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Every healthcare professional must be open and honest with patients when something that goes wrong with their treatment or care causes, or has the potential to cause, harm or distress. This means that healthcare professionals must: tell the patient (or, where appropriate, the patient’s advocate, carer or family) when something has gone wrong apologise to the patient (or, where appropriate, the patient’s advocate, carer or family) offer an appropriate remedy or support to put matters right (if possible) explain fully to the patient (or, where appropriate, the patient’s advocate, carer or family) the short and long term effects of what has happened. Healthcare professionals must also be open and honest with their colleagues, employers and relevant organisations, and take part in reviews and investigations when requested. They must also be open and honest with their regulators, raising concerns where appropriate. They must support and encourage each other to be open and honest, and not stop someone from raising concerns

On a couple of occasions when myself or other key listeners have been in the process of supporting staff in the SISOS calm zone, there has been a knock on the door. This knock speaks far louder than you or I ever could. The knock in it’s intensity says, "I disapprove". These occasions are rare but they do happen. One comment I overheard was, "if you can’t take the heat you shouldn’t be here". My answer to this attitude is onwards and upwards. The location of the room is in it’s favour because it isn’t isolated and is easily accessible without the need to change into or out of scrubs. This makes it available to other departments and also to the support staff, such as chaplaincy who visit us fairly frequently when we request. This clearly has had a positive effect on take-up. The room itself is simply furnished and is in sharp contrast to the clinical environment. A small windowless store room, triangular in shape, has been transformed into a sanctuary of calm and psychological safety. The makeover consisted of a woodland scene wall mural, a Himalayan salt lamp, a reclining chair, a small side table, a coffee table and two regular chairs. I’m frequently asked, "Can we use the calm zone as a prayer room?" The answer is yes, because we must aim to support staff in their working environment and, provided one group or another doesn’t claim the room as their own, then why not? None of us can know what someone else’s journey has been like. When we put on our shoes and leave our homes to come to work we also put on our professional fronts often masking our private lives. This became very apparent to me in the first week and is shaping how the framework for SISOS is evolving and the breadth of support we are now providing. Originally set up to provide emotional support for staff centrally or peripherally involved in safety incidents, we recognised that these incidents are fortunately rare. However, you don’t need to be involved in an incident to be affected emotionally and most of our take-up is supporting staff for none-incident related events. We had one such event recently that affected a large number of our staff because of the circumstances and the age of the patient. Following this event, myself and another 'key listener' were relieved of our clinical duties and we were able to provide emotional support over a couple of days. This put our model to the test and I'm pleased to say it passed. These are work-related events. The other side to take-up involves staff who are distressed because of none-work related issues. We deal with this by signposting staff to other support structures, such as our Employees Assistance programme and our mental health First Aiders Hub. What we discovered was staff were not prepared to accept SISOS simply as a support for ‘second victims’. They demonstrated a need for other kinds of support, such as domestic abuse, money worries, bullying, and they wanted support for these issues. They weren’t prepared to differentiate. We have developed other pathways to support staff holistically. Staff come to us at a rate of approximately three per week (theatre department) requesting a ‘SISOS’ – meaning, I need to talk, and that can be on any topic. The anonymity SISOS provides, because of the confidentiality and trust, is impacting favourably and staff are opening up. Patients too. Our badge wearing listeners have attracted the attention of several patients who have felt safe enough to open up about domestic abuse. The SISOS team have supported three such patients and have taken advantage of that small window of opportunity to hopefully help them to change their lives for the better. SISOS is now part of a broader staff support model at Chase Farm Hospital and we are working on various new arms for it, including a student nurse support arm. This happened directly as a result of a student nurse needing support out of university hours after witnessing a distressing event. Read my other blogs on SISOS: Part one Part two Part three If you are thinking about setting up a similar initiative in your trust, I would be happy to discuss SISOS further with you. Contact: carolmenashy@nhs.net

The second PSHO investigation found that the local NHS investigation processes were not fit for purpose, they were not sufficiently independent, inquisitive, open or transparent, properly focused on learning, or able to span organisational and hierarchical barriers, and they excluded the family and junior staff in the process. Had the investigations been proper at the start, it would not have been necessary for the family to pursue a complaint. Rather, they would, and should, have been provided with clear and honest answers at the outset for the failures in care and would have been spared the hugely difficult process that they have gone through in order to obtain the answers they deserved. As a result, service and investigation improvements were also delayed.

In this article, Miles suggests that we need to recognise that the culture of any one organisation does not arise in isolation. It is part of, and to some extent derives from, an overarching NHS culture. And the national culture does not always seem to treat patient feedback as a valued resource for learning. Evidence of this includes the following: We tolerate the use of dismissive language. Patient feedback is routinely referred to as 'anecdotal evidence'. That diminishes patient experience, and robs it of its value for learning. We are comfortable with a double standard in use of evidence. Medical evidence is cherished, preserved and used. Patient experience evidence is treated as disposable. Both sets of evidence should be accorded equal value. We are content to weaken the independent patient voice. Healthwatch, set up in the wake of the Francis Inquiry, was meant to be a strengthened successor to the Local Involvement Networks. But Healthwatch funding has fallen by over a third since 2013. So what can be done? Miles says we can make a start straight away by tackling the cultural issues referred to above. The term 'anecdotal evidence' must be challenged wherever it is used. Directors of Nursing could lead on this. Patient experience evidence should be embedded in professional training, clinical guidelines and practice protocols—just as medical evidence is.

Key messages The report calls for: All public services to become trauma- and agenda-informed. NICE to incorporate trauma-informed principles into guidance. Service commissioners to adopt trauma-informed principles. All inspectorate bodies to incorporate trauma-informed principles. Government to lead the way in putting these principles into practice.

Wrong tooth extraction has been clearly designated as a 'never event' since April 2015. However, in 2016/17, wrong tooth extraction topped the charts as being the most frequently occurring never event based on NHS England’s data. What can we do to mitigate these incidents? Based on both practical experience and research evidence, BAOS advises that the main methods for mitigation of errors are: learning from mistakes – including investigation and root cause analysis engaging the clinical team when developing 'correct site surgery' policies utilising the LocSSIPs template and guidelines from NHS England/RCS England developing a correct site surgery checklist that is appropriate for your clinical environment providing training for staff on the use of the checklist ensuring that the checklist is being used correctly through active audits of the processes involved supporting the clinical team throughout the process and not taking punitive action when incidents do occur.

The survey measures: workload communication teamwork safety systems learning leadership. The SCS for dental practice teams opened on Thursday 1 August 2019 and will close on Tuesday 31st March 2020.

Developed by Agency for Healthcare Research and Quality (AHRQ) and the US Department of Defense, TeamSTEPPS® offers core strategies for use in a variety of healthcare environments coupled with approaches for distinct areas of care such as dental, long term care and office practice. The program collectively offers free training modules, webinars, train the trainer strategies and a bibliography of research describing how the tools have been used.

The WorkSafeMed study combined the assessment of the four topics psychosocial working conditions, leadership, patient safety climate, and occupational safety climate in hospitals. Looking at the four topics provides an overview of where improvements in hospitals may be needed for nurses and physicians. Based on these results, improvements in working conditions, patient safety climate, and occupational safety climate are required for health care professionals in German university hospitals – especially for nurses.

As a second victim, on reflection, the two things I recognised that I had needed were peer support and a safe psychological space. A place where I could have been supported and my dignity protected. Over the years I’ve seen too many of my colleagues breaking down in the tea room, hiding in the sluice, or crying in the toilets. This is not acceptable. The NHS Constitution Key principal three states: "Respect, dignity, compassion and care should be at the core of how patients and staff are treated not only because that is the right thing to do but because patient safety, experience and outcomes are all improved when staff are valued, empowered and supported". Health Education England are now talking about safe spaces and psychological support. Our SISOS Calm Zone has been the most amazing achievement. Since the provision of our safe space, our staff talk about feeling valued. A member of staff who might have previously gone home because they had a headache, rest in this safe space and often are able to return to work safely within the shift. I talked about setting up a safe space where staff could go and rest and be support if needed and was promised that when we moved to our new hospital building a room would be provided. For the first six months SISOS functioned without a dedicated safe space in our old building and I faced the same old challenges that I’d faced as a member of the bullying and harassment support team many years ago. One of my roles then was to support staff who alleged bullying and the biggest challenge I always faced when I received a call was finding a suitable place to provide support. So often the support I gave was negatively impacted by an inadequate space. So I was very disappointed to find every door in our new department had a label on it and not one said SISOS Calm Zone. This was a challenge and I approached my manager and asked nicely but directly: "Where is the room I was promised?" "You’ll need to speak to orthopaedics," came the reply and so I did. "We have a lot of equipment", said the orthopaedic sister. "What’s more important, your crates or our staff?" I said. My words didn’t fall on deaf ears and our fabulous staff helped to clear the storeroom, relocate stock and also get rid of stuff we hadn’t used for years. The room is small, triangular in shape and windowless but the location is perfect. Safety is paramount and the room is located next to the tea room and so isn’t isolated and is easily accessible without the need to wear scrubs. This is important for staff who need support but also for anyone coming in to support staff such as chaplaincy, who frequently come up to support our staff when requested. Once we had the room I panicked a little realising that we would need to furnish it. I wrote to several charities, one of which was the Louise Tebboth Organisation. I was seeking confirmation that I was on the right track. This wonderful organisation not only supported our initiative but donated generously towards the purchase of a reclining chair. Realising that I wasn’t able to personally receive funds, I contacted our Royal Free Charity who took up the reins. They guided us and provided further funding for a woodland scene wall mural, a side table and a Himalayan Salt lamp. These simple furnishings have transformed the store room into a sanctuary of peace. My next fear was, "What if no one uses the room?" So I put in a wooden money box with bingo counters and a short note asking people to place a counter into the box if they had used the room and felt that they had benefited from it. I wanted to maintain confidentiality but needed to know numbers. We have eight theatres in our department and in the first week I counted 52 counters, the second week 56 counters. I carried on counting for a couple of months and the lowest count was 38. We knew for certain that the room was being used and it was being used appropriately and with respect. One consultant I work with classes himself as a SISOS frequent flier. He has a ten minute power nap during his shift. So the room isn’t only used to support second victims, fortunately that isn’t needed very often, but on a daily basis staff can zone out when they need to with or without support. We would highly recommend a safe space but if your department cannot provide any such space then look to see where a room might be found in another area that you can use to support staff. It is about planning and even if no room is available anywhere think about how you could set up a temporary safe space if needed. My next blog will talk about take up. Read part one and part two of this blog series

There have been many advancements in medical education over the past 20 years, including how outcomes such as competencies are defined and used to guide teaching and learning. To support this positive change, the AAMC has launched the New and Emerging Areas in Medicine series. This first report in the series focuses on quality improvement and patient safety (QIPS) competencies across the continuum of medical education. It presents a roadmap for curricular and professional development, performance assessment, and improvement of healthcare services and outcomes. The competencies can help educators design and deliver curricula and help learners develop professionally. The competencies are for use in: engaging diverse health care professionals in collaborative patient-safety-improvement discussions, including cross-continuum and cross-discipline colleagues conducting gap analyses of local curricula and training programmes planning individual professional development developing curricular learning objectives developing assessment tools furthering research and scholarship in medical education and quality improvement guiding the strategic integration of QIPS into the curricula and the clinical learning environment.

In this short video, Kath Evans explains the importance of working with families to ensure that the safest care to our children and young people is given by healthcare professionals.

In this five minute video, the authors chose to focus on the main theme – the human cost to healthcare workforce when there is a failure to cultivate a just culture and systems approach overall, but especially when managing unfortunate harm events.

This report, Hearing and Responding to the Stories of Survivors of Surgical Mesh, describes how restorative justice approaches were used to uncover the harms and needs created by surgical mesh use in New Zealand. The actions that consumers and healthcare stakeholders indicated would restore well-being, trust and safe healthcare in New Zealand are included. Skilled facilitators used restorative practices to create a safe space for consumers and health professionals to tell their stories. The same approach supported collaboration between multiple agencies so they could act for repair and prevention. The team that co-created the project includes academics, consumers, facilitators and New Zealand's Chief Clinical Officers. Formal research will evaluate the project next year and consider findings in the context of resilient healthcare systems