient’s safety. Unlike some trusts, our outreach, CCU and HDU are all managed as one big team. With this in mind, we brainstormed ideas for the reasons behind this ‘divide' and decided a regular newsletter might help us. The initial benefits would be: To keep CCU/HDU staff up to date with our current projects - this was a problem identified during recruitment into the outreach team as CCU staff suggested that they had limited opportunity to become involved in the work of the outreach team. Having the CCU staff become more involved and aware of the ‘extra’ work we do has helped to improve our working relationships; various nurses are now more involved with some of our projects, and others are looking to help with the view of progressing into a future outreach role. To explain our role as it not always widely understood by some colleagues on CCU. To offer our support to any individual wanting to work on a QI, but was not sure how to proceed. To highlight our achievements and hard work and to introduce staff to some of our ‘behind the scenes’ work. To involve all staff - we regularly asked staff for suggested content that they would find most useful. The success of the newsletter quickly led us to adapt it to all hospital staff of any discipline or grade: The above benefits were similar, but now pertinent to a larger audience, including healthcare assistants, students, physios, occupational therapists, speech and language therapists, doctors and management. Some of our team are relatively new and it is a good tool to introduce them, using photographs to help improve our visibility and approachability within the hospital. We wanted an ‘educational hot topic’ to be a regular feature to help maintain high quality care and standards amongst staff. We asked readers what topics they wanted to engage with. We now have a number of ‘guest writers’ for this section, from various specialties, to help share their knowledge and expertise. It is encouraging to hear how healthcare assistants, students and associate practitioners have found our newsletter content so educational and helped them to provide better care to the patients (and feel more engaged with the care they are providing). Every time a new edition of the newsletter is sent out, I have received personal feedback of how useful and interesting it has been. Staff have often personally thanked me on the wards and in the corridor. There is a lot of effort and time that goes into these newsletters, but I feel it is definitely worthwhile. I am a great believer in valuing staff and this has really helped me to keep going, despite the difficulties encountered. The newsletter is now jointly written with our Hospital Out of Hours (HOOH) team. Although we are two separate teams, our lead, Rhona, is shared. We all work very closely, supporting each other and preach many of the same messaged, so this just made sense. Challenges and lessons learnt: Team engagement – not all team members wish to be involved in the newsletter and feel there is little extra time to engage with this extra workload. The time spent writing and editing is significant and cannot be done within my working hours, so much of this work has been in my own unpaid time. I have to rely on some sections being written by other professionals. It is difficult to quickly replace sections if deadlines are missed or not already within a requested word limit. I initially edited the newsletter in Word, but found formatting was very difficult. I discovered Publisher and taught myself to use this. I am sure I can learn much more, but have so far found this much easier to work with. We wanted to send to ‘All email users’ within the hospital, but were told this was not possible. Instead, I use various groups of staff set up on our work email system. My first Ward newsletter was only sent out to CCU staff and Ward Managers. This was not always shared with other staff; inboxes were frequently full and therefore emails could not be received; and this method missed vital teams such as physiotherapists, speech and language, doctors, students. Following my distribution issues, I have since compiled a ‘mailing list’ which I add to regularly (this includes professionals in other trusts who enjoy our newsletter too). The hospital librarian team and individual keen students have personally asked to be added to this list which is encouraging. Perhaps we could all share our newsletters and stories within our trusts and on the hub and support each other in this patient safety initiative. I’d love to hear from others on ideas for newsletters and how they have overcome some of the challenges I describe above. CCOT Newsletter to WARDS FEB 2019 Edition 1.pdf CCOT Newsletter for ITU Staff Edition 1. Feb 2019.pdf Joint CCOT and HOOH Newsletter 2nd Edition June 2019.pdf

The Framework identifies the competencies and areas necessary for organisational leadership and management of health services, acknowledging there should be a balance between three domains: Personal attributes. Core functions of leadership: competencies relating to a leader’s ability to set direction and know how to prepare an organisation for safe and effective service delivery. Ability to ‘Execute’/Mise-en-place: competencies relating to a leader’s ability to create enabling environments, systems, processes and mechanisms, and to empower people for delivering patient-centered, quality and safe services.

We have all heard of the terrible stories of nurses going to the coroner’s court. These stories have been fed to us by our seniors, our mentors, our lecturers since we were students. "If you don’t document properly, you will end up in the coroner’s court, you might even get struck off!" These stories strike the fear of god into you. No one wants to go to coroner’s court, no one wants to be criticised for the work they have spent years training to do. No one wants to be publicly humiliated. This is my story of what happened when I attended a coroner's hearing on a patient who was in my care. I was a band 6 at the time. It was a usual day on the medical ward. Busy. I had a bay of six patients. Three of them were fit for discharge, but no community placement for them to go to, two medical patients and one who was a surgical patient. The surgical patient was under the medics and the surgeons. He came with abdominal pain; he was waiting for a surgical review. Many patients are under numerous teams on the medical ward. One of my roles is to ensure that they get seen by each team every day to ensure a plan for treatment. Today was no different. The patient was seen by the medical team who said "await surgeons". I chase up the surgeons, but they are in theatre. From experience I know that they will be out of theatre by late afternoon – so hopefully I can catch them then. In the meantime, the surgical patient becomes unwell. His blood pressure drops, his NEWS of 5 from 0. He is tachycardic. I call the medics who attend – they want me to call the surgeons… no answer. Intensive care team arrive – to this day I’m not sure how they knew to come, perhaps one of the medics called them? The intensive care doctors I hear raging down the phone at a poor surgeon who is in theatre. The surgeon comes to the ward and soon realises the gravity of the situation. There are discussion that are being had away from the bedside – I’m not sure what was being said or plans that were being made. I was not part of the process. I’m busy doing observations every 5 minutes as requested, plus trying to look after my other five patients. All of a sudden we are going to theatre. I’m still unsure what’s going on. What’s he going there for? The patient looks really scared. I bet I look scared too! I help wheel him down to the operating theatre. As soon as we arrive in the anaesthetic room he has a cardiac arrest. We try and resuscitate him to no avail. I went back to the ward; bewildered, sweating from doing chest compressions, confused and with tears in my eyes. I have a quick cup of tea and I’m back out on the ward again. Three months later my manager asks to see me in the office. ‘What have I done wrong?’ When anyone asks for you to come to the office, its usually bad. They ask if remember the surgical patient who arrested a few weeks back. Of course, I do. I had been thinking about it ever since. I had been worrying about it. I felt it was my fault. They tell me that the case is going to the coroner's court and I was to be called as a witness. I cry. That’s me done then. I’m going to be struck off. I’m going to be found out that I am a rubbish nurse. My manager was amazing. They had experience in these hearings. They explained the whole process. From what would happen from now until the end of the hearing. That afternoon I was contacted by the Trust investigation team. They were lovely too. They asked me exactly what happened and help me write a statement. They put me at ease. It was made clear that what happened was not my fault and that they want to find out what happened to prevent it happening again. The next week or so I had contact with the Trust legal team. I had never spoken to a legal team before in my life. I did feel as if I was a criminal at first. The legal team were also brilliant. They spoke through the actual process; who was in the room, the layout of the room, what questions I might be asked, what the outcomes often are. They gave me advice on how to answer questions; answer what you know as fact, not opinion. If you don’t know, say you don’t know. Be honest. I had two further meetings with the legal team and the investigating team. This was to check I was ok, to make sure I was supported. For what could be an extremely stressful period of my career, was made so much easier by people taking the time out just to check I was ok. I carried on working throughout this period and working with confidence. The hearing came. I knew what to expect. I knew the layout of the room. I knew the patient’s relatives were in the front row, I knew I had to swear an oath, I knew I had support from my Trust. I was able to speak freely – even the bad bits; no covering up or making excuses for others. I was asked what happened that day. I was honest. I didn’t know what was going on. I didn’t know what was wrong with my patient. I was not used to caring for surgical patients. Admitting that I ‘didn’t know’ was awful. I should know, shouldn’t I? When I was saying this, I could feel the eyes of the patient's widow bore into me. I had let my patient down and I had failed. The coroner asked me many questions related to escalation of care to seniors, the policy, my adherence to the NEWS policy – to which I had followed. My part was over in a flash. The next was the surgeon, who got most of the grilling. Why was he not there, where was his documentation, why did he not come when asked repeatedly? It wasn’t his fault either. He was in theatre with another patient. He can’t be in two places at once. I felt really sorry for him. I hope he got the same support I did. The outcome of the hearing was to issue a regulation 28. This ensures that a report is sent to the government by the Trust as the coroner believes that action needs to be taken can to prevent future preventable deaths. So, what happened then? I went back to work and carried on as usual. The ward where I worked no longer takes surgical patients. They made a new unit called the ‘surgical assessment unit’ where surgical nurses care for this cohort of patients. I wanted to share this – yes, there are many issues surrounding this, but the point I wanted to get across is that the investigation team, my manager and the legal team supported me through this difficult time. I am not sure if other Trusts have this level of support for staff attending coroners court.

This guide is for reviewers undertaking Structured Judgement Reviews (SJR's). A SJR is usually undertaken by an individual reviewing a patient’s death and mainly comprises two specific aspects: explicit judgement comments being made about the care quality and care quality scores being applied. These aspects are applied to both specific phases of care and to the overall care received. The phases of care are: admission and initial care – first 24 hours ongoing care care during a procedure perioperative/procedure care end-of-life care (or discharge care) assessment of care overall. While the principle phase descriptors are noted above, dependent on the type of care or service the patient received not all phase descriptors may be relevant or utilised in a review.

ITU handover Bedside checklists Transducing arterial lines Arterial line sampling Bedside monitoring Observations Ventilation basics Activity sheet. About the author Sam is a registered nurse who works for a Trust on the South Coast of England