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Found 84 results
  1. News Article
    Many hospital staff treating the sickest patients during the first wave of the pandemic were left traumatised by the experience, a study suggests. Researchers at King's College London asked 709 workers at nine intensive care units in England about how they were coping as the first wave eased. Nearly half reported symptoms of severe anxiety, depression, post-traumatic stress disorder or problem drinking. One in seven had thoughts of self-harming or being "better off dead". Nursing staff were more likely to report feelings of distress than doctors or other clinical staff in the anonymous web-based survey, which was carried out in June and July last year. Just over half reported good well-being. Victoria Sullivan, an intensive care nurse at Queen's Hospital in Romford, said she often can't sleep because she's thinking about what is happening at the hospital. Her worst moment was breaking the news of a death on the phone, she said, adding that the screams from the patient's relatives "will honestly stay with me forever". "Telling someone over the phone and all you can say is 'I'm really sorry', whilst they're crying their heart out, is quite traumatising," she said. "Although you're saying how sorry you are, in the back of your mind, you're also thinking: 'I've got three other patients I've got to go and see, the infusions need drawing up, and meds need to be given and a nurse needs support'. "The guilt is just too much." Lead researcher Prof Neil Greenberg said the findings should be a "wake-up call" for NHS managers. He said: "The severity of symptoms we identified are highly likely to impair some ICU staff's ability to provide high-quality care as well as negatively impacting on their quality of life." Read full story Source: BBC News, 13 January 2021
  2. Content Article
    As an additional option to the text below, you might like to watch the following short video from Claire Cox, Patient Safety Learning's Associate Director of Patient Safety, and Clive Flashman, Chief Digital Officer. Making the case for staff safety and its impact on patient safety COVID-19 has resulted in unprecedented levels of focus on the issue of staff safety in health and social care, showing the important role it has in keeping patients safe. The pandemic has exposed risks to staff physical and mental wellbeing, with inadequate Personal Protective Equipment, intensely difficult physical and psychological working conditions, and inadequate infection control, which tragically has resulted in deaths from exposure to the virus. At Patient Safety Learning, we believe that staff safety is intrinsically linked to patient safety. To improve the safety of patients, we need to ensure that staff are safe, both physically and psychologically. Psychological safety involves providing the conditions where staff feel able to speak up about patient safety risks and mistakes, moving away from a culture that seeks to simply assign blame when things go wrong. Blame culture incentivises people to cover up mistakes, rather than reporting them, and often singles out individuals rather than tackling the systemic causes of errors. Health and social care needs to move towards a just culture approach – one of Patient Safety Learning’s six foundations of safe care – a working culture that fosters learning and where all staff feel able to raise concerns. Working directly with staff to understand the issues they face Through conversations we have had with staff – both via our patient safety platform, the hub, and directly with them – it is clear to see that a just culture does not exist widely across the health and care system, and that many staff generally do not feel able to speak up about risks to patient safety. For example: New members of the hub are often not willing to publicly disclose their organisation or role. People are hesitant to comment on articles or in Community discussions on the hub at the risk of identifying themselves. This leads to lots of viewing activity but less sharing of experiences and interaction than we would like. Members of the hub from NHS organisations are not willing to share information that might be sensitive or controversial. Staff express their fear that they will be ‘found out’ and do not have permission to share good practice. Encouraging staff to speak up We have taken various measures this year to raise awareness about the importance of staff safety and its impact on patient safety. On the hub, we’ve worked with members to enable them to post their stories anonymously. We are continuously developing and improving the hub, based on user feedback and the trends we are seeing. Some of these future updates will include allowing members to anonymously post comments on articles and in Community discussions, and creating private areas for NHS organisations to share and collaborate in safety. Raising awareness about the importance of staff safety Staff safety was the theme for this year’s World Patient Safety Day (17 September 2020). We interviewed staff from across the health and care system, sharing their unique insights and experiences on the hub. By doing so, we were able to highlight the key issues in staff safety, draw on common themes, share and promote good practice, and gain a clearer idea of the kind of change that is needed to keep staff, and ultimately patients, safe. Also in September, we held a small, interactive workshop-style event, exclusively for staff. Within two hours of promoting the event to members of the hub, places to the event were fully booked. We worked with Gill Phillips, creator of the innovative Whose Shoes© model, which the workshop was based on. The intimate, highly participative event gave staff the chance to talk openly about their personal experiences around key issues in staff safety and how they impact patient safety. On World Patient Safety Day, we shared a glimpse into the event for all to see the main points of discussion and the learning that came out of it. During September, on our social media channels, we asked the public to share with us the three things they thought were most needed for staff to be safe. We gathered these responses, identified the most common themes and shared our learning on the hub. Looking ahead to 2021 We will continue to work with staff, both directly and via the hub, giving them a platform so they can raise their concerns or perceived risks to staff and patient safety. We will also continue to share their stories with the public more widely. We will use what we learn to engage with leaders in health and care so that staff, and therefore patients, are kept safe from harm.
  3. Content Article
    Bullying and scapegoating ride on the back of fear: When things go wrong or have an outcome that we were not anticipating different aspects of second victim phenomenon kick in, such as shame, guilt and fear. It is terrifying to fear for the loss of one’s professional registration or to be recognised as the care worker who damaged the reputation of your organisation. Quite apart from the pain and accompanying worry of knowing that you may have brought harm to your patient. Encouraging openness and honesty, permits emotional healing, supports staff retention and reduces the number of safety incidents. Emotional healing rides on the back of openness and honesty: In order to move on from a safety incident, it is essential to be truthful. Recognise that peoples’ perceptions of an incident are subjective and may differ from your own. Perceptions often germinate during a time of chaos. Refrain from judging, instead focus on your own personal recovery. Draw strength and comfort from your courage to speak the truth as you perceive it. No such thing as a Never Event: The use of the term ‘Never Event’, increases feelings of guilt and shame for those of us unfortunate enough to be associated with a safety incident. We are, at the end of the day, human beings working within a system of systems. There can never be such a thing as a Never Event. The term second victim is out dated: It degrades the trust that patients and families place in us as care givers. I suggest the term PIAE as an alternative. People In Adverse Events. Not all PIAEs will be involved in a review process. The majority won’t. Sometimes simply seeing something is sufficient to cause psychological trauma for a care worker. All PIAEs should have access to tiered emotional support. This is my challenge to the NHS. Finally the biggest challenge I faced on my amazing journey, was helping people to understand that PIAE support is not competing with other support initiatives. It is a specialised area, providing timely, empathetic, non-judgmental support by trained Listeners, for a specific group of people, namely PIAEs. Read Carol Menashy's other blogs on SISOS: Part one Part two Part three Part four
  4. News Article
    Trusts have been urged to reflect on their disciplinary procedures, and review them annually where required, following the death of a senior nurse who took his own life after being dismissed. NHS England’s chief people officer Prerana Issar has written to trust leaders to highlight Imperial College Healthcare Trust’s new disciplinary procedures, which were put in place following Amin Abdullah’s suicide. Mr Abdullah, a senior nurse at Charing Cross Hospital in west London, was suspended in September 2015 before being let go from his job that December. He died in February 2016 after setting himself on fire. An independent investigation criticised both the trust and its staff and concluded he had been “treated unfairly”. The summary report produced by the trust was labelled a “whitewash”, which “served to reassure the trust that it had handled the case with due care and attention”, and the delay of three months between the events and hearing were “troubling”. The report, which also criticised the delays as “excessive” and “weak” in their justification, said Mr Abdullah found the delay “stressful” and caused him to become “distressed”. In the letter sent on Tuesday, seen by HSJ, Ms Issar said: “The shared learning from Amin’s experience has demonstrated the need for us to work continuously and collaboratively, to ensure that our people practices are inclusive, compassionate and person-centred, with an overriding objective as to the safety and wellbeing of our people… our collective goal is to ensure we enable a fair and compassionate culture in our NHS. I urge you to honestly reflect on your organisation’s disciplinary procedure…" Read full story (paywalled) Source: HSJ, 3 December 2020
  5. Content Article
    Prerana Issar is the Chief People Officer of NHS England and NHS Improvement. She was appointed in February 2019 to this post, which was created after senior leaders in the NHS and Department of Health and Social Care realised that a new approach was needed to a number of serious workforce issues which had become apparent. Among these is the complex, and hugely important, issue of speaking up (sometimes referred to as whistleblowing or raising concerns). Prerana recently retweeted a message from NHS England and NHS Improvement that "It's so important (for NHS staff) to feel able to speak up about anything which gets in the way of patient care and their own wellbeing".[1],[2] She is absolutely right... in principle. She is right to point out that NHS staff have both the right and the duty to speak up about problems like this, as is spelt out in the NHS Constitution[3] and professional codes of conduct for healthcare professionals.[4],[5],[6] The problem is that in practice, as an unknown but substantial number of NHS staff have discovered to their cost, their careers may be at risk if they do speak up as is evident from almost all the replies to both tweets.[1],[2] There is a sad pattern of disciplinary action being taken against staff who have, in good faith, raised concerns in the public interest. Even though their motivation in speaking up in the first place is to improve patient care, they discover to their astonishment that they are considered to be troublemakers for having done so. A depressing cycle of suspension, isolation, unfair dismissal, denigration and blacklisting of the person who has spoken up is often played out, whilst the original concerns and their validity are covered up. What a waste of valuable resources. The existence of such hostility to staff who have spoken up is evidenced in the 2015 report of the Freedom To Speak Up (FTSU) Review: "an independent review into creating an honest and open reporting culture in the NHS".[7] The press release which accompanied its publication announced that the review "identifies an ongoing problem in the NHS, where staff are deterred from speaking up when they have concerns and can face shocking consequences when they do. The review heard stories of staff that have faced isolation, bullying and counter-allegations when they’ve raised concerns. In some extreme cases when staff have been brave enough to speak up, their lives have been ruined".[8] The FTSU report calls for "an overhaul of NHS policies so that they don’t stand in the way of people raising concerns with those who can take action about them" and sets out "20 Principles and Actions which aim to create the right conditions for NHS staff to speak up". The principles are divided into five categories: the need for culture change; improved handling of cases; measures to support good practice; particular measures for vulnerable groups; and extending the legal protection.[7] In theory the law protects whistleblowers, but in practice, as a procession of disillusioned NHS staff who have experienced reprisals from their employers after speaking up have discovered the hard way, it does not. Employment tribunals are an alien environment for most healthcare staff. Case after case has shown that they are woefully ill-equipped to deal with precipitating patient care issues, in which tribunals appear to have little interest. Even when NHS staff are, against massive odds, found to have been unfairly dismissed after raising concerns in the public interest, the so-called remedy they receive almost invariably amounts merely to paltry financial 'compensation'. These are monetary awards that generally come nowhere near compensating for the full financial consequences. The adverse impact of this lack of protection for whistleblowers is not only on the individual but also includes the chilling effect of deterring other staff from raising concerns and the consequences of cover ups. True overall costs to the NHS, patients, whistleblowers and taxpayers of retaliation against staff who speak up are very much greater than financial costs alone. Staff surveys show that nearly 30% of NHS staff would not feel secure raising concerns about unsafe clinical practice.[9] Over 40% would not be confident that their organisation would address their concern if they do speak up.[10] There is still a lot to do in this area, as has been brought to the fore by recent reports of hostile responses by some NHS organisations to staff who have raised serious personal protective equipment (PPE) concerns affecting patient safety and health of themselves and their families. To be fair, serial staff surveys show a marginal improvement in the percentage of NHS staff who agreed they would feel secure raising concerns about unsafe clinical practice, up from a disturbingly low 68.3% in 2015 to 71.6% in 2019.[9] And a further tiny improvement in the percentage confident that their organisation would address their concern, up from an even lower 56.2% in 2015 to 59.8% in 2019. Viewed from the perspective of NHS whistleblowers whose careers have been wrecked after speaking up these are painfully slow rates of improvement. Bearing in mind widespread reports of PPE shortages, and warnings to NHS staff not to make a fuss about this, it will be interesting to see whether this glacial pace of change in speaking up culture is maintained when the results of the 2020 survey are available. Based on experience in the last two years, we can expect another prolonged FTSU publicity campaign in the month preceding the annual autumn NHS staff survey. The NHS Interim People Plan, published in June 2019, refers to development of a focus on whistleblowing and speaking up. It highlights the need for inclusive and compassionate leadership so that all staff are listened to, understood and supported, and the need to do more to nurture leadership and management skills of middle managers.[11] The original aim was to publish a full, costed NHS People Plan by Christmas 2019,[12] building on the interim plan, but this was delayed by unforeseen events, including a change of government, general election, Brexit ramifications and now the coronavirus pandemic. The interim plan makes clear the need to embed culture changes and leadership capability in order to achieve the aim of making the NHS "the best place to work". There is much to do, and I wish well to those who want to make it safe for staff to speak up, but they must be under no illusion – there is a long way to go – and this will take more than an overhaul of NHS policies. I hope to develop these themes in future postings to the hub. Comments welcome. References NHS England and NHS Improvement tweet, @NHSEngland, 15 May 2020, 6:35pm. Prerana Issar tweet, @Prerana_Issar, 15 May 2020, 6:47pm. The NHS Constitution for England. Updated 14 October 2015. Nursing and Midwifery Council (NMC). The Code: Professional standards of practice and behaviour for nurses, midwives and nursing associates, 2015, updated 2018. General Medical Council (GMC). Good medical practice: The duties of a doctor registered with the GMC. 2013, last update 2019. Health and Care Professions (HCPC). Standards of conduct, performance and ethics: The ethical framework within which our registrants must work, 2016. Freedom to speak up: An independent review into creating an open and honest reporting culture in the NHS. Report by Sir Robert Francis QC, 11 February 2015. Press release: Sir Robert Francis publishes his report on whistleblowing in the NHS, 11 February 2015. NHS Staff Survey 2019. q18b: % of staff agreeing or strongly agreeing with the statement that: 'I would feel secure raising concerns about unsafe clinical practice'. NHS Staff Survey 2019 q18c: % of staff agreeing or strongly agreeing with the statement that: 'I am confident that my organisation would address my concern'. Interim NHS People Plan, June 2019. https://www.longtermplan.nhs.uk/publication/interim-nhs-people-plan/ NHS People Plan overview, 2019.
  6. News Article
    "It's a full-time job that you can't quit. It's a massive burden that you didn't ask for, didn't expect." Diagnosed with type 1 diabetes at the age of 19, Naomi, now 33, says she reached a point where she simply could not handle "the physical or mental challenges of diabetes any more", a condition known as "diabetes burnout". About 250,000 people in England have type 1 diabetes, which means the body cannot produce insulin, the hormone that controls blood sugar levels. It can lead to organ damage, eyesight problems and - in extreme cases - limb amputation. But for many there is also a significant psychological impact of learning to manage the condition. Naomi felt she could no longer bear testing her blood sugar levels many times each day to calculate how much insulin she needed to inject, even though she knew she was risking her long-term health and putting herself in extreme danger, at risk of developing diabetic ketoacidosis (DKA), which can lead to a coma. She became so ill she was admitted to an eating disorder unit even though she was not struggling to eat. The head of the unit, Dr Carla Figueirdo, says of her diabetes patients: "These people are seriously unwell, seriously unwell. They are putting themselves at harm every day of their lives if they don't take their insulin." Naomi's consultant at the Royal Bournemouth Hospital, Dr Helen Partridge, says the psychological impact of a diabetes diagnosis should not be underestimated. The hospital is hosting one of two NHS England pilot projects looking at how to treat type 1 diabetes patients whose chronic illness affects their mental health. NHS England diabetes lead Prof Partha Kar says: "The NHS long-term plan commits strongly on getting mental and physical health together. If we do tackle these two together, it will help improve outcomes." Read full story Source: BBC News, 16 November 2020
  7. Content Article
    As a result of the investigation, one recommendation has been made to the Care Quality Commission (CQC) on assessing factors such teamwork and psychological safety in its regulation of maternity units. Based on the evidence gathered, the report also sets out a series of questions to consider in order to help staff identify strengths and opportunities for improvement within their own maternity unit. Safety recommendation It is recommended that the Care Quality Commission, in collaboration with relevant stakeholders, includes assessment of relational aspects such as multidisciplinary teamwork and psychological safety in its regulation of maternity units. Questions to consider Does your unit have a role, or another means, separate from the labour ward co-ordinator, dedicated to monitoring and anticipation of activity across the maternity service and troubleshooting, such as a roving bleep holder? Do you have regular multidisciplinary ward rounds throughout the day? Do you have regular safety huddles and multidisciplinary handovers using a structured information tool? Do you hold multidisciplinary in situ simulation and facilitated debriefing that includes both technical and non-technical skills? Are scenarios and incidents encountered in your unit included in the training? Do you know what your staff’s perceptions of teamwork, psychological safety and communication are within your unit? Are actions taken in response? How are midwifery staff empowered to contact consultants directly if they have concerns? Is time and resource dedicated to regular multidisciplinary forums that provide a safe space to openly discuss scenarios where things did not go well? Do these forums also include discussion and reflection on scenarios where things went well despite unexpected events? Are senior midwifery staff assigned to triage and assessment areas? Is there adequate medical presence in these areas? In larger units, is the workload on the labour ward separated into elective and emergency work? If so, are there separate labour ward co-ordinators for each? How does the physical infrastructure support work? For example, use of DECT telephones, availability of equipment, consultant offices on/near the labour ward, proximity of antenatal ward and neonatal unit to the labour ward. How are issues with staffing and workload escalated and responded to? Are senior trust personnel aware and involved?
  8. Content Article
    According to the responses we received, the four themes that became most obvious - the four things you think staff most need to be safe - are: Compassionate leaders and role models who prioritise their staff’s wellbeing A respectful, supportive team with good communication and united by a common purpose A safe and just culture that invites staff to speak up Psychological safety, protecting staff form burnout
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