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Found 97 results
  1. Content Article
    This paper aims to summarise all available published research in English about FRAM. A PRISMA approach has been followed to review more than 1700 documents on the FRAM. The analysis presents descriptive and interpretative results on the usage of the FRAM. The FRAM’s strengths and limitations and potential future research are presented. The FRAM is not a one-size-fits-all modelling solution.
  2. Content Article
    In 2023, the first BD Healthcare Resilience Barometer explored the variety of factors that impact the stability of our healthcare system – from shifting population demographics and resourcing constraints to developments in the macroeconomic environment and the increase of chronic disease. This year, BD look closer at three core components that impact care delivery: the patients, the workforce, and the processes that drive overall efficiency. These components are tightly interconnected. Therefore, the challenges affecting them must be addressed holistically to enable us to build sustainable and resilient healthcare systems that can preserve access to safe, high-quality care for current and future generations and minimise the impact on the environment. The comprehensive solutions that are needed to address the challenges of today’s healthcare systems call for collaboration and collective commitment from all actors connected directly and indirectly to care delivery. It includes policymakers, regulators, researchers, academia, healthcare providers, funders, insurers, patients, and industry. The 2024 BD Healthcare Resilience Barometer captures the perspectives of stakeholders across the healthcare ecosystem and outlines the role we can all play in building sustainable healthcare systems that stand resilient, responsive, and ready for the evolving needs of our societies.
  3. Content Article
    The 2024 BD Healthcare Resilience Barometer is a comprehensive analysis conducted by BD. It sets out to explore the resilience of healthcare systems in 100 countries across Europe, the Middle East, and Africa (EMEA) and is based on several healthcare-related indicators. Alongside a ranking and a healthcare resilience score per country, the BD Healthcare Resilience Barometer also highlights the perspectives of multiple key opinion leaders to help contextualise the barometer scores and bring unique insights into what can drive or threaten the resilience of healthcare systems, now and in the future.
  4. Content Article
    Error reporting and analysis is a key element of a learning organisation. This article describes one healthcare organisation's approach to systematic review of serious harm events through use of a standardised classification system, frequent meetings, inclusion of the patient and family voice, and application of human factors strategies.
  5. Event
    The overall objective of this masterclass is to build good governance commitment, capacity, and resilience in the face of severe resource constraints and complex staff, patient, political and regulatory expectations. The programme is interactive, developmental, based on best practice and focused on achievable improvement of practice, behaviours and outcomes. The course includes online access to the relevant CQG e-learning module for 12 months and a discount code to purchase additional modules. This masterclass is one of a series that will help enhance your understanding and application of governance in healthcare, this module is designed to help boards avoid silo thinking, over-complex agendas or multiple reports by exploring the three elements of Integrated Governance which are: Integrated thinking, systems, and reporting. At the completion of this module, the participant will be able to: Appreciate the value of integrated thinking Recognise the importance of building integrated systems Understand the importance of integrated reporting to inform management, the board, and stakeholders Apply the learning to the participant’s own organisation using the CQG Maturity Matrix. Register
  6. Community Post
    I was just listening to a podcast interview between Dr Rangan Chatterjee and Matthew McConaughey (In the series 'Feel better, live more'). Matthew M. mentioned that he came from a highly resilient family. If someone fell over, his mother would tell them to get right back up straight away and carry on. He added that he thought that while this resilience was generally a good thing, there should be (what he called) a 'loophole' in it so that there was time to learn why they have fallen over to begin with. Was there a crack in the pavement that needed to be avoided? That way, it wouldn't happen again in the future. This made me think about whether there really was a conflict between resilience in organisations and the need to learn from failure. What do you think??
  7. Content Article
    All the public and preliminary hearings from the Covid 19 Inquiry can be found here.
  8. Content Article
    There are signs that some US healthcare organisations are scoring some successes in addressing the worker morale and retention crisis. But data from Press Ganey surveys shows that there is a widening gap between the most- and least-successful organisations. This article draws lessons from the former. It discusses three key elements needed to engage workers, make them more resilient, and make them feel more aligned with their leaders.
  9. Content Article
    In May 2021, the Irish public health service was the target of a cyber-attack. The response by the health service resulted in the widespread removal of access to ICT systems. While services including radiology, diagnostics, maternity and oncology were prioritised for reinstatement, recovery efforts continued for over four months. This study describes the response of health service staff to the loss of ICT systems and the risk mitigation measures introduced to safely continue health services. It also explores the resilience displayed by frontline staff whose rapid and innovative response ensured continuity of safe patient care.
  10. News Article
    The NHS has too few staff to prepare for a pandemic surge, while its ageing buildings and social care’s weak ‘resilience and capacity’ would also undermine its response, NHS England has warned. A new NHSE submission to the Covid-19 public inquiry says funding pressure from 2010 has undermined the health service’s “resilience” and that “resilience and capacity issues in social care are national issues which must be addressed from the centre”. The document was posted unnoticed on the inquiry website last month. No current or former NHSE leaders have so far given evidence to the inquiry. It is the first time NHSE has clearly set out that understaffing and underinvestment compromised the service’s readiness to deal with the pandemic. Referring to the NHS’s ability to create “surge capacity [with] flexible staff and equipment which can be pivoted into different roles”, it goes on: “It is only possible to train staff to work more flexibly into different roles/environments if they can be freed up to attend training and refreshers. “This requires ‘surplus’ staff numbers on rotas, which is not currently possible in relation to many staffing groups across the NHS.” Read full story (paywalled) Source: HSJ, 3 October 2023
  11. Content Article
    Their paper, published in BMJ Quality & Safety, examines a key opportunity for patient engagement—the ward round—and investigates the links between patients’ expressed preference to be involved and their observed level of involvement during subsequent ward rounds. The authors report little relationship between the two, concluding that involvement is affected by a range of contextual factors.
  12. Content Article
    The world is facing challenges emerging from multiple crises, including pandemics, wars and climate change. Against this backdrop, the Government of Japan will host the Group of Seven (G7) Summit in Hiroshima and the G7 Health Ministers' Meeting in Nagasaki, Japan, in May 2023. This article in The Lancet outlines key recommendations for G7 action to address these challenges through a human security approach and a transformation of global health architecture: Enhance resilience to public health emergencies by boosting country-led efforts to achieve universal healthcare Advance timely and equitable access to life-saving medical countermeasures as common goods Promote a multilayered approach to global health governance, including financing, that facilitates effective collaboration among state and non-state actors beyond the health sector at global and regional levels.
  13. Content Article
    NHS and social care continues to have significant challenges. This blog cannot change that but it offers food for thought on how to stay afloat.  It’s been a while since I have posted a blog. I continue to coach NHS colleagues – their calmness, focus, resilience, professionalism and ‘can do’ shining through in spades. Inspirational, appreciative leaders of teams, small and large. Our current systems and challenges are too complex to have one person at the helm taking all the decisions. We need leadership at all levels. Great leaders inspire people to have confidence in themselves. Whether you are part of a team, a team leader or leader of many, here’s four things to contemplate: 1. Reality check The Covid aftermath, understandable unrest and general distress and frustration have impacted, of course they have, but we have a dedicated, professional, caring workforce. 2. The power of appreciation Take a moment to identify and reflect on your contributions and those of your colleagues. Appreciate those contributions. Make time to share them with each other. Individually and collectively feel proud. 3. Strengthen your resilience I can’t remember where I read this, but a simple way to focus the mind and build your resilience is to start each day with this simple reminder: I am … add in the words that best describe your talent and experience. I have … add in things that support and energise you at work and home. I will ………..your intentions for that day, this week. 4. Look out for each other Tune in. Sometimes we just want someone who will listen, a space to talk to a colleague, friend, coach, mentor. If you don’t already have this, think about who could help. In my experience, how we care for each other and appreciate our respective contributions helps to sustain us on the brightest days and the not so bright. Thanks for reading this. I have used this quote before but it seems apposite just now: "She stood in the storm and when the wind did not blow her away, she adjusted her sails." Elizabeth Edwards. Further blogs from Sally: Keep your light shining bright – three tips Swimming with the tide Standing tall in the storm
  14. Content Article
    Social care in England entered the pandemic in a fragile state. With much already written about the government’s response to the Covid-19 pandemic in the social care sector, this new report from the Nuffield Trust in collaboration with the Care Policy and Evaluation Centre analyses the structural and systemic factors that influenced that initial national response. Covid had far-reaching impacts on social care and exacerbated many longstanding issues. This work seeks to highlight progress and identify where action is needed to create a more resilient system.
  15. Content Article
    MIT Sloan experts offer a systematic approach to organisational resilience that can help leaders manage risk and rebound rapidly when catastrophic events strike. In their executive education course, “Building Organizational Resilience: A System Approach to Mitigating Risk and Uncertainty,” Carrier and Levi lay out a playbook for improving organisational resilience. They advocate for an approach that leans on systems thinking and continuous improvement to help organisations identify problems before they occur. They also detail how to identify the right intervention points in operations and the supply chain to help an organisation stop or recover from an evolving critical situation before its impact turns catastrophic. In this article they summarise the key advice from their resilience framework. "It starts at the top with C-suite executives who are fully committed to understanding what’s happening on the front lines so they can ask the right questions and be open to the right recommendations and actions."
  16. Content Article
    The Resilient Health Care Society (RHCS) is a non-profit organisation registered in Sweden. The goal of the Society is to provide an international forum for coordination and exchange of principles, practices, and experiences, by bringing together researchers and professionals working with or interested in Resilient Health Care. Research and practice in Resilient Health Care aims to develop and promote practical solutions, based on a solid scientific foundation, to ensure that health care systems can perform as intended under expected and unexpected conditions alike. Links to some of their publications can be found below. Resilient Health Care, Volume 3 (2016) Reconciling Work-as-Imagined and Work-as-Done Edited ByJeffrey Braithwaite, Robert L. Wears, Erik Hollnagel Delivering Resilient Health Care (2019) Edited By Erik Hollnagel, Jeffrey Braithwaite, Robert L. Wears Working Across Boundaries (2019) Resilient Health Care, Volume 5 Edited By Jeffrey Braithwaite, Erik Hollnagel, Garth S Hunte Resilient Health Care (2021) Muddling Through with Purpose, Volume 6 Edited By Jeffrey Braithwaite, Erik Hollnagel, Garth Hunte
  17. News Article
    Two in three UK doctors are suffering “moral distress” caused by the enfeebled state of the NHS and the damage the cost of living crisis is inflicting on patients’ health, research has found. Large numbers are ending up psychologically damaged by feeling they cannot give patients the best possible care because of problems they cannot overcome, such as long waits for treatment or lack of drugs or the fact that poverty or bad housing is making them ill. A new survey found that 65% of doctors overall, including nearly four in five (78%) GPs and more than half (56%) of hospital doctors, have experienced “moral distress” as a direct result of situations they have encountered working in the NHS. Seeing patients with malnutrition or hypothermia, or stuck on trolleys in A&E corridors asking for help or forced to choose between heating their home or getting a prescription dispensed are among the events triggering their distress, medics said. “There’s barely a doctor at work in the NHS today who doesn’t see or experience this distress on a daily basis,” said Prof Philip Banfield, the leader of the British Medical Association. The NHS is “impossibly overstretched”, has thousands of vacancies for doctors and has a quarter fewer doctors a head of population than Germany, he added. “In practice that means we can almost never give the standard of care we would want, only ever the care we can manage. That takes its toll, as we see here,” Banfield said. Read full story Source: The Guardian, 28 December 2023
  18. Event
    until
    This half-day conference will be hosted in Parliament by Chris Green MP on 12 May 2022 at 2pm and chaired by Dame Barbara Hakin, Former Deputy Chief Executive of NHS England and Chair of the Health Tech Alliance. The NHS has been critically impacted by the pandemic as well as dealing with workforce challenges resulting from the exit of the European Union and is now preparing for significant structural changes expected this year following the Health and Care Bill. Throughout it all, however, it has been clear that HealthTech has played a key role in supporting the NHS tackle these challenges – being branded the ‘key lesson learned’ by the Health and Social Care Committee, following their inquiry into Coronavirus in October 2021. Featuring two panel sessions and keynote speeches, this conference will explore the steps that will need to be taken in the years to come to ensure that this momentum is maintained, cementing innovation within the NHS in the long-term to make the healthcare system more resilient for its staff and patients. Networking drinks will take place after the conference at 5pm. Register
  19. Event
    until
    HR leaders, mental health professionals and technology experts will be discussing how the NHS can support staff through peak demand at a forthcoming HSJ webinar. Charlotte Andrews, head of wellbeing and development at Kingston Hospital Foundation Trust; Neil Greenberg, professor of defence mental health at King’s College London and lead for trauma at the Royal College of Psychiatrists; Karon Hart, assistant director of human resources (operations and wellbeing) at Buckinghamshire Healthcare Trust; and Coppelia Rose, global SAP healthcare and life sciences leader at DXC Technology will together discuss how workforce resilience and wellbeing can be supported during times of extreme stress. This free HSJ webinar, which is being supported by SAP, will be chaired by HSJ contributor Claire Read. Register
  20. Community Post
    Here's a recent interesting blog post on leadership under pressure https://www.med-led.co.uk/2019/08/19/under-pressure/
  21. Content Article
    The scale of the emergency response to the COVID-19 pandemic has been extraordinary, but what comes next? The King's Fund spoke with people involved in response efforts for disasters from around the world, from the Christchurch earthquakes in New Zealand to the Grenfell Tower fire in London, to understand what the health and care system can learn from the experience of recovery from other disasters as it responds to the pandemic.
  22. Content Article
    The General Medical Council views resilience as a critical part of becoming a “professional”.  All graduating medical students should have proved that they are resilient, and NHS job specifications expect it. They define resilience as “the capacity to recover quickly from difficulties.” It implies “toughness”, and an untiring effort to do more, to work faster, and to be better.  The Medical Schools Council suggests screening for resilience in interviews, and now once admitted, medical students receive formal resilience training as part of the curriculum. The GMC’s “Professional Behaviour and Fitness to Practise” guidance underlines the importance of emotional resilience, which it defines as an “ability to adapt and be resourceful, mindful, and effective in complex, uncertain, or stressful situations.” This sounds impressive, but is resilience a trainable skill? Katherine Ripullone and Kate Womersley discuss this in this BMJ Opinion article.
  23. Content Article
    Nursing and midwifery are unarguably stressful endeavours requiring high levels of psychological capital and coping strategies. The impact of the work environment on patient safety outcomes suggests that high nurse/midwife stress may be associated with more adverse patient events. The purpose of this study, published in Nursing and Health Sciences, was to explore the psychological capital of clinical nurses and midwives and identify explanatory factors (including psychological capital, well‐being and health related behaviours) contributing to attitudes to patient safety.The findings suggest that nurse and midwife wellbeing is an important consideration when striving to improve patient safety.
  24. Content Article
    In this blog, Farrah Pradhan, Project Manager for Clinical Quality, Education and Projects at RCOG, describes her work with maternity professionals, namely obstetricians, and through undertaking an MSc in Patient safety. Farrah’s focus was on their 'work as done' to see if the concepts of Safety-II (capability mindfulness and resilience engineering) helped them to work more safely. ‘Work as done’ Because healthcare is constantly evolving and complex, by looking more closely at everyday work and finding out what actually happens, it allows an understanding of what it is, that frontline clinicians do to ensure successful outcomes. This is termed as looking at 'work as done' and informs us about the nuances, the adjustments, the compromises, the workarounds, the actions and the decision making that is taken to meet the needs of the patients they are caring for. ‘Work as done’ is a combination of expertise, clinical decisions, experience and tacit knowledge. It is because clinicians are flexible and can vary their performance that allows the system to function albeit with acceptable or adverse outcomes. As healthcare is intractable (not easily controlled), performance adjustments are vital. Things often go well because obstetricians make sensible adjustments in response to the situations to ensure safety, often within a highly pressurised environment. These adaptations and performance variables, under complex circumstances, are not well understood. Combining the concepts of capability mindfulness, positive deviance and resilience engineering as the principles of safety-II and understanding the 'work as done' and the performance variability of obstetricians’ (that results in good or successful outcomes), may bring insights that can be used to help build adaptive capacities and capabilities in obstetricians when working in unpredictable and unanticipated stressful clinical environments. Compassion against a backdrop of complexity My first encounter with an obstetrician was over 21 years ago when I was pregnant with my first baby. The attention and kindness that I received by the obstetrician and his team were incredible; I was cared for with gentleness and understanding. He spoke to me with compassion, and in moments of delivering uncertain news, he placed his hand on my shoulder, showing his empathy for my circumstances. I saw him regularly until it was time for my baby to be born, twelve weeks early. This experience, although very traumatic, opened my eyes to a caring profession that surpassed any expectation that I could ever have imagined. When I came to work at the Royal College of Obstetricians and Gynaecologists nearly seven years ago, I had the privilege of witnessing more of these encounters. I visited maternity units, listening and watching obstetricians and their colleagues work tirelessly for women and their babies against a backdrop of complexity and variation. Intrigued by this, I decided to pursue a Master’s degree in Patient Safety. I wanted to understand what it was that gave obstetricians this skill; to work effectively while maintaining a constant awareness of situations, identifying and managing emergencies and providing day-to-day care, all at the same time. Proactive safety management My dissertation (under the supervision of Professor Suzette Woodward) focused on obstetricians’ use of proactive safety management concepts (termed Safety-II). Taking a safety-II approach includes looking at 'work as done’ [1]. These are the adjustments, compromises, workarounds, actions and decisions that obstetricians make, to meet the needsof the women they care for. Obstetricians have to make prompt decisions, organise multiple activities and co-ordinate care rapidly, all within an already complex system. ‘Work as done’ is achieved because of a combination of expertise, clinical decisions, experience and tacit knowledge and because obstetricians vary their performance, depending upon changing circumstances, that allows the system to function. Reliability, adjustment, and safety Studying ‘work as done’ brought insights into how obstetricians build adaptive capacities when working in complex settings. This adaptation is an essential factor in the interaction between complex infrastructures and human behaviour. Because healthcare is intractable, clinicians are relied on to adjust to situations (emergency cases, staff shortages, high patient numbers etc.) to create safe outcomes, as well as recover from unexpected events. Reliability is a necessary requirement of safety and is concerned with the likelihood of occurrence of failure [2]. Clinicians are vital to creating high reliability and a resilient system. Through my research with obstetricians, I found that they successfully demonstrated their adaptive capabilities to respond to unforeseen, unpredictable and unexpected demands and recover from high-risk situations, also known as resilience engineering [3]. The ability of obstetricians and their teams to be in a state of constant alertness, sensitive to changes in women’s conditions, continually re-evaluate their safety supposition, and respond as appropriate, is a key resilient strength that was evident. It also requires an organisational culture that nurtures a climate of trust and respect. The importance of culture and relationships During interviews, obstetricians described the importance of trusting relationships, which fostered excellence in team working, and the ability to be collectively and consciously alert to risks and mitigations. Overall, they demonstrated excellent leadership attributes, valued safe care centred on the woman and her baby, good working relationships and the feeling that they made a positive difference. "It was having the willingness to step in and take that level of responsibility in that situation. … it was also familiarity with the team and communication with the team, and drawing in the expertise of cardiologists and the anaesthetist so that we did have a cohesive joined up plan that we'd all agreed on and we'd communicated out to everyone." (Consultant Obstetrician, Manchester) “It’s about staying calm, understanding what the whole situation is, … it's about gaining the trust of the woman and the staff, gaining the trust of the staff is much easier if it's a team that you know, who you've worked closely with, who know you as well, because they know what your skill set is.” (Consultant Obstetrician, London) Improving maternity safety – some final thoughts My research concluded that a systems approach to maternity safety including human factors and safety management must be adopted to understand 'work as done'. Safety can be improved through ‘learning from excellence’ as a way of cultivating habits in focussing on the activities that promote good outcomes, hence strengthening resilience as well as continuing to learn from the inevitable errors. I suggested using human reliability analysis, a technique looking at a process of care and systematically examining the process, to pinpoint and foresee possible failure points to proactively manage safety within a unit. Excitingly, the NHS Patient Safety Strategy [4] is striving to embed safety-II principles, and healthcare regulators are considering how proactive safety management can be measured and developed as part of their inspection frameworks. Indicators for resilience engineering [5] are also emerging which will assist with assessing a resilient work environment and provide metrics for safety measurement. You can read Farrah's full dissertation paper in the document attached towards the end of this webpage. References 1. Hollnagel E, Braithwaite J. From Safety-I to Safety-II: A White Paper. The Resilient Health Care Net; 2015. 19 2. Vincent C. The measuring and monitoring of safety. UK: The Health Foundation; 2013. 3. E. Hollnagel JB, R Wears. Resilient Health Care: Ashgate Publishing Limited; 2013. 225 p. 4. NHS Improvement. The NHS Patient Safety Strategy Safer culture, safer systems, safer patients. July 2019. Available from https://www.england.nhs.uk/wp-content/uploads/2020/08/190708_Patient_Safety_Strategy_for_website_v4.pdf 5. Ranasinghe U, Jefferies M, Davis P, Pillay M. Resilience Engineering Indicators and Safety Management: A Systematic Review. Saf Health Work. 2020;11(2):127-35.
  25. Content Article
    Resilient Healthcare is an emerging theoretical field that has developed with influence from engineering, safety science, psychology, ergonomics, human factors, and aeronautics. Resilient Healthcare research has centred on understanding and improving the quality and safety of healthcare delivery. Theory is increasingly well-developed, but so far has only been applied in limited ways with select settings and activities. In order to improve the quality and safety of healthcare, it is essential to first understand the sources of complexity in clinical work. This ethnographic study from Sanford et al. of five hospital teams in a large, teaching hospital in central London aims to contribute to this growing evidence base by presenting data on specific challenges faced by healthcare workers and the adaptations they use to overcome them in everyday clinical work. This paper will present a new framework for recognising misalignments between demand and capacity and corresponding mechanisms for adaptation, which can be used to understand work-as-done in complex settings and to manage risk.
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