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

The National Action Plan centres on four foundational and interdependent areas, prioritised as essential to create total systems safety, with 17 recommendations to advance patient safety. Culture, Leadership, and Governance 1. Ensure safety is a demonstrated core value. 2. Assess capabilities and commit resources to advance safety. 3. Widely share information about safety to promote transparency. 4. Implement competency-based governance and leadership. Patient and family engagement 5. Establish competencies for all healthcare professionals for the engagement of patients, families, and care partners. 6. Engage patients, families, and care partners in the co-production of care. 7. Include patients, families, and care partners in leadership, governance, and safety and improvement efforts. 8. Ensure equitable engagement for all patients, families, and care partners. 9. Promote a culture of trust and respect for patients, families, and care partners. Workforce safety 10. Implement a systems approach to workforce safety. 11. Assume accountability for physical and psychological safety and a healthy work environment that fosters the joy of the health care workforce. 12. Develop, resource, and execute on priority programmes that equitably foster workforce safety. Learning system 13. Facilitate both intra- and inter-organisational learning. 14. Accelerate the development of the best possible safety learning networks. 15. Initiate and develop systems to facilitate interprofessional education and training on safety. 16. Develop shared goals for safety across the continuum of care. 17. Expedite industry-wide coordination, collaboration, and cooperation on safety.

It is expected the executive lead for FTSU to use the guide to help the board reflect on its current position and the improvement needed to meet our expectations. Ideally the board should repeat this self-reflection exercise at least every two years. It is not appropriate for the FTSU Guardian to lead this work as the focus is on the behaviour of executives and the board as a whole. But obtaining the FTSU Guardian’s views would be a useful way of testing the board’s perception of itself. The improvement work the board does as a result of reflecting on our expectations is best placed within a wider programme of work to improve culture. This programme should include a focus on creating a culture of compassionate and inclusive leadership; the creation of meaningful values that all workers buy into; tackling bullying and harassment; improving staff retention; reducing excessive workloads; ensuring people feel in control and autonomous, and building powerful and effective teams.

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

This document sets out the guiding principles that will allow NHS board members to understand the: Collective role of the board including effective governance in relation to the wider health and social care system. Activities and approaches that are most likely to improve board effectiveness in governing well. Contribution expected of them as individual board members.

Key points A robust safety culture is the combination of attitudes and behaviours that best manages the inevitable dangers created when humans work in complex environments. Great leaders know how to wield attitudinal and behavioural norms to best protect against these risks. These include: psychological safety – that is, an environment where no one is hesitant to voice a concern and caregivers know that they will be treated with respect when they do) organisational fairness – where caregivers know that they are accountable for being capable, conscientious and not engaging in unsafe behaviour, but are not held accountable for system failures a learning system in which engaged leaders hear patients and front-line caregivers’ concerns regarding defects that interfere with the delivery of safe care, and promote improvement to increase safety and reduce waste. Leaders are the keepers and guardians of these attitudinal norms and the learning system.

In the late eighties, I attended a presentation on the future of the UK Medtech sector presented on behalf of the government by KPMG. The main message being the government’s desire for the industry to focus on research and development whilst transferring manufacturing to China! What relevance does this have to patient safety? Fast forward some twenty years and I am presenting the case for adoption of one of our most successful unique patented patient safety products (successful global use at this point around the 5 million patient level) to one of the largest NHS trusts. The difficulties faced by industry The trust we presented to operates a clear policy that industry should not even provide literature on products to any clinician unless procurement permission is given. We complied with this policy and were invited in to present after an anaesthetist had highlighted that the trust had experienced patient injury from the current standard practice of using rolls of tape to secure patients' eyes during anaesthesia to protect from hazards and prevent the eyes from drying out causing potentially serious harm. Our product literature carries an endorsement from the Association of Perioperative Practice who clearly state that the practice of using tape to address these issues is “not recommended and that Eyepads fit for purpose should be used”. The meeting is attended by a man from procurement and a Sister from the trust with many years of experience in her role. I present the product case and pass samples to the Sister. Within a minute of handling the product she dismisses the product as “expensive nonsense”! The man from procurement proclaims the session over and we part company. The anaesthetist that initiated the meeting was not present and was not allowed to take her desire to try our solution any further. This story is reflective of not only our experience but typical of the path we and other Medtech companies encounter in attempting to introduce new innovative patented solutions to the NHS UK companies. The drive towards ever cheaper manufacturing adoption by the NHS is led by NHS supply chain, dominating the tendering market for products with multiple manufacturing sources. The NHS is now globally recognised as a procurement-driven market, focussed on reducing costs through purchasing and negotiating lower pricing. An organisation that issues “zero inflation pricing increase” policies. This can be very effective and is certainly a major driving factor in the success of the multitude of Chinese manufacturing companies supplying the NHS. A market that has produced a multitude of failed schemes for the adoption of new technologies in favour of sourcing ever cheaper, often poor quality products. But we did not jump on that bandwagon and instead chose to continue working with the best patented technological solutions emerging. We recently had the pleasure of working with Helen Hughes and Patient Safety Learning on a webinar presenting one such product. We introduced this product over a year ago and immediately engaged with the latest NHS Accelerated Access Collaborative innovation adoption scheme. In the webinar I described how this and all of our other efforts had failed to make any serious impact other than producing great results with a small band of community health nurses. Then COVID-19 strikes and almost overnight procurement is bypassed. There is a priority in addressing shortages of products perceived as vital in maintaining care levels in the impending increased demand due to COVID-19. This leads to the successful sale of several hundred of our units. However, when the government moves to address the issue through large scale purchase of the product, our solution is dismissed and offered no part of the contracts awarded in a process that was uncannily like the experience described above. A culture of cost cutting and fear Management of the NHS is an enormous undertaking. However, I would suggest that many years of focus on cost cutting has delivered a culture of fear and apathy toward the adoption of the amazing new technologies that can transform care. The plethora of schemes for innovation adoption that we have engaged with over the years have failed, often at the outset, simply due to inadequate funding and planning. During this period industry has also had to bear the substantial increased costs of product and staff regulatory changes. When I engage with some of these schemes, I cannot understand why there are so many companies in the mix pitching products and services that have nothing to do with healthcare, but offer instead procurement or management “more efficient management” tools! Some trusts appear to be more concerned with this aspect than the actual delivery of healthcare. One trust insists that we supply our products through a third-party purchase company because the product they buy is not listed on NHS supply chain. They have now ceased to order after the third-party supplier entered administration, owing us several thousand pounds! In November we will launch a new patented product with patient safety benefits, invented by two operating department practitioners (OPDs) in Liverpool. We will manufacture the product in the UK and manage global marketing from the UK. However, we are currently focused on marketing the product overseas; engaging with NHS procurement is not a priority. I know other companies have that same view. It’s recognised that efficient procurement is an important element of NHS management, largely developed from the political direction in the Eighties on cheaper globalised manufacturing policies. Unfortunately, whilst to some degree it has been very successful in cutting costs, patient and staff safety has on occasion been compromised. There is now a culture of cost cutting with procurement completely focused on this. Call for action NHS adoption of new beneficial technologies is woefully inadequate and remains largely under the control of procurement services often disinterested in it and unqualified to manage it. For patient and staff safety to benefit, I would like to see: Simplified fast-tracked product assessment procedures managed by appropriately qualified staff. The removal of products and services designed for healthcare management from the assessment of products directly involved in improving healthcare outcomes. Our current structures are simply not fit for this purpose.

These interviews include: Dr Julie Barker, GP, End of Life lead and member of Care Home cell. Clinical Design Authority clinical lead for Nottingham Nottinghamshire Integrated Care System (ICS) Joanne Taplin, GP Partner – Abbey Medical Centre, Beeston, Nottinghamshire. GP team member working with NottsWest PCN Advance Care Planning Nurses. Jane Borland, Care Home Manager Rathgar Care Home, Northamptonshire Patient story (anonymous).

This webinar discusses: how we currently respond to harm how restorative justice practices differ why restorative justice is important in this complex healthcare environment application to practice.