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Meredith Wilson’s “The Music Man” is an American musical set in 1900’s River City Iowa. First seen on Broadway and then as a 1960s film, the story rests on hope that arrives in town on the shoulders of a con man, Harold Hill. There are lots of themes we could track from this story into our times today – but one scene in particular is on point for this month’s letter. Hill distributes music and instruments to his students with instructions to practice on their own and they come together to play for the town. Let’s just say it doesn’t go so well. Although committed to the goal, the kids can’t play the music without solid instruction, synchronised development, collective practice and effective leadership. A band needs to follow the same score of the same tune in order to MAKE music that works. The COVID response in the US seems to have put patients, the public and clinicians in a situation similar to that of the River City kids. States, schools and cities seem to be playing from different arrangements of the same tune resulting in a lack of coordination and consistency across the country. The result is not just noise but profound failure. Ed Yong in The Atlantic summarises the systemic discord that has contributed to an estimated 183,000 deaths in the US. He highlights how despite ample warnings the country was unprepared for a pandemic, and suggests it remains unprepared for the next one. Weaknesses in leadership, testing, state policies, data capture and dissemination, public health infrastructure and information inaccuracies set the stage for the spread of COVID. Lack of respect for science, ingrained bias against people of colour and an ineffective health system perpetuated much of what could have been prevented. The situation Yong describes in his article has led the USA to a patchwork response to the pandemic. Across the country a variety of populations are being put at risk. For example, students and teachers at colleges and universities are having to navigate their way through the crisis – sorting through local concerns and statistics to devise a course that will serve their communities best while serving a mobile population of students who come from home to learn while potentially carrying or picking up the virus to take home or to their dorms. As examined in Kaiser Health News students arriving for classes are experiencing varying approaches to testing, hybrid online/in person class models and stay-at-home and masking orders. And should students become ill, universities may not be well equipped to keep those patients safe. Strategies to address these problems from politicians, researchers and healthcare abound. There is a recognised need of a national policy that aligns efforts to manage the COVID situation. As noted in USA Today, countries that have had relative success in managing the virus, such as Germany and Denmark, have a collective approach to address the problem they have committed to. The article compares international responses to those of the US to illustrate gaps and highlight areas where coordination and collaboration are desperately needed to move the country’s effort forward. Healthcare seems particularly suited to offer suggestions for improving the situation. The American Association of Medical Colleges recently published a guidance to set a direction for a safer future. The Way Forward on COVID-19: A Road Map to Reset the Nation’s Approach to the Pandemic outlines 11 recommendations to support and motivate the nation to adopt a systemic, collective plan to reset the country. Informed by expert insights from a variety of fields, the document shares actionable suggestions on topics such as testing improvement, national standards on face coverings and other safety protocols, and vaccine deployment planning. Suggestions include undertaking research to determine efficacy of face coverings to reduce transmission of COVID-19, distribution data to compare the impact of school reopening and designing a government-funded vaccine distribution and use process that involves a wide range of providers. The Music Man ends with a rousing performance of “76 Trombones.” The kids in the band follow a course toward success, resplendent in full uniform, high stepping and proud, seamlessly working together. The families and townsfolk people beam with accomplishment and join in on the celebration of collective achievement. When will we be ready to take up our instruments and perform cohesively together with no one left behind due to having a different COVID-19 score?

This edited collection can be seen to facilitate global learning. This book will, hopefully, form a bridge for those countries seeking to enhance their patient safety policies. Contributors to this book challenge many supposed generalisations about human societies, including consideration of how medical care is mediated within those societies and how patient safety is assured or compromised. By introducing major theories from the developing world in the book, readers are encouraged to reflect on their impact on the patient safety and the health quality debate. The development of practical patient safety policies for wider use is also encouraged. The volume presents a ground-breaking perspective by exploring fundamental issues relating to patient safety through different academic disciplines. It develops the possibility of a new patient safety and health quality synthesis and discourse relevant to all concerned with patient safety and health quality in a global context.

Complaints from staff are not being heeded. Why is it that healthcare staff's opinions and pleas for their safety and the safety of patients do not matter? Here are just some examples of where safety has been compromised: Disposable gowns are being reused by keeping them in a room and then reusing after 3 days. There were no fit tests. Staff were informed by management that "one size fits all, no testers or kits available and no other trusts are doing it anyway". Only when the Health and Safety Executive (HSE) announced recently that fit tests were a legal requirement, then fit tests were given. I queried about fit checks only to discover that it was not part of the training and, therefore, staff were wearing masks without seals for three months before fit tests were introduced and even after fit tests! I taught my colleagues how to do fit checks via telephone. There was no processes in place at the hospital to aid staff navigation through the pandemic (no red or green areas, no donning or doffing stations, no system for ordering PPE if it ran out); it was very much carry on as normal. A hospital pathway was made one week ago, unsigned and not referenced by governance, and with no instructions on how to don and doff. Guidelines from the Association for Perioperative Practice (AFPP) and Public Health England (PHE) for induction and extubation are not being followed – only 5 minutes instead of 20 minutes. Guidelines state 5 minutes is only for laminar flow theatres. None of the theatres in this hospital have laminar flow. One of my colleagues said she was not happy to cover an ENT list because she is BAME and at moderate/high risk with underlying conditions. She had not been risk assessed and she felt that someone with lower or no risk could do the list. She was removed from the ENT list, told she would be reprimanded on return to work and asked to write a report on her unwillingness to help in treating patients. The list had delays and she was told if she had done the list it would not have suffered from delays. Just goes to show, management only care about the work and not the staff. It was only after the list, she was then risk assessed. Diathermy smoke evacuation is not being used as recommended. Diathermy is a surgical technique which uses heat from an electric current to cut tissue or seal bleeding vessels. Diathermy emissions can contain numerous toxic gases, particles and vapours and are usually invisible to the naked eye. Inhalation can adversely affect surgeons’ and theatre staff’s respiratory system. If staff get COVID-19 and die, they become a statistic and work goes on as usual. The examples listed above are all safety issues for patients and staff but, like me, my colleagues are being ignored and informed "it's a business!" when these safety concerns are raised at the hospital. The only difference is they are permanent staff and their shifts cannot be blocked whereas I was a locum nurse who found my shifts blocked after I spoke up. Why has it been allowed to carry on? Why is there no Freedom To Speak Up Guardian at the hospital? Why has nothing been done? We can all learn from each other and we all have a voice. Sir Francis said we need to "Speak Up For Change", but management continues to be reactive when we try to be proactive and initiate change. This has to stop! Actions needed We need unannounced inspections from the Care Quality Commission (CQC) and HSE when we make reports to them. Every private hospital must have an infection control team and Freedom To Speak Up Guardian in post.

Key findings: Successive governments have pursued policies to improve the quality of care in the NHS, but the many and varied initiatives failed through a lack of consistency and the distraction of other reforms. Efforts to improve quality of care have been hampered by competing beliefs about how improvements are best achieved. More than ever, the NHS must focus on delivering better value to the public. This means tackling unwarranted variations in clinical care, reducing waste, becoming more patient- and carer-focused, and ensuring that quality and safety are at the top of the health policy agenda. This is best done by supporting clinical leaders through education and training in quality improvement methods, and developing organisational cultures where leaders and staff focus on better value as a primary goal. Clarity about the role of inspection in a quality improvement system is vital. Done well, inspection has a part to pay in quality assurance – but this should not be confused with quality improvement.

What will I learn? History of sepsis guidance Oxford AHSN approach to implementation of the guidance Care bundles (resource) Regional pathway for sepsis How to measure surveillance Limitations of coding sepsis Patient outcomes

This report identifies key factors needed for successful change and explores why they are not consistently present in the NHS. It sets out how national bodies can help make successful change more likely, in part by boosting the support provided to organisations and focusing on NHS staff leading change. It draws on: Workshops focusing on what helps and hinders change in the NHS involving commissioners, leaders in quality improvement and people who had participated in Health Foundation leadership programmes. Interviews with clinicians, academics, improvement leaders, commissioners, managers and leaders in national bodies about how change happens and what could be done differently. Our experience of funding, researching, supporting and evaluating improvement projects. Specific analysis of provider transformation, based on interviews with senior leaders from a range of acute providers. A scan of available empirical evidence about the barriers to making change in the NHS.

This report is a call to action for health leaders, clinicians, and policy makers to take the necessary steps to ensure patient and family engagement is a core value at all levels of healthcare. It includes recommended actions for: leaders of healthcare systems healthcare clinicians and staff healthcare policy makers patients, families and the public.

The full report provides several tools to assist with implementation of the recommendations, including a checklist of safe practices for improving drug allergy CDS and an educational PowerPoint file describing the workgroup’s findings and recommendations, which can be used to garner support for the organisation’s effort.

The WHO Flagship Initiative “A Decade of Patient Safety 2020-2030” will: Respond to global movement and latest developments in the area of patient safety. Give due prominence to the concept “First do not harm” and patient safety area of work. Call for political commitment and immediate action at country level. Leverage resources (internal and external/financial and human). Ensure institutional mechanisms within the organisation for coordinated work across departments/divisions, especially with disease-specific programmes.

The US National Comprehensive Cancer Network hosted the Ensuring Safety and Access in Cancer Care Policy Summit in June 2017 to discuss pertinent patient safety issues and access implications under the Trump administration, as well as policy and advocacy strategies to address these gaps and build on opportunities moving forward. This report summarises the discussions from the Summit.