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News Article
NHS trust under investigation accused of hypocritical email to staff
Patient Safety Learning posted a news article in News
The boss of a hospital trust being investigated by police for alleged negligence over 40 patient deaths has been accused of sending a hypocritical email urging staff to have the courage to raise concerns despite the dismissal of whistleblowing doctors. The investigation, Operation Bramber, was sparked by two consultants who lost their jobs after raising concerns about deaths and patient harm in the general surgery and neurosurgery departments of the Royal Sussex County hospital in Brighton. In an email to staff on Friday, the chief executive, George Findlay, said the trust was committed to learning from its mistakes. He said: “When things do go wrong, we must be open, learn and improve together. That openness is how we give people courage to raise concerns and make a positive difference to patient care.” James Akinwunmi, a consultant neurosurgeon who was unfairly dismissed by the trust in 2014 after he raised the alarm about patient safety, said Findlay’s email was “laughable”. He told the Guardian: “Whistleblowers, including myself, have done exactly what he is encouraging in the email and they were sacked for it, so you can draw your own conclusions. I suspect what they are doing is damage limitation. Instead, they should be dealing with surgeons who have been a problem for years.” Another more recent whistleblower, who did not want to be named, expressed incredulity at Findlay’s claim that he wanted to encourage staff to raise concerns. They said: “The email is hypocritical. How can staff have the ‘courage to raise concerns’ after what has happened to those who have? Those brave enough to blow the whistle about patient safety have been sanctioned, lost their job and had their lives destroyed.” Read full story Source: The Guardian, 3 December 2023 -
News Article
Minister: There’s systemic racism in the NHS
Patient Safety Learning posted a news article in News
A health and social care minister privately said there was ‘systemic’ racism within the NHS and called for an investigation into it. Helen Whately told Matt Hancock of her belief in a private message which was today shown to the covid public inquiry. An inquiry hearing with Mr Hancock – who said he agreed with the point – was shown an exchange between Ms Whately, then care minister, and Mr Hancock in June 2020. The Guardian had reported the previous day that an internal report had found systemic racism at NHS Blood and Transplant. Ms Whately, who is now minister of state covering social care and urgent and emergency services, said: “I think the Bame next steps proposed are important but don’t go far enough. There’s systemic racism in some parts of the NHS, as seen in NHSBT.” She added: “Now could be a good moment to kick off a proper piece of work to investigate and tackle it.” Read full story (paywalled) Source: HSJ, 1 December 2023 -
Content ArticleThe first 14 minutes of this programme are focused on a Newsnight investigation into allegations of cover-up, avoidable harm and patient deaths relating to University Hospitals Sussex NHS Foundation Trust. At the time of broadcast, Sussex Police were investigating 105 claims of alleged medical negligence at the Trust.
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Content ArticleHospital leaders need to embed a safety culture across their organisations - read the latest guest blog on the Patient Safety Commissioner website from Maria Caulfield, the minister for mental health and women's health strategy. Maria gives three examples of how we are advancing patient safety across our NHS.
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Content Article
Developing cultural change in healthcare: Part 1 – by Dawn Stott
Dawn Stott posted an article in Good practice
If we are to continue improving healthcare services, then developing cultural change in healthcare is crucial. Improving the quality of care, reducing medical errors and, ultimately, enhancing patient outcomes is essential for the future. Transforming the culture within healthcare organisations requires a comprehensive approach that involves leadership commitment, employee engagement, continuous education and a focus on patient-centred care. In a two-part blog for the hub, Dawn Stott, Business Consultant and former CEO of the Association for Perioperative Practice (AfPP), talks about the strategies that can help you develop cultural change in your organisation. In part one, Dawn sets out the steps to develop a programme of change to support you to achieve good solutions. -
Content ArticleProductivity is misunderstood at every level in the NHS, not least because the leadership so often use the word to mean something entirely different. So what is it and what are the big misunderstandings about it? In his LinkedIn post, Stephen Black discusses what productivity is and what misunderstandings are feeding the problem.
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Content ArticleThe healthcare workplace is a high-stress environment. All stakeholders, including patients and providers, display evidence of that stress. High stress has several effects. Even acutely, stress can negatively affect cognitive function, worsening diagnostic acumen, decision-making, and problem-solving. It decreases helpfulness. As stress increases, it can progress to burnout and more severe mental health consequences, including depression and suicide. One of the consequences (and causes) of stress is incivility. Both patients and staff can manifest these unkind behaviours, which in turn have been shown to cause medical errors. The human cost of errors is enormous, reflected in thousands of lives impacted every year. The economic cost is also enormous, costing at least several billion dollars annually. The warrant for promoting kindness, therefore, is enormous. Kindness creates positive interpersonal connections, which, in turn, buffers stress and fosters resilience. Kindness, therefore, is not just a nice thing to do: it is critically important in the workplace. Ways to promote kindness, including leadership modelling positive behaviours as well as the deterrence of negative behaviours, are essential. A new approach using kindness media is described. It uplifts patients and staff, decreases irritation and stress, and increases happiness, calmness, and feeling connected to others.
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Content ArticleWhistleblowing presentation from Peter Duffy to the Association for Perioperative Practice, September 2022. York University.
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Content ArticleThe latest Care Quality Commission (CQC) report on the state of care in England is far from an encouraging read.1 Although the healthcare system is under serious strain, maternity services are among the areas identified as especially challenged. The problems identified in maternity care, while shocking, come as no surprise. The sector is seeing repeated high profile organisational failures and soaring clinical negligence claims, together with grim evidence of ongoing variation in outcomes, culture, and workforce challenges and inequities linked to socioeconomic status and ethnicity. In this BMJ Editorial, Mary Dixon-Woods and colleagues discuss why it's time for a fresh approach to regulation and improvement.
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Content Article
Thirlwall Inquiry
Mark Hughes posted an article in Other reports and inquiries
The Thirlwall Inquiry has been set up to examine events at the Countess of Chester Hospital and their implications following the trial, and subsequent convictions, of former neonatal nurse Lucy Letby of murder and attempted murder of babies at the hospital. This website provides information about inquiry team, terms of reference and publications relating to this. -
News ArticleThe public inquiry into the Lucy Letby murders will seek changes to NHS services and culture next year despite the fact that formal hearings are likely to be delayed until the autumn. Inquiry chair Lady Justice Thirlwall will issue an update message later today. In it she will stress the inquiry will “look for necessary changes to be made to the system of neonatal care in this country in real time and at the earliest opportunity, avoiding delays in making meaningful change”. HSJ understands Lady Thirlwall will look to agree on some changes, based on the inquiry’s evidence gathering and discussions with the sector before it begins oral hearings – which are unlikely to start for at least a year due to ongoing legal action. Lady Thirlwall will say the legal constraints mean its early work will focus on the experience of families who were named in the cases already heard; and “on the effectiveness of NHS management, culture, governance structures and processes, as well as on the external scrutiny and professional regulation supposed to keep babies in hospital safe and well looked after”. She said, “I want this to be a searching and active inquiry in the sense that it will look for necessary changes to be made to the system of neonatal care in this country in real time and at the earliest opportunity, avoiding delays in making meaningful change”. Read full story (paywalled) Source: HSJ, 22 November 2023
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Content ArticleSurviving in Scrubs have published their first report 'Surviving healthcare: Sexism and sexual violence in the healthcare workforce' is now live. The report is an analysis of 150 survivor stories submitted to their website since they launched in 2022. It details the findings on the incidents, factors and challenges unique to healthcare that permit sexism and sexual violence in the healthcare workforce. The report contains recommendations to healthcare organisations to better support survivors and end these behaviours.
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News ArticlePatient safety is being put at risk by the “toxic” behaviour of doctors in the NHS, the health ombudsman has said. Rob Behrens, who investigates complaints about the NHS in England, warned that the hierarchical and high-handed attitude of clinicians was undermining the quality of care in some hospitals. He called for medical training to be redesigned to encourage a more empathetic and collaborative approach from doctors. Pointing to failings in the treatment of sepsis and the problems in maternity services, Behrens said he was “shocked on a daily basis” by what he saw as ombudsman. Too often, “organisational reputation has been put above patient safety”, he told The Times Health Commission. The ombudsman warned of a “Balkanisation” of health professionals, with rivalries between doctors and nurses or midwives and obstetricians harming patient care. “For all the brilliance of clinicians quite often they’re not very good at working together,” he said. “Time and again, the handover from one clinician to another, from one shift to another, or the inability to raise the issue at a senior level has been a key factor in what has gone wrong.” Read full story (paywalled) Source: The Times, 18 November 2023
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Content ArticleIncivility in the workplace, school and political system in the United States has permeated mass and social media in recent years and has also been recognized as a detrimental factor in medical education. This scoping review in BMC Medical Education identified research on incivility involving medical students, residents, fellows and faculty in North America to describe multiple aspects of incivility in medical education settings published since 2000. The results of the review highlight that incivility is likely to be under-reported across the continuum of medical education and also confirmed incidences of incivility involving nursing personnel and patients that haven't been emphasised in previous reviews.
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Content ArticleThe government recently published terms of reference for the Thirlwall Inquiry following the crimes committed by former neonatal nurse Lucy Letby while working for the Countess of Chester Hospital NHS Foundation Trust. As well as examining the detail of the offences, the inquiry will also probe whether the trust’s culture, management, governance structures and processes contributed to the failure to protect babies. In the wake of this tragedy, it became apparent that staff had sounded the alarm about Lucy Letby, but that their concerns were not acted on. The case has propelled the issue of NHS management structures and the regulation of managers back into the headlines and made it the subject of political debate.
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Content ArticleDisruptive behaviour can have a significant impact on care delivery, which can adversely affect patient safety and quality outcomes of care. Disruptive behaviour occurs across all disciplines but is of particular concern when it involves physicians and nurses who have primary responsibility for patient care. There is a higher frequency of disruptive behaviour in neurologists compared to most other nonsurgical specialties. Disruptive behaviour causes stress, anxiety, frustration, and anger, which can impede communication and collaboration, which can result in avoidable medical errors, adverse events, and other compromises in quality care. Healthcare organisations need to be aware of the significance of disruptive behaviours and develop appropriate policies, standards, and procedures to effectively deal with this serious issue and reinforce appropriate standards of behaviour. Having a better understanding of what contributes to, incites, or provokes disruptive behaviours will help organizations provide appropriate educational and training programs that can lessen the likelihood of occurrence and improve the overall effectiveness of communication among the health care team.
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Content ArticleA substantial barrier to progress in patient safety is a dysfunctional culture rooted in widespread disrespect. Leape et al. identify a broad range of disrespectful conduct, suggesting six categories for classifying disrespectful behaviour in the health care setting: disruptive behaviour; humiliating, demeaning treatment of nurses, residents, and students; passive-aggressive behaviour; passive disrespect; dismissive treatment of patients; and systemic disrespect. At one end of the spectrum, a single disruptive physician can poison the atmosphere of an entire unit. More common are everyday humiliations of nurses and physicians in training, as well as passive resistance to collaboration and change. Even more common are lesser degrees of disrespectful conduct toward patients that are taken for granted and not recognised by health workers as disrespectful. Disrespect is a threat to patient safety because it inhibits collegiality and cooperation essential to teamwork, cuts off communication, undermines morale, and inhibits compliance with and implementation of new practices. Nurses and students are particularly at risk, but disrespectful treatment is also devastating for patients. Disrespect underlies the tensions and dissatisfactions that diminish joy and fulfilment in work for all health care workers and contributes to turnover of highly qualified staff. Disrespectful behaviour is rooted, in part, in characteristics of the individual, such as insecurity or aggressiveness, but it is also learned, tolerated, and reinforced in the hierarchical hospital culture. A major contributor to disrespectful behaviour is the stressful health care environment, particularly the presence of “production pressure,” such as the requirement to see a high volume of patients.
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News Article
Nursing watchdog to miss target to cut soaring complaints backlog
Patient Safety Learning posted a news article in News
The nursing watchdog will miss its target to tackle a 5,500-case backlog of complaints as referrals hit a record high. The Nursing and Midwifery Council NMC has admitted it won’t hit its pledge to cut the number of unresolved complaints against nurses and midwives to 4,000 by March 2024. The news comes as it faces questions over the way it handles complaints after The Independent revealed a number of serious allegations, including poor investigations that have led to fears of rouge nursing going unchecked. The newspaper exposes have prompted two independent reviews. Details of the first two reviews have been revealed for the first time and will look at: The NMC’s response to whistleblower concerns, including whether they were treated fairly and whether it acted fairly and reasonably. Any evidence of cultural issues which may have impacted the NMC’s response to whistleblowing. Whether concerns raised are substantiated and indicate a decision-making process by the NMC which is insufficient in protecting the public. Evidence of shortcomings in guidance and training. The senior whistleblower whose evidence prompted the review said: “The NMC has refused to change its approach to the investigations into my whistleblowing concerns to allow me to share and explain my evidence without fear of reprisal. I don’t think it is possible to draw safe conclusions about either how I have been treated or the impact of our culture on case work from reviewing only 13 of our current 5,500 open cases, and 6 closed cases and a selection of my emails.” Read full story Source: The Independent, 16 November 2023 -
Content ArticleThe story behind Martha’s rule is depressingly familiar. A parent raising significant concerns about their daughter’s ongoing care only to be ignored with tragic consequences. Unfortunately, this feels like the latest in a long line of incidents where the NHS has failed to heed warnings from patients and their families about the quality of their care. This article by Dan Wellings looks at recent collaborative work by The King's Fund and the Heads of Patient Experience (HOPE) network to understand why the NHS is still too often not listening to people who use its services. He highlights that progress made since the early 2000s in improving how the health service listens to patients has stalled, with the proportion of patients feeling involved in decisions about their care or treatment falling in recent years. He also outlines how organisational cultures that focus disproportionately on the positive miss opportunities to hear and respond to stories that demonstrate serious patient safety and experience issues.
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Content ArticleNurse bullying has been an issue for decades and continued during the Covid-19 pandemic. Now, in the post-pandemic era, allegations of toxic behaviour are continuing to climb. Becker's spoke with Jennifer Woods, vice president and chief nursing officer at Baptist Health Hardin in Elizabethtown, Pennsylvania, and Jamie Payne, chief human resources officer at Saint Francis Health System in Tulsa, Oklahoma, to understand the increase in nurse bullying and how their health systems are working to address it.
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Content ArticleLearn from Patient Safety Events (LFPSE) is a centralised system that healthcare staff can use to record patient safety events and access data and analytics about patient safety events nationwide using the NHS database. It replaces the National Reporting and Learning System (NRLS) that was used to upload incidents to the NHS. LFPSE introduces improved capabilities for the analysis of patient safety events occurring across healthcare, and enables better use of the latest technology, such as machine learning, to create outputs that offer a greater depth of insight and learning that are more relevant to the current NHS environment. LFPSE fields can now integrated into Datix incident form, and the information is uploaded to the national database upon the completion of an incident report. After the reviewing manager’s and Patient Safety Team review, any changes are automatically re-uploaded and the information updated in the national database. CSH Surrey share their presentation slides on LFPSE and Datix.
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Content Article“Crisis,” “collapse,” “catastrophe” — these are common descriptors from recent headlines about the NHS in the UK. In 2022, the NHS was supposed to begin its recovery from being perceived as a Covid-and-emergencies-only service during parts of 2020 and 2021. Throughout the year, however, doctors warned of a coming crisis in the winter of 2022 to 2023. The crisis duly arrived. In this New England Journal of Medicine article, David Hunter gives his perspective on the current state of the NHS.
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Content ArticleDisruptive behaviours have been shown to have a significant negative impact on staff collaboration and clinical outcomes of patient care. Disruptive episodes are more likely to occur in high stress areas such as the Emergency Department (ED). Having the structure, process, and skills in place to effectively address this issue will lower the likelihood of preventable adverse events. This study assessed the status of disruptive behaviours and staff relationships in the ED setting. It concluded that disruptive behaviours in the ED have a significant impact on team dynamics, communication efficiency, information flow, and task accountability, all of which can adversely impact patient care. EDs need to recognise the significance of disruptive behaviours and implement appropriate policies and protocols to address this issue.
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News Article
Don’t panic when staff leave, NHSE advises managers
Patient Safety Learning posted a news article in News
New NHS England guidance has advised line managers to ‘remain calm’, ‘not panic’, and ‘show kindness’ when handling staff resignations. The Expectations of Line Managers in Relation to People Management framework, published on the NHS England website, contains guidelines on several areas for line managers, including equality, diversity and inclusion, recruiting and flexible working. In the “managing exits” section, managers are told they are expected to: “Support your colleague by showing kindness to them, respect their decision, and wish them well for the future”; “Lead by example and remain calm, ie do not panic when key colleague leaves”; “Use opportunity to reflect and innovate, ie should services be redesigned?”; and “Be mindful that the colleague may have mixed emotions about leaving. Include them in planning any leaving event”. Managers are also told they should “undertake an exit interview, or ask another manager if appropriate, to understand the employee’s experience of working in your organisation” and “consider skills gaps and risks of someone leaving”. Read full story Source: HSJ, 9 November 2023 -
Content ArticleNHS England has launched this framework on the expectations of NHS line managers in relation to people management. The report contains a recommendation to create a clear view on the expectations of line managers in the service in relation to people management and the implications for provision of people services.
