Search the hub

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

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

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

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

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.