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Found 35 results
  1. Content Article

    Faded rainbows

    Claire Cox
    When driving to work at the beginning of the pandemic, I felt a sense of worry and apprehension of what I would be faced with. As a critical care outreach nurse I never know what I may be faced with, but this has never bothered me. However, during the pandemic it did bother me. I worried how I could do my job; would I get sick and how would I navigate my way through the new ways of working? Seeing the brightly coloured rainbows in people’s windows gave me some hope. I knew that the public were thinking of us; they knew the risks we were putting ourselves at and our families. For a time, I felt special. It sounds pathetic, I know. For a time, I felt valued. Valued by the public, valued by the trust I work for and valued by politicians. As NHS staff we had priority shopping, we had discounts from big stores, we had free parking, we had donations of food every day while we were at work, we were donated hand creams and toiletries. School children drew us pictures to put on the walls of our staff room saying ”thank you”. What made me feel valued more than anything was staff wellbeing being at the forefront. Extra staff were redeployed to work on the ITU, we were made sure we had all our breaks and we were made to feel that each and every one of us counted. Relatives of patients wrote and expressed their gratitude, even if they were unable to visit their dying family – they were truly grateful to us. The ITU where I work received so many beautifully written letters and cards. We pinned every one onto the wall so we were reminded that we were shining bright despite the darkness. Then there was the Thursday clap. Personally, I thought this was an odd thing to do, but it seemed to bring people together and have a shared purpose – even if it was for a fleeting 5 minutes a week. When I think back at those months, it seems like a lifetime ago. Eve Mitchell’s recent blog on the hub highlighted that care homes are receiving complaint letters and some are even receiving threats of litigation. “Not enough PPE”, “lack of care given to my family member”, “my family member was neglected during the pandemic” – frustration and anger are palpable. Frustration and anger because families were unable to visit their relatives in their last days, frustration and anger that these precious moments have been denied from them. If it were my mum or dad would I feel the same? Of course I would. I would be the loudest voice there. Is it the fault of the care home? Should they be vilified for the protection of their residents? And now it’s the turn of the hospitals. We now have over a million people waiting on lists for operations, procedures, appointments. Some have already waited months before the pandemic started. Some have already died as a result of not having surgery at the right time. Patients have received surgery and treatment late and this has led to complications and a longer hospital stay – which then increases their mortality. At some point the gratitude from the public will turn to anger and frustration, as it has with the care homes. Would I be angry if my mum was waiting for an operation and died as a result of a prolonged wait? Yes I would. It is a natural response to blame the very people who should have helped – the NHS staff. I now drive to work and see faded rainbows in windows, I will be paying for parking again in the next few weeks, the donations of food have dried up, staff are back at ‘normal’ levels and I am back to having no breaks some days, not to mention that nurses were not included in the recent pay rise. I feel that we have served our purpose. ‘Thanks very much – now get back to normal, sort the waiting lists out and work harder to make sure it happens’. I don’t envy our senior leaders in acute Trusts. They are stuck in the middle of the Department of Health and Social Care and NHS England who are trying to fathom out a strategy to get the waiting lists down, and support frontline staff who are exhausted and a frustrated public that may erupt at any moment. Frontline workers have been through it the last few months. Navigating our way through complaints and litigation and an angry public who feel that they are not receiving the care that they expect in the coming months fills me with dread. We are not equipped. Faded rainbows – is this a representation of the fading support we are receiving in the NHS?
  2. Event
    until
    The Flight Safety Foundation goal with this Seminar is to promote further globally the practical implementation of the concepts of system safety thinking, resilience and Safety II. There will be two sessions, one for each day, that will consist of briefings and a Q&A panel afterwards. The following themes are suggested for briefings and discussions for the Seminar 1.The limits of only learning from unwanted events. 2. Individuals’ natural versus organisations’ consciously pursued resilience. 3. How the ancient evolutionary individual instincts for psychological safety affect individual and team learning and how these can be positively managed? 4. The slow- and fast-moving sands of operations and environment change over time and their significance for safety. 5. How to pay as much attention to why work usually goes well as to why it occasionally goes wrong? 6. Understanding performance adjustments of individuals to get the job done. 7. The blessings and perils of performance variability. 8. Learning from data versus learning from observing. 9. Learning from differences in operations versus learning from monitoring for excrescences. 10. Can risk- and resilience-based concepts work together? 11. Does just culture matter for learning from success? 12. How to document explicitly, maintain current and use the information about success factors and safety barriers and shall this be a part of organisational SMS? Further information
  3. Content Article
    Over the last couple of weeks I have been engaging in one of my favourite pastimes – chatting. I realise this seems a little frivolous, but after the more formal ‘meetings’ of previous weeks, chatting seemed appropriate. There is a serious reason behind this, the impact of ‘emotional labour’. Emotional labour is defined as “having to induce or suppress feeling in order to sustain the outward countenance that produces the proper state of mind in others”.[1] Or, in layman’s terms, pretending you are OK. For my colleagues and clients across health and social care, and particularly for frontline nursing and care staff, there has been an even greater need to deliver compassionate patient care whilst managing their own emotions during the pandemic, and somehow with the easing of lockdown some of the façade has started to fail. Through conversation, it has become clear that there is a new impact of COVID-19 on the mental health and wellbeing of healthcare staff: absorbing the anger of the public, patients, and their carers. In a previous post I mentioned that there was fear from some colleagues about potential litigation once the pandemic was over. Looking for someone to blame for what was and was not done. This is not an unusual reaction, but showering staff with vitriol does seem a little unprecedented. For example, in the care homes I work with every home has received letters or complaints about the care of their residents from family members: "you did not care for my mother"; "you let my father die alone"; "my mother died of loneliness as you wouldn’t let me see her"; "it is down to your lack of care that my brother died"; whether the home had COVID infections or not. The upset this has caused is palpable, with exhausted staff bearing the brunt for doing their job in the most difficult of circumstances. A similar story is heard from GP practice nurses and reception staff – patients refusing to wear masks, accusing the nurses and doctors of wilfully letting them suffer and refusing to see them when they were in need, demanding to see a professional immediately, refusing to leave the premises. A massive change for the surgeries who earlier were being given gifts of cake and chocolate and sent messages of gratitude. Hospital staff seem to have faired better, although as outpatient appointments come back online there is an expectation that the pent-up fear and frustration will be released in this setting too. Maybe it is not only health and care staff who suffer from compassion fatigue – it has happened to the general public at the same time as the clapping stopped and the next normal dawned. However, it is not clear how we should deal with this. Ensuring the welfare of staff across all settings of care should remain at the forefront of workforce planning and is enshrined in the new NHS People Plan; but it doesn’t tell us how to navigate and dissipate the anger of the public, and whilst this remains unaddressed it is our frontline staff that will bear the brunt, sending them ever closer to burnout, and puts the future of our health and care workforce at risk. And anything that impacts on staff safety, impacts on patient safety. References: Hochschild AR. The Managed Heart: Commercialisation of Human Feeling. Oakland: University of California Press: 2012. World Health Organization. Mental Health and Psychosocial Considerations During the COVID-19 Outbreak. Geneva: WHO; 2020.. Patient Safety Learning have set up a community page on the hub to capture insights from staff on their safety. World Patient Safety Day on Thursday 17 September this year focuses on staff safety. If you have been affected by the issues raised in this blog and want your voice to be heard (whether attributable or anonymously), please share here. Patient Safety Learning will use such insights to highlight the staff safety issues and call for action.
  4. Content Article
    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).
  5. Content Article
    In this short video, Dr Donna Prosser discusses these questions below. 1. Healthcare workers are under extreme stress these days as they deal with the COVID-19 pandemic. Can you share some insight about what they are dealing with right now? What are you hearing from the frontline? 2. What are some tips that hospitals can employ to mitigate some of this stress? 3. What are some ways that healthcare workers can better support each other at this time?
  6. Content Article
    Ideas about resilient systems are now becoming better known in the healthcare community, but the most common question asked is “this is great but how do I put it into practice?” CARe QI provides the answers. The aim of CARe QI is to help people to apply the insights of resilient systems and ‘Safety II’ to the design, implementation and evaluation of quality improvement interventions. It is a structured collection of information, tools, guidance and documents that helps you to develop interventions to strengthen system resilience and in turn improve quality and safety. In the handbook you will find an overview of the arguments for improving quality through resilience, followed by step by step guidance in applying the method and downloadable worksheets to help you to document your own project. There are four main steps to CARe QI – setting up the project, capturing work as done, describing resilience in everyday work and choosing resilience interventions and outcome measures. The foundation of CARe QI is that you understand your clinical system in depth before starting to design and implement interventions.
  7. Content Article
    The importance of good mental health and wellbeing in the workplace is a subject of increased public awareness and governmental attention. The Department of Health advises that one in four people will experience a mental health issue at some point in their lives. Although a number of recent developments and initiatives have raised the profile of this crucial issue, employers are experiencing challenges in promoting the mental health and wellbeing of their employees. Mental Health & Wellbeing in the Workplace contains expert guidance for improving mental health and supporting those experiencing mental ill health. This comprehensive book addresses the range of issues surrounding mental health and wellbeing in work environments – providing all involved with informative and practical assistance. Authors Gill Hasson and Donna Butler examine changing workplace environment for improved wellbeing, shifting employer and employee attitudes on mental health, possible solutions to current and future challenges and more. Detailed, real-world case studies illustrate a variety of associated concerns from both employer and employee perspectives. This important guide: Explains why understanding mental health important and its impact on businesses and employees. Discusses why and how to promote mental health in the workplace and the importance of having an effective ‘wellbeing strategy’. Provides guidance on managing staff experiencing mental ill health. Addresses dealing with employee stress and anxiety. Features resources for further support if experiencing mental health issues.
  8. Community Post
    I am interested in what colleagues here think about the proposed patient safety specialist role? https://improvement.nhs.uk/resources/introducing-patient-safety-specialists/ https://www.independent.co.uk/news/health/nhs-patient-safety-hospitals-mistakes-harm-a9259486.html Can this development make a difference? Or will it lead to safety becoming one person's responsibility and / or more of the same as these responsibilities will be added to list of duties of already busy staff? Can these specialist be a driver for culture change including embedding a just culture and a focus on safety-II and human factors? What support do trusts and specialists need for this to happen? Some interesting thoughts on this here: https://twitter.com/TerryFairbanks/status/1210357924104736768
  9. Content Article
    Resources LfE Quality Improvement Toolkit (based on PRAISe project) Quick start up guide LfE (July 2016) LfE top 10 tips (Jan 2017) How to get started – a few tips from our experience Framework for “reverse SIRI” (now named IRIS) – adapted from Appreciative Inquiry methodology Template (in MS word) for IRIS meetings Example LfE FAQs – for you to adapt for your organisation Mini-AI template – Mini-AI template, as used in PRAISe project 10 uses for LfE & AI LfE how to set up checklist LfE Appreciation card template – front LfE Appreciation card template – back
  10. Content Article
    The US observance of ’Groundhog Day‘ is more than just the annual emergence of Punxsutawney Phil – the rodent soothsayer who ceremoniously predicts the timing of the arrival of Spring. It is the name of a popular film that represents how the repetition of unwanted experiences can contribute to scepticism, callousness and burnout for the primary character – weatherman Phil. However, he emerges from the darkness by applying what he learns over time to arrive at a new brighter day. Patient safety leaders are apt to feel like weatherman Phil. Repetitiveness – the feeling that something been done over and over again without change – can decrease engagement but it can also lead to experiential knowledge that can be applied to future efforts. Community engagement is paramount to patient safety success but it can be challenging if people feel like they wake to the same problem every day despite efforts to make a difference. The Boston-based Betsy Lehman Center has developed Including the Patient Voice: A Guide to Engaging the Public in Programmes and Policy Development. The Guide shares a six-element approach to involving members of the public as partners to reduce reoccurrence of poor care. Strategies focus on enabling community members to succeed as partners and contribute as experts to designing health services that are evidence based and accessible to all. This includes leadership-led mini-workshops for staff to inform their engagement programmes and patient correspondence reviews to identify the right consumers to invite as participants. Similarly lessons have been shared by MedStar Health, a large regional healthcare system that sought to engage patients and design strategies that engage patients and families in safety improvement. Organisational structures such as Patient and Family Advisory Councils (PFAC) served as the focal point of the shared learning effort. The system developed a network of courses that shared best practices to foster innovation and sustain realised improvements in event reporting, disclosure (the CANDOR Toolkit), after-incident support and sepsis reduction. The tactics used include board and leadership activation activities, a mentorship programme for new community leaders and public awareness campaigns. For example, the system launched a collaborative to share information to improve early detection of sepsis. Patients who had contracted sepsis along with PFAC members and in-house quality experts were brought together to design an educational video to reduce sepsis that highlighted symptom identification and response. The programme contributed to marked sepsis treatment improvement. The City of Philadelphia recently launched a prescription monitoring strategy to curtail the overprescribing of opioids in their region. Because this programme identifies by name the 10% of physician that overprescribe, these individuals can be offered targeted training and, if necessary, legal interventions to address their behaviour. Home-grown programmes can also be proactive to prevent overprescribing. One Boston-based family medicine clinic described their five-year change management effort to reduce opioid overuse. The authors reported their focus on developing “shared general principles”; communication mechanisms to connect clinicians with in-house addiction experts, patient registries, targeted training, certification opportunities and centralised leadership were all instrumental in embedding improved prescribing practices throughout the organisation. Consistent unremitting workload pressure perpetuates stress and fatigue. Its presence degrades staff relations, performance and the safety of care delivery. It’s a common problem that medical residents are burnt out: no news there. What conveys great promise are programmes like what the Virginia Mason Medical Center in Kirkland Washington has done to address burnout by implementing workflow changes and fostering a culture of “collegiality, respect and innovation”. The Center changed workflow by standardising clinical tasks, defining staff roles and carving out protected time for staff to recharge, self-educate and participate in improvement efforts. The Center has enhanced its culture and improved staff morale through leadership efforts to lower hierarchy, welcome and respond to feedback, and address inefficiencies that can discourage staff and derail efforts. Ninety percent of staff at Kirkland reported in a 2018 internal survey feeling content and engaged about their work. Medical residents can also find support through programmes like the ACGME Aware initiative. This set of tools targets strategies that junior doctors can use to build resilience and embrace their professional community through a mobile phone app to find support as they need it. Personal tactics to protect against burnout for more experienced healthcare professionals are also in demand. A news story in Medical Economics highlights what doctors and hospital administrators can do to minimise burnout, such as making time to socialise with peers and using the opportunity to share stories, rethinking their roles to bring joy back to medicine, and to listen. For 2020, Phil has told us that Spring is due to arrive early. Will the application of the successes reviewed in this month’s Letter reduce the recurrence of opioid overprescribing and staff burntout? We need more than a rodent to speculate on that for us. But given efforts by patient safety champions in the US and UK, improvements optimism is in the air.
  11. Community Post
    Here's a recent interesting blog post on leadership under pressure https://www.med-led.co.uk/2019/08/19/under-pressure/
  12. Content Article
    The growing global evidence that Anne Marie and academic colleagues have gathered shows we need more nurses, with the right skills and support, if we want to reduce patient mortality and improve nurses’ wellbeing. The RCN has used this research to create the aims of its safe staffing campaign and to tell all four UK governments what nurses and patients need now.
  13. Content Article
    What will I learn? Within the toolkit you will find: The SBAR (Situation-Background-Assessment-Recommendation) technique, which provides a framework for communication between members of the health care team about a patient's condition. Action Hierarchy, a component of RCA2 that will assist teams in identifying which actions will have the strongest effect for successful and sustained system improvement. A daily huddle agenda, which gives teams a way to proactively manage quality and safety. Failure Modes and Effects Analysis (FMEA): also used in Lean management and Six Sigma, FMEA is a systematic, proactive method for identifying potential risks and their impact.
  14. Content Article
    In two studies, researchers found that doctors with high levels of burnout had between 45% and 63% higher odds of making a major medical error in the following three months, compared with those who had low levels. To ensure well-being and motivation at work, and to minimise workplace stress, people have three core needs, and all three must be met. A - Autonomy/control – the need to have control over our work lives, and to act consistently with our work and life values. B - Belonging – the need to be connected to, cared for, and caring of others around us in the workplace and to feel valued, respected and supported. C - Competence – the need to experience effectiveness and deliver valued outcomes, such as high-quality care. The review identified inspiring examples of organisations that meet these three core needs for doctors. An integrated, coherent intervention strategy will transform the work lives of doctors, their productivity and effectiveness, and thereby patient care and patient safety.
  15. Content Article
    Four key themes were identified in the study: context of exposure fear of punitive action team culture hierarchy. On the one hand, students recognised there was a professional obligation bestowed upon them to raise concerns if they witnessed sub-optimal practice; however, their willingness to do so was influenced by intrinsic and extrinsic factors. Students have to navigate their moral compass, taking cognisance of their own social identity and the identity of the organisations in which they are placed.
  16. Content Article
    In this blog, David Naylor, a senior leadership consultant at The King’s Fund, reflects on ‘imposter syndrome’, considering its impact on third sector leaders and beyond.
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