Search the hub

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.

Case study examples The following case studies show how trusts have been using the tool. Roles and responsibilities of staff have been reviewed and new workforce plans have been co-designed with staff at the frontline to deliver new ways of working that put the patient at the centre of care – whatever the setting. The Hillingdon Hospitals - Safety Supervision and Savings.pdfThe Hillingdon Hospitals - Ward Reconfiguration for Safety.pdf GIG Cymru NHS Wales - Residential Nursing homes Case Study.pdfChelsea and Westminister Hospital Case Study - Empowering Staff.pdf GIG Cymru NHS Wales - District Nursing Principles Case Study (1).pdfBerkshire Health Community Nursing Case Study.pdf Organisational benefits Integrated care levels, costs and common language enables clinical and corporate leads to collaborate and meet the requirements of a next-generation health and social care workforce: Precise staffing profiles and options appraisal support CIP development and budgeting. Gap analysis compared to budget and standards for exact hours and WTE requirement for each band. Uplift for leave is specific to each role and expected joiners, avoiding blanket uplifts that may not fit the needs of the unit. Governance and control underpinned by agreed, costed roster templates, with ready reckoners to keep within range. Improved recruitment and retention with evidence of staffing levels and support. Outcomes track quality, with benchmarking to assure. Clinical benefits Professional judgement in workforce planning is supported by this NICE-endorsed tool: Planning care levels and WTE for expansion, efficiency, reconfiguration and new service models. Evaluating alternative shift models to reorganise, invest or save. Modelling skill-mix and impact of new roles. Understanding and validating variation. Challenging peaks and troughs in cover to improve safety, release capacity and release cost savings. Benchmarking and triangulation of patient care levels, with outcomes for correlation. Mapping other staff group input across each setting. Background on 'Establishment Genie' Creative Lighthouse was founded in response to frustration at the focus on financially led decisions in health and social care management that did not consider the safety and care of patients or staff. We set out to build a platform that would allow all management groups in the healthcare sector to collaborate on safe staffing and financial governance. Creative Lighthouse self-funded the development of a unique workforce-planning tool under the brand name ’Establishment Genie’, endorsed by the National Institute of Health and Care Excellence (NICE) in 2017. In April 2017, the Creative Lighthouse team were awarded a grant from Innovate UK to continue to develop the tool to include all settings of care in the knowledge that patient safety and workforce planning is not only the responsibility of acute services, but of all providers and commissioners of care. This is a critical aspect of enabling the improvement of quality and patient outcomes in a cost effective way, whilst providing data driven analytics to support professional judgment. About the author I am a healthcare professional with over 15 years’ experience working in and consulting to public and private health and social care organisations. I have worked with a variety of health and care sector clients in the delivery of complex change, from transformational change and organisational design process to programme leadership and execution. I am passionate about the safe staffing agenda, recognising that in order for any organisation to ensure appropriate care and evidence for professional judgement, there must be consistency in approach and a way of linking staffing levels to quality outcomes that can then be benchmarked within and across organisations. This passion resulted in the birth of ‘Establishment Genie’.

The transport of the ICU patient is a complicated process and can lead to patient harm. In the Department of Critical Care Medicine, Calgary Health Region, staff underestimated the risks of intrahospital transport, which led to the two adverse events mentioned above. This article published in Healthcare Quarterly has describes the development of an ICU patient transport decision scorecard to support the safe transport of ICU patients for diagnostic testing. The scorecard is a visual assessment tool. Each item on it is a decision point and a simple reminder to ensure that appropriate resources are available prior to transport. Outcome measures have been added to begin to measure the effectiveness of the tool. Several lessons were learned from the development of this tool: the need to form a subgroup with team members from all sites and disciplines to ensure early buy-in; the involvement of a human factors expert to make the tool easier to use; and the need to continuously retest the tool using PDSA cycles.

This report builds on those of previous years to provide analysis of longer-term trends and insights into the changing NHS staff profile. It focuses specifically on the critical NHS workforce issues that have been repeatedly identified in recent years: nursing shortages, and shortages of staff in general practice and primary care. The report also explores key pressure points: student nurses the international context and international recruitment retention. The report concludes by summarising the key workforce challenges that will need to be considered in the development of the full NHS people plan. Patient Safety Learning's repsonse to the report: This report on NHS workforce trends released by the Health Foundation today includes some really interesting findings, particularly around the changes in the skills mix between nurses and clinical support staff (including health care assistants and nursing assistants). The report states that in 2009/10 there were equal numbers of nurses and support staff, with one clinical support staff member for every FTE nurse in the NHS. In 2018/19, the number of support staff per FTE nurse had risen 10% to 1.1 FTE per nurse. Looking at the numbers, this translated to the NHS employing 6,500 more clinical support staff to doctors, nurses, and midwives, compared to 4,500 more FTE nurses. While changes to ratio of nurses to clinical support staff may reflect changing patient needs, technological advances and other factors, the report also notes concerns that these may be ‘introduced in an unplanned way in response to negative factors – such as cost pressures or recruitment difficulties – rather than positive drivers of improvement’. At Patient Safety Learning we believe to achieve a patient-safe future, patient safety must be more than a priority for an organisation. It must be core to its purpose, reflected in everything that it does. This should apply to the NHS when considering changes in workforce staffing and numbers so that the impact that these may have on patient safety is considered as an intrinsic part of the decision making process. While the report notes that in many cases decisions on skill mix changes are implemented well and evidence led, it’s not clear whether patient safety has been taken into account. Our view is that these decisions should involve a explicit, evidence-based assessment of the impact on patient safety which leads to the selection of the option that offers that safest outcome for patients.

In this talk, Rob Hackett, director of The PatientSafeNetwork, takes a look at the medical error problem, why it exists, why it persists, what we can do through working together to overcome it and create the best environment for patient care.