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Being able to effectively give feedback is fundamental to building and maintaining a high performing team, and the way we deliver that feedback can make or break psychological safety. This workshop dives into how we can work most effectively with feedback, and ensure it’s a “tool for good”, helping us meet our goals. It will cover everything from principles and approaches to practical tools, mechanisms and traps to avoid. This Power of Effective Feedback workshop is designed to be applicable for those working in all industries, domains and roles. It may be most useful for those with people responsibilities, including managers, leaders, trainers, supervisors and mentors. In this workshop, we explore: Psychological Safety Fundamentals The purpose of feedback Characteristics of great feedback Traps to avoid Psychologically safer feedback “I’m ok, you’re ok” and other models The flipside of feedback – learning to receive it well The Local Rationality Principle Non-Violent Communication Practical tools and strategies Further reading and resources You’ll leave with a new perspective on the power of feedback and a range of practical tools to help you use it most effectively in your context. Register

In this blog, Patient Safety Learning’s Director Clare Wade reflects on the challenges that growing prevalence of corridor care poses to reporting and acting on patient safety concerns in the NHS. As highlighted by Lord Darzi’s independent investigation into the state of the NHS in September, the health service in the UK is currently facing unsustainable pressure accompanied by a range of critical challenges.[1] One of the most alarming indicators of this pressure is the rise and growing prevalence of 'corridor care'. Corridor care refers to patients receiving treatment in hospital corridors, cupboards and other unsuitable spaces due to bed shortages and overwhelming demand. These are referred to formally by NHS England as ‘temporary escalation spaces’.[2] While this practice aims to provide some level of care amidst resource constraints, it raises significant concerns about patient safety, dignity and quality of care. Recent reports have highlighted how corridor care is becoming increasingly common. In On the frontline of the UK’s corridor care crisis published last month, the Royal College of Nursing (RCN) highlighted from a survey of its members that nearly 70% of nursing staff deliver care in unsuitable spaces such as corridors, and over 90% believe this compromises patient safety.[3] Some hospitals, including Whittington Hospital in North London, have even advertised for 'corridor nurses' to manage patients in these overflow areas, where basic amenities like oxygen and power outlets are hastily installed.[4] Implications for patient safety As we set out in more detail in a blog published last month on the extent of corridor care in the UK,[5] this practice of corridor care poses numerous patient risks, including: Delayed treatment: Patients in corridors often face delays in receiving timely interventions as these areas lack proper infrastructure for urgent care. Inadequate monitoring: Without essential monitoring equipment and privacy, the early detection of patient deterioration is less likely. Compromised infection control: Corridors are high-traffic zones, making it harder to maintain proper hygiene and prevent hospital-acquired infections. The systemic and operational challenges posed by corridor care can also significantly undermine safety culture at an organisation, as set out in more detail in a recent blog by my colleague Claire Cox.[6] Patient safety incident reporting in the NHS In the face of such risks, it is essential that we have robust systems for reporting events or situations that potentially harm, or could harm, patients while they are receiving care. NHS England has recently introduced a new service for recording and analysing patient safety incidents in England. The Learn from Patient Safety Events (LfPSE) service replaces the previous National Reporting and Learning System and is intended to improve patient safety incident reporting in the NHS. Stating how it will do this, NHS England says that when it is fully functional it will: Make it easier for staff across all healthcare settings to record safety events, with automated uploads from local systems to save time and effort, and introduce new tools for non-hospital care where reporting levels have historically been lower. Collect information that is better suited to learning for improvement than what is currently gathered by existing systems. Make data on safety events easier to access, to support local and specialty-specific improvement work. Utilise new technology to support higher quality and more timely data, machine learning, and provide better feedback for staff and organisations.[7] LfPSE has now been rolled out across most of the NHS. However, the way in which this system works, coupled with the conditions created by corridor care, can present significant challenges to reporting and learning from patient safety risks associated with corridor care. Reporting rates At Patient Safety Learning we have heard concerns from frontline staff that significant time pressures can deter them from submitting incident reports. When working in less than ideal conditions such as delivering corridor care, this is further exacerbated. Staff who face significant additional time pressures that accompany monitoring and caring for patients in non-standard spaces can simply have less time and capacity to report incidents. Focus on digital systems LfPSE depends heavily on digital tools for incident reporting. For some organisations this can still be a barrier to their use as they continue to work with outdated IT infrastructure. These infrastructure limitations impact in a range of areas, one of which can be the accessibility and ability to capture incidents comprehensively using the new LfPSE service. This is another issue amplified when working in overcrowded and chaotic environments like corridors, where staff may not have easy access to appropriate IT. Lack of timely feedback Some healthcare staff told us that feedback from LfPSE can be delayed or absent altogether. Without timely insights, the potential for learning and improvement diminishes, and staff may be less likely to report issues if they don’t see evidence of concerns being acted on. Sharing learning Sharing learning from patient safety incidents is a fundamental component of improving patient safety and delivering safe care. However, at Patient Safety Learning we have concerns that LfPSE lacks effective mechanisms for disseminating the learning derived from reported incidents. Currently, LfPSE data is not made readily available for analysis. Trusts can see reports of their own data (which they already have access to) but not system-wide information to help them assess risk or engage with others. This can create a siloed approach where individual trusts or departments may benefit from their data but fail to contribute to a wider culture of safety improvement. For example, in the context of corridor care, incidents such as missed deteriorations or infection outbreaks may provide valuable lessons but, without NHS-wide sharing of this information, other organisations are unable to implement preventive measures. Underrepresentation of corridor care data Many corridor care incidents may be unreported or under-reported, as they often occur in makeshift spaces outside formal wards or departments. This creates a gap in the data and limits the system’s ability to address specific risks associated with such practices. At present, there appears to be no formalised mechanism to capture data from healthcare providers specifically highlighting ‘corridor care’ as a contributory factor to an increased risk of or actual patient harm. NHS England have recently announced that they will now require trusts to report on the number of patients who receive care in ‘temporary escalation spaces’.[4] To date, this data has not been made available so we are unaware of the true frequency of corridor care, where the ‘hot spots’ are or how long patients are being cared for in a corridor/escalation area. Cultural barriers There is a significant body of evidence, ranging from staff survey results to whistleblower testimonies, highlighting the wider problem of the persistence of blame cultures and a fear of speaking up in parts of the NHS.[8] [9] This is particularly true in high-pressure settings like corridors, where staff may feel they are being judged for circumstances beyond their control. Given the significant media focus on this issue, staff may feel reluctant to speak up, fearing a negative response from the trust worried about the reputational impact of reported concerns. Addressing the challenges There are clearly a number of challenges associated with reporting, learning from and acting on patient safety risks and incidents associated with corridor care. Reporting corridor care incidents needs to improve, which could involve introducing specific reporting categories to help identify and address systemic issues more effectively. Also, actively encouraging staff to share their insights to enable trusts and the wider healthcare system to better understand the nature and scale of risk to patient’s safety would be beneficial. There are also a number of wider system issues that need to be considered: Improved sharing of learning: The NHS must establish robust mechanisms for sharing insights from LfPSE data, ensuring that safety lessons from one trust are accessible more widely across the organisation. National safety alerts or learning forums could support this initiative. Support for staff and patients/families: Equipping staff/patients/families with the skills and confidence to report incidents without fear of blame is essential. Investment in IT infrastructure: Upgrading digital systems across NHS trusts will ensure the LfPSE is accessible and efficient, allowing staff providing corridor care to easily use the IT to report to LfPSE. Real-time feedback mechanisms: Providing timely analysis and feedback to staff will reinforce the value of reporting and enable immediate improvements. Using the safety science tools being promoted in PSIRF: Undertaking thematic analysis and observations of corridor care to identify the reality of ‘work as done’, including: – the risks of unsafe care – the contributory factors to these risks (task, environment, process factors, etc) – the potential opportunities for immediate improvement – sharing these insights across the healthcare system as a matter of urgency. Trusts should be made aware of colleagues who are developing good practice to mitigate risks to patients and to enable them to implement in their environments. Focus on systemic solutions: Policy reforms must address resource allocation, especially around primary care, bed management and alternative care pathways to reduce reliance on corridor care. The combination of corridor care and the limitations of the LfPSE underscores the urgent need for systemic change within the NHS. While the LfPSE is a promising tool for learning from safety events, its full potential will only be realised if these shortcomings are addressed. By prioritising the sharing of learning, fostering a culture of transparency, investing in resources and refining reporting systems, the NHS can take a vital step towards safeguarding patient safety and dignity in even the most challenging circumstances. References The Rt Hon. Professor the Lord Darzi of Denham. Independent Investigation of the National Health Service in England, 12 September 2024. NHS England. Principles for providing safe and good quality care in temporary escalation spaces, 17 September 2024. Royal College of Nursing. On the frontline of the UK’s corridor care crisis, 16 January 2025. Lintern S, Wheeler C. Hospital advertises for ‘corridor care’ nurses to ease NHS crisis. The Times, 11 January 2025. Patient Safety Learning. Response to RCN report: on the frontline of the UK’s corridor care crisis, 17 January 2025. Claire Cox. How corridor care in the NHS is affecting safety culture: A blog by Claire Cox. Patient Safety Learning, 27 January 2025. NHS England. Learn from patient safety events (LFPSE) service, Last accessed 27 January 2025. Patient Safety Learning. We are not getting safer: Patient safety and the NHS staff survey results, 26 March 2024. Peter Duffy and Helen Hughes. Speaking up for patient safety: A new interview series about raising concerns and whistleblowing. Patient Safety Learning, 15 January 2025.

Adverse event reporting is critical for advancing patient safety within healthcare systems. A significant factor in enhancing reporting rates is establishing a 'just culture'; a framework that emphasises accountability and learning over punitive measures. While just culture significantly enhances adverse event reporting, its successful implementation requires robust commitment at all organisational levels. Reporting adverse events is essential for ensuring patient safety and fostering a culture of continuous improvement in healthcare. Adverse events, defined as unintended injuries or complications arising from healthcare management, offer crucial insights into systemic weaknesses that, if addressed, can prevent future harm. However, underreporting such events remains a significant challenge, often driven by fear of punitive actions, reputational damage or legal repercussions. To address these concerns and promote a robust reporting culture, healthcare organisations must adopt a just culture by implementing standardised frameworks for evaluating errors and establishing robust reporting systems. Transparency in handling reported incidents is critical for building trust among healthcare professionals. Understanding just culture Just culture represents a shift from a blame-oriented approach to one that balances accountability with a focus on systemic improvement. Originating in high-risk industries such as aviation, the concept emphasises that errors result from flawed processes rather than individual negligence. In a just culture, individuals are held accountable for their actions within a fair and transparent system that prioritises learning and improvement. Central to the philosophy of just culture is the idea of psychological safety. When healthcare professionals feel confident reporting errors will not lead to unjust punishment, they are more likely to disclose incidents. This openness enables organisations to identify trends, address root causes and implement preventive measures. Moreover, just culture recognises the distinction between human errors, at-risk behaviours, and reckless conduct, advocating for tailored responses that align with the nature of the behaviour. Barriers to adverse event reporting Despite its potential, the implementation of just culture faces several obstacles. A predominant challenge is the deeply ingrained blame culture within many healthcare organisations. Historical reliance on punitive measures has created an environment where professionals fear repercussions, discouraging transparency. Additionally, managerial inconsistency in addressing errors often undermines trust in the system. For instance, discrepancies in how similar incidents are handled can create perceptions of unfairness, further discouraging reporting. Another barrier is the lack of understanding and awareness of just culture principles among healthcare staff. Without proper training and education, employees may misinterpret the approach as being lenient or as failing to hold individuals accountable. Legal and regulatory pressures also pose challenges, as concerns about litigation can deter organisations from fully embracing non-punitive reporting frameworks. Strategies for implementing just culture Implementing a just culture in healthcare requires a multifaceted approach that addresses organisational, managerial and individual factors. Leadership commitment is paramount; leaders must model just cultural behaviours, demonstrate accountability and prioritise safety over blame. Developing clear policies and guidelines for error classification and response is equally important as it ensures consistency and fairness in how incidents are addressed. Education and training programmes are vital in promoting awareness and understanding of just culture principles. These programmes should emphasise the distinction between human errors, at-risk behaviours and reckless conduct, providing staff with the tools to respond appropriately. Role-playing scenarios, workshops and case studies can help reinforce these concepts and demonstrate their practical application. The integration of non-punitive reporting systems is another critical component. Such systems should be designed to facilitate easy and confidential reporting, with mechanisms to protect the anonymity of reporters when appropriate. Feedback loops are essential for ensuring that staff are informed about the outcomes of reported incidents, which can reinforce the value of reporting and build trust in the system. Measuring the impact of just culture Assessing the effectiveness of just culture initiatives requires the development of standardised metrics and evaluation tools. Key performance indicators may include reporting rates, staff perceptions of psychological safety and the frequency of systemic improvements resulting from reported incidents. Periodic surveys and interviews can provide valuable insights into staff attitudes and identify areas for improvement. Case studies from organisations that have successfully implemented just culture can also serve as benchmarks for best practices. For instance, hospitals that report significant increases in adverse event reporting rates following the adoption of just culture principles often attribute their success to strong leadership, comprehensive training, and consistent application of policies. Sustaining cultural change Sustaining a just culture requires ongoing commitment and adaptability. Organisations must regularly evaluate their policies and practices to ensure alignment with just culture principles. Staff feedback should be actively sought and incorporated into decision-making processes, fostering a sense of ownership and engagement. Continuous education and training are essential for reinforcing just culture behaviours and addressing emerging challenges. Additionally, leadership succession planning should prioritise candidates who are committed to upholding just culture principles, ensuring continuity in organisational values. Conclusion Adverse event reporting is a fundamental component of patient safety, and the principles of just culture provide a robust framework for enhancing reporting rates and fostering systemic improvements. By balancing accountability with a focus on learning and improvement, just culture creates an environment where healthcare professionals feel empowered to report incidents without fear of retribution. Leadership commitment, staff education and integrating non-punitive reporting systems are critical for overcoming barriers and sustaining cultural change. A just culture represents a paradigm shift in addressing adverse events, emphasising systemic improvement over individual blame. Its successful adoption has the potential to transform healthcare organisations, making them safer and more resilient. Future research should focus on developing standardized metrics to evaluate just culture initiatives and exploring their applicability across diverse healthcare settings.

The Patients Association is running a webinar to support Future Health’s campaign, The Forgotten Majority. This campaign aims to raise awareness among policy representatives from Government and other political parties, as well as other key stakeholders, about the real life every day challenges faced by people with long-term health conditions and advocate for meaningful policy change as we approach the General Election. This webinar will provide patient experience to bring to life policies and initiatives aimed at addressing gaps in care for people with long-term health conditions. We hope this will raise awareness among policymakers and key stakeholders about the challenges faced by the ‘forgotten majority’ and the urgency of addressing their treatment and care. Rachel Power, Chief Executive of the Patients Association, will be chairing this webinar. The panel will share their insights on the importance of addressing the needs of people with long-term health conditions, and will advocate for improved care and support services. Hopefully this will increase awareness and understanding among policymakers and key stakeholders about the challenges faced by individuals with long-term health conditions, and drive systemic change. Register for the webinar

This conference will focus on measuring, understanding and acting on patient experience insight, and demonstrating responsiveness to that insight to ensure patient feedback is translated into quality improvement and assurance. Through national updates and case study presentations the conference will support you to measure, monitor and improve patient experience in your service, and ensure that insight leads to quality improvement. Sessions will include learning from patients, improving patient experience, practical sessions focusing on delivering a patient experience based culture, measuring patient experience, demonstrating insight and responsiveness in real time, monitoring and improving staff experience, the role of human factors in improving quality, using patient experience to drive improvement, changing the way we think about patient experience, and learning from excellence in patient experience practice. For further information and to book your place visit https://www.healthcareconferencesuk.co.uk/virtual-online-courses/patient-experience-insight or email [email protected] Follow on Twitter @HCUK_Clare #PatientExp hub members receive a 20% discount. Email [email protected] for the discount code.

This is part of our series of Patient Safety Spotlight interviews, where we talk to people working for patient safety about their role and what motivates them. James talks to us about the value of patient feedback in boosting morale and enabling organisations to make real patient safety improvements. He also describes the power of the unique perspective patients have on safety, and asks how we can use this insight to shift culture and provide safer care.