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Defensiveness is often implicated in systemic organisational failures to explain why early warning signs were ignored and organisational resilience was compromised. But how does an organisation become defensive? The authors of this study propose that defensiveness can arise as a response to contradictory work demands. The research focuses on UK hospital staff tasked with responding to criticism online (herein complaint handlers). It examines these responses to criticism using a mixed methods explanatory sequential design. Six defensive tactics were reliably identified: redirecting patients to other channels, evading issues, psychologising concerns, invalidating concerns as incomplete, closing the feedback episode, and individualising concerns with bespoke workarounds. These defensive tactics were generally associated with less organisational learning and were sometimes viewed as unhelpful. To explain these results, the authors introduce the complaint handler’s bind: staff are tasked with responding to complaints without a viable pathway for organisational learning and an implicit injunction against voicing this dilemma. This demand-control double bind unwittingly gives staff little alternative but to be defensive. Future research, the authors conclude, needs to conceptualise defensiveness as sometimes a symptom rather than a cause of problems in organisational learning. -
Content Article
This report on public service performance at the local level, shows that patient satisfaction is higher in GP practices that have more GPs (particularly GP partners), have smaller list sizes, deliver more GP appointments and do more of those appointments face-to-face. Additional direct patient care staff – such as physiotherapists, pharmacists and care co-ordinators – are not associated with higher satisfaction. Despite that, all those trends are heading in the opposite direction: the number of GP partners continues to fall, particularly among those aged under 40. GP practices do far more appointments remotely than they did before the pandemic. The closure and merging of practices means that patient list sizes continue to creep up. In addition, the addition of almost 40,000 direct patient care staff since 2019 does not seem to have improved satisfaction. The report argues that the government needs to urgently address the crisis in the GP partner workforce, aim to improve the conversion rate from GP traineeship into the GP workforce, understand how to use the expanded direct patient care workforce most effectively, and better communicate how its reform programme will improve patients' experience of general practice.- Posted
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The US Agency for Healthcare Research and Quality (AHRQ) has released this rapid review examining the current literature on the effectiveness of programmes used by healthcare organisations to respond after patients experience harm during their care. The review focused on communication and resolution programs (CRPs) that included communication with the patient and family, event review, quality improvement, and in a qualifying subset of events, an apology for causing harm and an offer of compensation. The review found that while studies of CRPs’ effects have focused on organisational liability and cost outcomes rather than patient-oriented outcomes they did find ‘CRPs appear to have positive or neutral effects on the measured outcomes, with no significant negative effects. The findings support the implementation of CRPs while highlighting the need for more research about patient, family, and clinician-oriented outcomes.- Posted
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News Article
Patient satisfaction with NHS has hit record low of 21%, survey finds
Patient Safety Learning posted a news article in News
Public satisfaction with the NHS is at a record low and dissatisfaction is at its highest, with the deepest discontent about A&E, GP and dental care. Just 21% of adults in Britain are satisfied with how the health service runs, down from 24% a year before, while 59% are dissatisfied, up from 52%, the latest annual survey of patients found. Satisfaction has fallen dramatically from the 70% recorded in 2010, the year the last Labour government left office, and the 60% found in 2019, the year before the Covid-19 pandemic. Mark Dayan, a policy analyst at the Nuffield Trust thinktank, which analysed the data alongside the King’s Fund, said the years since 2019 have seen “a startling collapse in NHS satisfaction. “It is by far the most dramatic loss of confidence in how the NHS runs that we have seen in 40 years of this survey.” A&E is the NHS service the public is least happy about. Satisfaction fell from 31% in 2023 to just 19% last year – the lowest proportion in the 41 years the British Social Attitudes (BSA) survey of the views of patients in England, Scotland and Wales has been carried out. Satisfaction with NHS dentistry has collapsed, too, from 60% as recently as 2019 to just 20% last year. More people (55%) are dissatisfied with dental care than with any other service. Similarly, fewer than a third (31%) of adults are satisfied with GP services. “The latest results lay bare the extent of the problems faced by the NHS and the size of the challenge for the government”, said Dan Wellings, a senior fellow at the King’s Fund. “For too many people, the NHS has become too difficult to access. How can you be satisfied with a service you can’t get into?” Read full story Source: The Guardian, 2 April 2025 -
Content Article
The Nuffield Trust and The King’s Fund join forces each year to analyse and present findings from the gold-standard survey of public attitudes and opinions towards the NHS and social care, as surveyed by NatCen. The 2024 survey results show that the British public are deeply unhappy with the way the NHS runs – just 1 in 5 people said they were satisfied. Key findings Satisfaction with the NHS In 2024, just one in five British adults (21%) were ‘very’ or ‘quite’ satisfied with the way in which the NHS runs. This is the lowest level of satisfaction recorded since the survey began in 1983 and shows a steep decline of 39 percentage points since 2019. Only 2% of respondents were ‘very’ satisfied with the NHS, down from 4% in 2023. The percentage of people who were ‘very’ or ‘quite’ dissatisfied with the NHS rose to 59% in 2024, from 52% in 2023. This represents a statistically significant 7-percentage-point increase from the year before, which already had the highest dissatisfaction seen in 40 years of the British Social Attitudes survey. A higher proportion of people in Wales (72%) were dissatisfied with the NHS compared to the survey average and compared to people in England (59%). Supporters of the Reform party were less likely to be satisfied (13%) than the survey average and this was significant after controlling for other variables like age and income. There is a divide between generations, with satisfaction lower and falling in younger age groups. While the proportion of people who were satisfied rose slightly for those aged 65 and over, from 25% to 27%, among those under 65 it fell significantly, from 24% to 19%. Satisfaction with social care In 2024, only 13% of respondents said they were ‘very’ or ‘quite’ satisfied with social care (the same figure as 2023). 53% of respondents were ‘very’ or ‘quite’ dissatisfied. Respondents in Wales (69%) were again significantly more likely to be dissatisfied than the survey average. Satisfaction with different NHS services Public satisfaction with A&E services has fallen sharply, from 31% to just 19%, and dissatisfaction has risen from 37% to 52%. These are the worst figures on record by a large margin and make A&E the service with lowest satisfaction levels for the first time. Satisfaction with NHS dentistry has continued to collapse. As recently as 2019 this was at 60%, but it has now fallen to a record low of 20%. Dissatisfaction levels (55%) are the highest for any specific NHS service asked about. Satisfaction with GP services continued to fall, mirroring the trend over the last few years. 31% of respondents said they were satisfied with GP services, compared with 34% in 2023. Inpatient and outpatient hospital care is the part of the NHS with the highest levels of satisfaction, with 32% saying they were satisfied and only 28% dissatisfied. Attitudes to standards of care, staffing and efficiency The majority of the public (51%) said they were satisfied with the quality of NHS care. People aged 65 and over were more likely to be satisfied (68%) with the quality of NHS care than those under 65 (47%). Dissatisfaction with waiting times and the ability to get an appointment is widespread, and is consistent across respondents from all ages and UK countries: 62% of all respondents were dissatisfied with the time it takes to get a GP appointment. 23% were satisfied. 65% of respondents said they were dissatisfied with the length of time it takes to get hospital care. 14% said they were satisfied. Dissatisfaction levels are highest regarding the length of time it takes to be seen in A&E. 69% of respondents said they were dissatisfied, while just 12% said they were satisfied. Only 11% agreed that ‘there are enough staff in the NHS these days’. 72% disagreed. NHS funding, principles and priorities 8% of respondents said that the government spent too much or far too much money on the NHS; 21% said that it spent about the right amount, and 69% said that it spent too little or far too little. When asked about government choices on tax and spending on the NHS, the public would narrowly choose increasing taxes and raising NHS spend (46%) over keeping them the same (41%). Only 8% would prefer tax reductions and lower NHS spending. Only 14% of respondents agreed that ‘the NHS spends the money it has efficiently’. 51% disagreed with this statement. Respondents felt the most important priorities for the NHS should be making it easier to get a GP appointment (51%) and improving A&E waiting times (49%), with increases in staff (48%) and better hospital waiting times close behind (also 48%). A&E has now slightly overtaken staffing as a priority, reflecting the sharp fall in satisfaction described above. People under 65 were more likely to prioritise improving mental health services (34%) than those aged 65 and over (21%). As in previous years, a strong majority of respondents agreed that the founding principles of the NHS should ‘definitely’ or ‘probably’ apply in 2024: that the NHS should be free of charge when you need to use it (90%); the NHS should primarily be funded through taxes (80%); and the NHS should be available to everyone (77%). The percentage of people saying that the NHS should ‘definitely’ be available to everyone decreased from 67% in 2023 to 56% in 2024. This is the only statistically significant change year-on-year across all three principles. Supporters of the Reform party (20%) were significantly less likely to say that the NHS should ‘definitely’ be available to everyone than the survey average.- Posted
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Delivering effective feedback workshop
Patient Safety Learning posted an event in Community Calendar
untilBeing 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 -
Content Article
Integrated care systems (ICSs) have a key role in tackling health inequalities—this goal is set out as one of the four core principles of ICSs, alongside improving population health, enhancing value for money and making a wider social and economic contribution to society. Tackling health inequalities and their causes are at the centre of ICS strategies and joint forward plans, but system leaders need support to do this. This framework was developed by the Care Quality Commission's (CQC's) partnership with National Voices and the Point of Care Foundation and aims to support a whole-system approach to embedding meaningful engagement and reducing health inequalities. It helps ICSs identify marginalised groups and assess their current engagement strategies. Where gaps are identified, the framework encourages collaboration with external networks that have stronger ties to these communities, all aimed at tackling health inequalities.- Posted
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Quantitative studies of public opinion on healthcare often distinguish between support for the system and satisfaction with its services. The relationship between these two dimensions can appear contradictory: in UK surveys, strong support for the NHS co-exists with rising dissatisfaction with care quality. This study aimed to investigate this apparent contradiction by analysing 169 critical reviews of emergency care visits in the UK submitted to the Care Opinion platform between 2015 and 2023. While reviews all describe instances of poor care, the authors identify the ‘justificatory repertoires’ through which reviewers express continued support for the NHS. This may reveal how societal attitudes towards public healthcare provision are in a recursive relationship with actual experiences of healthcare, and that the articulation of those experiences is deeply shaped by awareness of the broader political context. -
Content Article
Research suggests that insights from patient narratives—stories about care experiences in patients' own words—contain information that can be used to improve care. However, assessments of narratives reported by clinical personnel have been mixed. This US study aimed to systematically measure how useful staff in primary care perceive patient narratives to be. The authors surveyed 276 clinical and administrative personnel in nine primary care clinics in a large health system in the USA. We found that perceived usefulness of patient narratives is generally high, but varies by individual characteristics such as level of burnout and professional role, and with organisational characteristics such as a clinic's learning orientation and history of using patient feedback to improve quality. These findings imply that narratives can be useful for improving primary care and that their perceived usefulness is greater when organisational practices facilitate learning from patients' narrative feedback.- Posted
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Patient Experience Agency website
Patient-Safety-Learning posted an article in Suggest a useful website
The Patient Experience Agency is an Australian consultancy that aims to change the approach of healthcare providers towards delivering exceptional patient experiences. They want to see a healthcare sector in Australia that works in partnership with its patients, embraces a team-based, data-driven approach, constantly monitors experiences and outcomes and uses patient insights to continuously improve.- Posted
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NHS Staff Survey National Results 2024 (13 March 2025)
Mark Hughes posted an article in Culture
The NHS Staff survey is one of the largest workforce surveys in the world and is carried out every year to improve staff experiences across the NHS. It asks staff in England about their experiences of working for their respective NHS organisations. Of the 1.5 million NHS employees in England, 731,893 staff responded to the survey in 2024. Responses to key patient safety questions in this year’s survey included: Reporting of errors, near misses and incidents 33.60% of staff have seen errors, near misses, or incidents that could have hurt staff and/or patients/service users in the last month (2023: 33.47%, 2022: 33.69%). 59.71% of staff said their organisation treats staff who are involved in an error, near miss or incident fairly (2023: 59.51%, 2022: 58.21%). 86.43% of staff said their organisation encourages staff to report errors, near misses or incidents (2023: 86.40%, 2022: 86.14%). 68.21% of staff said that when errors, near misses or incidents are reported, their organisation takes action to ensure that they do not happen again (2023: 68.22%, 2022: 67.42%). 61.29% of staff said that they are given feedback about changes made in response to reported errors, near misses and incidents (2023: 61.05%, 2022: 59.91%). Concerns about clinical safety 71.53% of staff said they would feel secure raising concerns about unsafe clinical practice (2023: 71.45%, 2022: 72.05%, 2021: 75.13%, 2020: 72.82%). 56.83% of staff said they were confident that their organisation would address their concern (2023: 56.87%, 2022: 56.76%, 2021: 59.51%, 2020: 60.57%). Speaking up about concerns 61.82% of staff said they feel safe to speak up about anything that concerns them in their organisation (2023: 62.34%, 2022: 61.53%, 2021: 62.07%, 2020: 65.70%). 49.52% of staff said they were confident that their organisation would address their concern (2023: 50.08%, 2022: 48.67%, 2021: 49.77%). Care for patients and service users 74.38% of staff said that care of patients or service users is their organisation's top priority (2023: 75.16%, 2022: 74.07%, 2021: 75.65%, 2020: 79.54%). 70.92% of staff agree that their organisation acts on concerns raised by patients or services users (2023: 70.64%, 2022: 69.17%, 2021: 72.12%, 2020: 75.03%). Workload and resources 47.26% of staff said they are able to meet all the conflicting demands on their time at work (2023: 46.59%, 2022: 42.85%, 2021: 42.91%, 2020: 47.53%). 58.08% of staff said they have adequate materials, supplies and equipment to do their work (2023: 58.40%, 2022: 55.51%, 2021: 57.20%, 2020: 60.24%). 34.01% of staff said there are enough staff at their organisation for them to do their job properly (2023: 32.28%, 2022: 26.24%, 2021: 26.93%, 2020: 38.16%).- Posted
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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.- Posted
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Content Article
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.- Posted
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Content Article
Every two years The Neurological Alliance runs the largest national neurological patient experience survey of its kind in the country – the My Neuro Survey. Data from the survey has been used to inform campaigning and influencing activities as well as supporting and informing service improvement in the health system. This rapid literature review was carried out by The Patient Experience Library as part of preparations for the 2024 iteration of the My Neuro Survey. Undertaken during a four week period in May 2024, it supports the Neurological Alliance in deepening its understanding of how patient experience data and insights are used to inform service improvement in the NHS.- Posted
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In this article, doctor and researcher Rageshri Dhairyawan discusses how the medical practice of silencing is a systemic issue that extends further than global health to every level of healthcare and research. She outlines how it predominantly affects the same minoritised communities that experience health inequities as well as other forms of social injustice, and exacerbates them.- Posted
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This report by the Neurological Alliance shares the results of the My Neuro Survey, the largest national neurological patient experience survey in the UK, which is carried out every two years. The survey and report aim to inform and support improvement in services for people affected by neurological conditions. Recommendations The NHS should develop a Patient Experience Dashboard. Healthcare providers should routinely collect and analyse patient experience data about their services. Everyone involved in gathering patient experience data and insights should coproduce actionable insights. Everyone involved in gathering patient experience data and insights should build in feedback loops. Everyone involved in gathering patient experience data and insights should ensure support and information is available to those who share their experiences.- Posted
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Kaye Reynolds, Lead Digital Health Clinical Safety Officer at Queen Elizabeth Hospital King’s Lynn NHS Foundation Trust, has shared her monthly clinical safety officer (CSO) newsletters with the hub.- Posted
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News Article
How to fix the NHS? Free waffles and a maximum BMI for nurses
Patient Safety Learning posted a news article in News
A website launched by Sir Keir Starmer to hear the public’s ideas on how to change the NHS has been flooded with unusual responses, including a maximum BMI for nurses and free waffles for every patient. Before the launch of the website on Monday, the prime minister said it was time to “roll up our sleeves and fix” the NHS, and asked the public for suggestions on how to do it. “We have a clear plan to fix the health service but it’s only right that we hear from the people who rely on the NHS every day to have their say and shape our plan as we deliver it,” he said. In a video launching the website, Wes Streeting, the health secretary, said: “We all owe the NHS a debt of gratitude … I’m calling on you to help us fix it. This government is launching a ten-year plan to turn the NHS around but we can’t do this alone. “We want patients and NHS staff to have your fingerprints all over it. Whether you work in the NHS or use it as a patient, you see firsthand what’s great but what isn’t working and we need to hear your experiences of the NHS to get your ideas about how to change it. “So please add your voice today by following the options below. It’s quick, easy and it’ll be worth it. Because if we get this right then together we can take the NHS from the worst crisis in its history, get it back on its feet and make it fit for the future. So get involved.” Read full story (paywalled) Source: The Times, 21 October 2024- Posted
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Event
untilThe 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- Posted
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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.- Posted
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There is widespread variation in the instance and quality of meaningful patient involvement across the 42 Integrated Care Systems (ICSs) of NHS England. This is seen throughout the structures, policies and processes of the ICSs, from the omission of patient representatives on decision-making bodies—such as Integrated Care Boards (ICBs)—to the neglect of clear consultation when decisions are made concerning a patient’s care. This report present the results of research and analysis conducted by the Medical Technology Group (MTG). It shows that where a patient lives is the biggest determinant to whether they are involved in their care meaningfully, or at all. It makes recommendations for the Government, NHS England and ICS's on the approach that should be taken to ensure meaningful patient engagement. Recommendations For Government The Department of Health and Social Care should publish guidance that requires patient representation on ICBs and the annual reporting of patient involvement and representation in ICB activity. The Care Quality Commission should be given more freedom to scrutinise the level of patient involvement being carried out by ICSs and ICBs. This should also take into consideration the structures for accountability and reporting on how patient feedback is considered. For NHS England NHS England should better incentivise ICBs to involve patients within decision-making structures. NHS England should encourage ICS leaders to come together to discuss best practice for patient involvement. NHS England should support ICBs to implement their ‘Working with People and Communities Strategy’ and promote the sharing of best practice nationally. For Integrated Care Systems ICBs should involve patient representatives on boards and on committees. ICBs should ensure that patient feedback loops are properly established and practiced allowing for patient input to formally contribute to the development of policy. Patient feedback should be anonymous and cover all forms of care. ICBs should ensure that there is a rolling patient satisfaction survey for patient treatments. These should be used as a management tool to improve services. ICBs should include a standing item on their Board meetings to review how effectively they consider the patient voice when making decisions regarding the delivery of care in their local area. ICSs and ICBs should first identify Voluntary, Community and Social Enterprises (VCSEs), review how they involve VCSEs, and emphasis should be placed on working collaboratively with community bodies.- Posted
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Patients are increasingly describing their healthcare experiences publicly online. This has been facilitated by digital technology, a growing focus on transparency in healthcare and the emergence of a feedback culture in many sectors. The aim of this study was to identify a typology of responses that healthcare staff provide on Care Opinion, a not-for-profit online platform on which patients are able to provide narrative feedback about health and social care in the UK. The authors used framework analysis to qualitatively analyse a sample of 486 stories regarding hospital care and their 475 responses. Five response types were identified: non-responses, generic responses, appreciative responses, offline responses and transparent, conversational responses. The key factors that varied between these response types included the extent to which responses were specific and personal to the patient story, how much responders' embraced the transparent nature of public online discussion and whether or not responders suggested that the feedback had led to learning or impacted subsequent care delivery. Staff provide varying responses to feedback from patients online, with the response types provided being likely to have strong organisational influences. The findings offer valuable insight and have both practical and theoretical implications for those looking to enable meaningful conversations between patients and staff to help inform improvement. The authors suggest that future research should focus on the relationship between response type, organisational culture and the ways in which feedback is used in practice. -
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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. -
Content Article
Diagnostic error research has largely focused on individual clinicians’ decision making and system design, largely overlooking information from patients. This article in the journal Health Affairs analysed a unique data source of patient- and family-reported error narratives to explore factors that contribute to diagnostic errors. The analysis identified 224 instances of behavioural and interpersonal factors that reflected unprofessional clinician behaviour, including ignoring patients’ knowledge, disrespecting patients, failing to communicate and manipulation or deception. The authors concluded that patients’ perspectives can lead to a more comprehensive understanding of why diagnostic errors occur and help develop strategies for mitigation. They argue that health systems should develop and implement formal programs to collect patients’ experiences with the diagnostic process and use these data to promote an organisational culture that strives to reduce harm from diagnostic error.- Posted
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In January 2023, NHS England’s Delivery plan for recovering urgent and emergency services committed the health service to ease the growing pressure on hospitals by scaling up the use of ‘virtual wards’. Also known as ‘hospital at home’, virtual wards allow people to receive treatment and care where they live, rather than as a hospital inpatient, while still being in regular contact with health professionals. This article by The Health Foundation looks at how NHS staff and the UK public feel about the use of virtual wards, based on the results of a survey of 7,100 members of the public and 1,251 NHS staff members. The survey aimed to assess how supportive these groups are of virtual wards and what they think is important for making sure they work well. Key findings The UK public is, overall, supportive of virtual wards (by 45% to 36%). But this support is finely balanced – with a further 19% unsure whether they are supportive or not. So there is further to go in raising awareness and in understanding and addressing the public’s concerns as this model of care is developed. Support for virtual wards is higher among disabled people and those with a carer – groups that typically have greater health needs and who might therefore be expected to be more intensive users of virtual wards. Those in socioeconomic groups D and E are on balance unsupportive of virtual wards, so it will be important to understand and address needs and concerns here. Notably, survey respondents in these socioeconomic groups who said that they would not want to be treated through a virtual ward were also more likely to say that their home would not be suitable for a virtual ward compared with those in other socioeconomic groups. Nearly three-quarters of the UK public (71%) are open to being treated through a virtual ward under the right circumstances, while 27% said they would not be – suggesting that, if implemented well, virtual wards should be acceptable to a large majority of service users. Interestingly, a higher proportion of the public, 78%, told us that they would be happy ‘to monitor their own health at home using technologies, instead of in a hospital’ – describing a scenario often seen as part of a broader virtual ward service, but avoiding the term ‘virtual ward’ – with only 13% saying they would not. This raises the question of whether using different terminology or providing more explanation could help alleviate concerns and build wider support. NHS staff in our survey were, on balance, clearly supportive of virtual wards (by 63% to 31%). When asked what will matter for making sure virtual wards work well, their top two factors were the ability to admit people to hospital quickly if their condition changes, and the ability for people to talk to a health professional if they need help.- Posted
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