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It’s the little ripples from management that make a huge impact on safety for staff. If we don’t look after our staff, we won’t have anyone to safeguard our patients. It’s simple really! This going home checklist helps remind staff how important it is to look after their own mental health and well-being.

Health and social care faces a conflict between safe and appropriate staffing and the (government) directive to be cost efficient. In a time of clinical and support staff shortages, increasing demand for services and financial austerity, there is a need for a consistent approach to workforce analysis, benchmarking and planning across the health and social care to enable informed decision-making across finance, HR and nursing management to put the patient and their safety at the centre of all we do. 'Establishment Genie' is an online workforce planning, safe staffing and benchmarking tool. It has been co-developed and tested with more than 300 teams across acute, community, residential care, hospice and independent providers of care. This has been supported by input from NHSE, NHS Professionals, The Florence Nightingale Foundation, Safe Staffing Alliance, Royal College of Nursing, Health Education England, Queen’s Nursing Institute and academic nurse staffing experts. Case study examples The following case studies show how trusts have been using the tool. Roles and responsibilities of staff have been reviewed and new workforce plans have been co-designed with staff at the frontline to deliver new ways of working that put the patient at the centre of care – whatever the setting. The Hillingdon Hospitals - Safety Supervision and Savings.pdfThe Hillingdon Hospitals - Ward Reconfiguration for Safety.pdf GIG Cymru NHS Wales - Residential Nursing homes Case Study.pdfChelsea and Westminister Hospital Case Study - Empowering Staff.pdf GIG Cymru NHS Wales - District Nursing Principles Case Study (1).pdfBerkshire Health Community Nursing Case Study.pdf Organisational benefits Integrated care levels, costs and common language enables clinical and corporate leads to collaborate and meet the requirements of a next-generation health and social care workforce: Precise staffing profiles and options appraisal support CIP development and budgeting. Gap analysis compared to budget and standards for exact hours and WTE requirement for each band. Uplift for leave is specific to each role and expected joiners, avoiding blanket uplifts that may not fit the needs of the unit. Governance and control underpinned by agreed, costed roster templates, with ready reckoners to keep within range. Improved recruitment and retention with evidence of staffing levels and support. Outcomes track quality, with benchmarking to assure. Clinical benefits Professional judgement in workforce planning is supported by this NICE-endorsed tool: Planning care levels and WTE for expansion, efficiency, reconfiguration and new service models. Evaluating alternative shift models to reorganise, invest or save. Modelling skill-mix and impact of new roles. Understanding and validating variation. Challenging peaks and troughs in cover to improve safety, release capacity and release cost savings. Benchmarking and triangulation of patient care levels, with outcomes for correlation. Mapping other staff group input across each setting. Background on 'Establishment Genie' Creative Lighthouse was founded in response to frustration at the focus on financially led decisions in health and social care management that did not consider the safety and care of patients or staff. We set out to build a platform that would allow all management groups in the healthcare sector to collaborate on safe staffing and financial governance. Creative Lighthouse self-funded the development of a unique workforce-planning tool under the brand name ’Establishment Genie’, endorsed by the National Institute of Health and Care Excellence (NICE) in 2017. In April 2017, the Creative Lighthouse team were awarded a grant from Innovate UK to continue to develop the tool to include all settings of care in the knowledge that patient safety and workforce planning is not only the responsibility of acute services, but of all providers and commissioners of care. This is a critical aspect of enabling the improvement of quality and patient outcomes in a cost effective way, whilst providing data driven analytics to support professional judgment. About the author I am a healthcare professional with over 15 years’ experience working in and consulting to public and private health and social care organisations. I have worked with a variety of health and care sector clients in the delivery of complex change, from transformational change and organisational design process to programme leadership and execution. I am passionate about the safe staffing agenda, recognising that in order for any organisation to ensure appropriate care and evidence for professional judgement, there must be consistency in approach and a way of linking staffing levels to quality outcomes that can then be benchmarked within and across organisations. This passion resulted in the birth of ‘Establishment Genie’.

The framework for safe, reliable, and effective care, set out by the Institute for Healthcare Improvement, provides clarity and direction to health care organisations on the key strategic, clinical, and operational components involved in achieving safe and reliable operational excellence, a 'system of safety', not just a collection of stand-alone safety improvement projects. This White Paper: describes the framework's two foundational domains, culture and the learning system, outlining what is involved with each and how they interact provides definitions and implementation strategies for nine interrelated components (leadership, psychological safety, accountability, teamwork and communication, negotiation, transparency, reliability, improvement and measurement and continuous learning) discusses engagement of patients and their families, the core of the framework, the engine that drives the focus of the work to create safe, reliable, and effective care. Healthcare organisations and systems may use the framework as a roadmap to guide them in applying the principles, and as a diagnostic tool to assess their work to date. Although initially focused on the acute care setting, the framework has evolved to be more broadly applicable in any setting, in acute care, ambulatory care, home care, long-term care and in the community.

Medical errors rank as the eighth leading cause of death in the U.S. Clearly medical errors are an epidemic that needs to be contained. Despite these numbers, patient safety and medical errors remain an issue for physicians and other clinicians. This book bridges the issues related to patient safety by providing clinically relevant, vignette-based description of the areas where most problems occur. Each vignette highlights a particular issue such as communication, human factors, electronic health records, and provides tools and strategies for improving quality in these areas and creating a safer environment for patients.

In their paper 'Managing risk in hazardous conditions: improvisation is not enough', Almaberti and Vincent ask "what strategies we might adopt to protect patients when healthcare systems and organisations are under stress and simply cannot provide the standard of care they aspire to". This is clearly a critical and much overdue question, as many healthcare organisations are in an almost constant state of stress from high workload, personnel shortages, high-complexity patients, new technologies, fragmented and conflicting payment systems, over-regulation, and many other issues. These stressors put mid-level managers and front-line staff in situations where they may compromise their standards and be unable to provide the highest quality care. Such circumstances can contribute to low morale and burn-out. Eric Thomas discusses this further in his Editorial published in BMJ Safety & Quality.

'The Productive Ward: Releasing time to care' was a quality improvement programme developed by the NHS Institute for Innovation and Improvement (NHSI) and introduced in 2007. It was designed to improve efficiency, productivity and performance at ward level in acute hospitals. It was based on three principles: good ward organisation so that materials were readily accessible displaying ward-level metrics such as patient safety and experience use of visual aids to understand patient status at a glance. This NIHR (National Institute for Health Research) funded study, published in the Health Services and Delivery Research journal, used quantitative and qualitative methods to evaluate the programme in six acute hospitals in England. It found some evidence of a lasting impact, such as wards continuing to display metrics and using equipment storage systems. But most hospitals that adopted the programme had stopped using it after three years, often due to a change in their approach to quality improvement. Productive Ward resources are still available from NHS England’s Sustainable Improvement team, but are under review. This evaluation may be helpful in designing future similar schemes.

A collection of resources from NHS Improvement to help you analyse, understand and improve the health and well-being of your workforce. Based on NHS Improvements's learning from the Improving Health and Well-being direct support programme, they have developed and collated some resources which will assist analysis of your quantitative and qualitative workforce data to drive and enable development of impactful evidence-based workforce health and well-being interventions. Resources: driver diagrams (tree diagrams) the health and wellbeing framework and diagnostic tool workforce stress and the supportive organisation — a framework for improvement.

There are 15 Academic Health Science Networks (AHSNs) across England, established by NHS England in 2013 to spread innovation at pace and scale – improving health and generating economic growth. Each AHSN works across a distinct geography serving a different population in each region.

A case study on how Healthier Lancashire and Cumbria have been driving forward their digital strategy. This strategy includes how they are standardising and redesigning digital systems to improve patient safety (see Theme 4 - Manage the system more effectively).

The PReCePT Programme is a quality improvement project designed to reduce the incidence of cerebral palsy through the administration of magnesium sulphate to eligible preterm mothers across England. This QI toolkit contains all the documents you will need to understand, plan and implement PReCePT in your maternity unit. Based on the success of the initial PReCePT project, some of the documents are categorised as ‘essential’ for successful implementation, others are ‘strongly recommended’ and some are ‘optional’. The toolkit includes: PReCePT QI Toolkit PDF PReCePT Programme Implementation Guide PReCePT Clinical Guideline Flow Chart PReCePT Magnesium Sulphate Quick Reference Poster PReCePT Management of Preterm Labour Proforma PReCePT Magnet Instructions PReCePT Infographic Poster PReCePT Think Magnesium Too Poster Magnesium Sulphate Parent Leaflet Quality Improvement Learning Log (PDF) Midwife Lead Role Obstetrician Lead Role

The successful NHS Productives series, from NHS Improvement, are about ‘the how not the what’ and use a learning by doing approach that builds knowledge and skills to support frontline teams to make real and lasting improvements for themselves. This toolkit includes: The Productive Leader The Productive Ward The Productive Mental Health Ward The Productive Operating Theatre Productive Community Services The Productive Community Hospital Productive Endoscopy If you work in the NHS or social care you can access online (downloadable PDF) versions of the boxsets free of charge. To get your copy, email [email protected].

This download is the third of three chapters of a book which complements the Chartered Institute of Ergonomics and Human Factors' Healthcare Learning Pathway and is intended as a practical resource for students The book aims to provide well-founded, practical guidance to those responsible for leading and implementing human factors programmes and interventions in health and social care. Designing tasks for human performance Chapter 3 objectives and learning outcomes: To describe the human contribution to task performance. To analyse systematically the impact of human performance on key vulnerabilities in the task. To reflect critically on the impact of work system and environmental factors on human performance. To assess the relative strengths and weaknesses of interventions aimed at improving human performance.