Search the hub
Showing results for tags 'Staff support'.
-
News Article
NHS call handlers quitting over stress amid ‘relentless exposure to trauma’
Patient Safety Learning posted a news article in News
NHS call handlers are quitting amid burnout at dealing with 999 calls about suicides, stabbings and shootings and the long delays before ambulances reach patients. The pressure is so intense that 27% of control room staff in ambulance services across Britain have left their jobs over the last three years, NHS figures show. Many feel overwhelmed by the demands of their roles, unsupported by their employers and powerless to help patients who are facing life-or-death emergencies, according to a report by Unison, with some resigning within a year of starting the role. Call handlers get so stressed that they took an average of 33 sick days a year each between 2021/22 and 2024/25, data obtained by the union also showed. That is far higher than the average four days taken off sick by workers in the UK overall. A report by Unison found that call handlers’ jobs have become increasingly challenging in recent years as the demand for care, which rose during Covid, has remained consistently high since, while ambulance handover delays outside hospitals have worsened. “These findings paint a bleak picture of the conditions faced by 999 control room staff. TV programmes about ambulance services don’t show things as they really are,” said Christina McAnea, the Unison general secretary. Unison’s report said: “Relentless exposure to traumatic and increasingly complex incidents, verbal abuse, long shifts and low pay are contributing to stress, burnout and fatigue. One call handler told Unison: “Some shifts are overwhelmingly traumatic, with 90% of the calls of a distressing nature. One shift, I handled three road traffic accidents and two cardiac arrests.” “There’s a persistent pressure to remain on the phone, no matter how emotionally drained we are.” Read full story Source: The Guardian, 17 June 2025- Posted
-
- Fatigue / exhaustion
- Staff support
- (and 2 more)
-
Content Article
We asked the Patient Safety Group (PSG) of The Royal College of Surgeons of Edinburgh (RCSEd) to draw up their top 10 priorities for patient safety in surgery. This resource is for surgeons, anaesthetists and other healthcare professionals who work in surgery and contains links to useful tools and further reading. See also: Safety in surgery series Top 10 tips for surgical safety: ‘Think Safety, think SEIPS’ Top 10 patient safety tips for surgical trainees 1. Foster a culture of safety through design Establish a psychologically safe environment, through design, where staff feel empowered to speak up without fear of blame. Promote a Just Culture, balancing personal accountability with systems-based learning from adverse events and near misses. Actively encourage multidisciplinary teamwork and peer support, with support from senior leadership, to enhance safety and well-being. Other useful RCSEd resources: Anti bullying and undermining campaign Sexual misconduct in surgery - Lets remove it campaign Addressing conflict in surgical teams workshop 2. Implement team-based quality and safety reviews Use team-based quality reviews (TBQRs) and structured case analysis to learn from everyday work, incidents and near misses. Translate findings into sustainable improvement initiatives that enhance both patient outcomes and staff experience. Foster a culture of collective learning, ensuring safety insights lead to actionable change. Other useful RCSEd resources: Making sense of mistakes workshop 3. Apply Human Factors principles and systems thinking principles in surgical and clinical practice Design resilient systems that mitigate work and cognitive overload and enhance performance reliability. Use TBQR principles to support this. Standardise workflows, optimise usability of IT systems and medical devices, and integrate cognitive aids (e.g. WHO Safe Surgery Checklists, prompts). Ensure governance processes support safe, efficient and user-friendly surgical environments. Other useful RCSEd resources: Systems safety on surgical ward rounds Improving the working environment for safe surgical care Improving safety out of hours 4. Enhance communication & handover processes Implement structured communication tools such as SBAR (Situation, Background, Assessment, Recommendation) to improve clarity and effective decision-making. Optimise handover processes with digital tools, checklists and standardised documentation. Reinforce closed-loop communication, ensuring critical information is confirmed and acted upon. Other useful RCSEd resources: Consultation Skills that matter for Surgeon (COSMOS) 5. Strengthen leadership & accountability in patient safety Senior leaders must visibly support safety initiatives and proactively engage frontline staff in decision-making. Embed structured mechanisms for raising concerns, including TBQR, safety huddles and escalation pathways. Ensure staff have access to training, resources and protected time for safety and quality improvement work. 6. Minimise medication errors in surgery Implement electronic prescribing and technology assisted medication administration to mitigate errors. Enforce double-check procedures for high-risk medications and standardised drug labelling. Improve intra and peri-operative medication safety with clear labelling, colour-coded syringes and real-time verification. 7. Improve early recognition & response to deterioration Appropriate regular training of teams on processes and pathways supported by good design of staff rota ensuring adequate staffing levels. Implement early warning scores and establish rapid response pathways for deteriorating patients. Standardise post-operative surveillance strategies, ensuring timely escalation and intervention. Other useful RCSEd resources: Recognition and prevention of deterioration and injury (RAPID) course for training in recognising critically ill patients 8. Engage patients & families as safety partners Encourage shared decision-making to align treatment plans with patient expectations and values. Provide clear communication on risks, benefits and post-operative care, using tools like patient safety checklists and focus on informed consent processes. Actively involve patients and families in safety and quality initiatives and hospital discharge planning. Other useful RCSEd resources: Patient/carer/families resources and information Informed consent courses (ICoNS) 9. Standardise, simplify & optimise surgical processes Reduce unnecessary complexity in clinical workflows, making processes intuitive, efficient and reliable. Co-design standard operating procedures, policies and pathways with frontline teams to minimise variation. Implement automation and digital solutions where feasible to streamline repetitive tasks. Other useful RCSEd resources: NOTSS (Non Operative Technical Skills for Surgery) courses for surgeons DenTS courses for dentists 10. Promote continuous learning & simulation-based training Conduct regular simulation training for critical scenarios (e.g. sepsis, airway emergencies, human factors). Use insights from TBQR and incident reviews to target training needs and refine clinical practice. Ensure ongoing professional development by providing staff with time, resources, incentives and institutional support for learning. Other useful RCSEd resources: Education pages Edinburgh Surgery OnLine MSc in Patient Safety and Clinical Human Factors- Posted
-
1
-
- Surgeon
- Surgery - General
- (and 12 more)
-
Content Article
Workplace incivility and bullying have persisted in healthcare in the USA since increasing during the Covid-19 pandemic. As the healthcare landscape continues to evolve, so do the challenges teams face, according to Brian Reed, vice president and chief human resources officer for Indianapolis-based Indiana University Health’s east region. This article in Becker's Hospital Review outlines seven strategies to reduce workplace incivility among healthcare teams: -
News Article
Trust ‘selectively targeted’ by workplace regulator after rise in work stress
Patient Safety Learning posted a news article in News
The national workplace regulator has told an ambulance trust to do more to tackle staff stress as part of a programme in which it is “selectively targeting” high-risk organisations. The Health and Safety Executive (HSE) inspected East of England Ambulance Trust for the first time in September 2024, after the NHS Staff Survey showed an increase in work-related stress. East of England has had well-documented cultural issues over the past few years and has been ordered to make improvements by the Care Quality Commission and the Equality and Human Rights Commission. However, early last year it was released from NHS England’s special measures. The trust said the HSE identified a number of actions it should take, including: Implementing measures to reduce unplanned overtime at the end of shifts. Developing protocols to protect staff from exposure to abuse. Reviewing mandatory training and ensuring appropriate line management and clinical supervision are available. Updating its work-related stress risk assessment. Read full story (paywalled) Source: HSJ, 19 May 2025- Posted
-
- Stress
- Staff support
-
(and 2 more)
Tagged with:
-
Content Article
The NHS workforce is under considerable operational pressure at every level from the combined effects of record demand and shortages of capital and resource. In addition, seismic shifts are on the horizon, including the abolition of NHS England (NHSE), the expected recommendations from the second Penny Dash report on patient safety, and the upcoming 10 year health plan. The level of change the NHS is facing, as a safety critical sector, makes culture a strategic priority. To achieve the ambition behind these changes, we need an engaged, motivated workforce and a supportive, enabling environment, writes Isabelle Brown and Laura Turner. Getting the “how” right of any reform that might be introduced by the 10 year health plan is just as important as the “what” and the ”why.”- Posted
-
- Organisational culture
- Organisational Performance
- (and 2 more)
-
Content Article
Physician burnout persists in USA. In part, this burnout is believed to be driven by the Electronic Health Record (EHR) and its fraught role in the clinical work of physicians. Artificial intelligence (AI)-enabled healthcare technologies are often promoted on the basis of their promise to reduce burnout by introducing efficiencies into clinical work, particularly related to EHR utilisation and documentation. Where documentation is perceived as the problem, AI scribes are offered as the solution. This essay looks closely at existing studies of AI scribes in clinical context and draws upon experience and understanding of healthcare delivery and the EHR to anticipate how AI may related to provider burnout. The authors find that it is premature to assert that AI tools will reduce physician burnout. Considering the integration of AI scribes into Learning Health Systems healthcare delivery becomes a starting point for understanding the challenges faced in safely adopting AI tools more generally, with attention to the healthcare workforce and patients. The authors found that it is not a foregone conclusion that AI-enabled healthcare technologies, in their current state and application, will lead to improved healthcare delivery and reduced burnout. Instead, this is an open question that demands rigorous evaluation and high standards of evidence before we restructure the work of physicians and redefine the care of our patients. -
Content Article
The being fair tool will support decision-making for patient safety incidents referred to workforce, and to ensure that staff are not treated unfairly after a patient safety incident. In rare circumstances a learning response may raise concerns about an individual’s conduct or fitness to practise. It is in these specific circumstances that the being fair decision-making tool can help decide what next steps to take.- Posted
-
- Organisational culture
- Patient safety incident
- (and 3 more)
-
Content Article
In this blog, Clare Wade, Patient Safety Learning's Director, draws attention to the impact toxic cultures have on staff and how, sadly, most often nothing is done about it. Clare shares her own personal reflections from past experiences in her career. There is a clear link between toxic cultures and patient safety, and while there are no easy answers these behaviours must be acknowledged, challenged and cured if the NHS is to survive. I’ve personally experienced toxic culture and behaviour on many occasions, but I found two examples particularly tough to navigate. The first was more than 20 years ago when I worked clinically in a trust largely staffed by the local population where most colleagues were either related or friends; I lived some distance away and commuted in. I’d witnessed troubling behaviour from one senior time-served nurse several times, but one day I heard a blatant, serious breach of patient confidentiality between her and another patient. I was shocked and initially didn’t know what to do. I raised it with the nurse involved who laughed at me, and then the sister in charge who told me to just forget it. After much deliberation, I went to the matron in charge of the department. Conversations took place behind closed doors and eventually I was hauled into trust HQ for a formal meeting, alone—the nurse was nowhere in sight. I was accused of causing upset and the nurse had denied any wrongdoing. In no uncertain terms it was made clear that I should keep my head down and mouth closed if I wanted to remain in post. From that day on my time was made miserable, colleagues closed ranks, stopped talking to me and I was ostracised until the day I left the trust. Later in my career, at a different trust, a new director was recruited to lead my department. From the start something felt off as several senior leaders quickly left their roles. It became obvious that the director was a bully; we largely worked in open plan offices, and the director thought nothing of shouting at and belittling people in front of everyone, even other directors and the CEO. It was impossible for senior colleagues not to know what was happening, but no action was taken. The situation worsened with many people taking sick leave or leaving the trust completely. I came under fire as the director didn’t agree with how I led my team or how we worked, even though our performance was excellent. An external consultant was brought in to identify issues with my practice and help build a case against me. The consultant admitted this to me and said they couldn’t find anything wrong to report back. At the time I had a mentor relationship with a senior board member, and I chose to confide in them with the hope of gaining some insight into how I might be able to better deal with the situation. I didn’t know until sometime later, but my mentor was informing the director about our conversations. As time passed, the behaviour worsened and, although many colleagues were experiencing it too, it was obvious I was on my own in wanting to speak up. I was encouraged to go to a senior HR colleague who would be empathetic, so I did and eventually the director agreed to mediation. I was so nervous ahead of the meeting, but it went ahead and to my surprise the director admitted to some of the allegations and agreed some actions. If I thought my treatment had been bad to this point, I had no idea what was to come. It felt like open season with the director’s full toxicity focussed on me. Derogatory rude emails would be sent daily, raising my anxiety as they landed in my inbox. Meetings where we were both present made me feel sick; they would think nothing of singling me out in front of everyone for their derision and nastiness. The barrage was constant and debilitating, affecting every part of my life and breaking my confidence. One day I couldn’t take any more so left work early and crawled into bed at home where I felt safe. I decided to call the senior HR colleague who had facilitated the previous mediation to ask for an update about the agreed actions. I was absolutely shocked to my core at their reaction, they shouted down the phone that I’d had my opportunity to air my grievances, nothing more was going to happen, the director wasn’t going to be held accountable for the agreed actions and I just needed to forget it and get on with my job. Was I naive to expect a different response? I hit rock bottom, felt scared to go into work and knew I had to get out of there for my health and sanity. Even when I left, the impact followed me to my next role; my confidence and resilience were shot and took a long time to rebuild. The director stayed in post for another couple of years until there were so many grievances that the CEO had to act. The sickening part is that after a period of ‘gardening leave’ the director secured another senior role in another trust in the area so will be perpetrating the same toxic behaviour onto others. I know there are thousands of experiences throughout the NHS just like mine and, unfortunately, in many organisations culture and behaviours aren’t improving. This problem is endemic and has decades of history behind it. There is a clear and acknowledged link between toxic cultures and patient safety. Within the NHS Patient Safety Strategy, NHS England states that: "positive patient safety and healthy organisational culture are two sides of the same coin. A culture in which staff are valued, well supported and engaged in their work leads to safe, high-quality care." In order to improve the care delivered to our loved ones, friends and ourselves, the NHS must take action to improve its culture. Forget the financial situation and the waiting lists, this is the most pressing and wicked problem facing our health service today; it permeates throughout everything and unless it is acknowledged, challenged and cured no other interventions will work. Money doesn’t solve toxic cultures, neither does restructuring the NHS for the umpteenth time. Sadly, some colleagues have taken their own lives because of the toxicity they have endured, this needs to stop now. There are no easy answers here but if we don’t put this right the NHS won’t survive. Share your story Have you worked in a toxic culture? Have you tried to speak up? Have you examples of a good team culture? Add your comment below (you will need to be a hub member and signed in) or contact us at [email protected] and we can share your story anonymously. Related reading on the hub Speaking up for patient safety: A new interview series about raising concerns and whistleblowing Speaking up as an agency nurse cost me my career My experience of speaking up as a healthcare assistant in a care home- Posted
- 3 comments
-
4
-
- Bullying
- Psychological safety
- (and 5 more)
-
News Article
NHS managers must undergo ‘cultural intelligence training’ says watchdog
Patient Safety Learning posted a news article in News
NHS managers should receive “cultural intelligence training” to tackle issues such as “the legacy of the British Empire” and improve the experience of overseas recruits, the National Guardian’s Office has recommended. The NGO’s report examined the experience of international recruits to the NHS, with a particular focus on their willingness to speak out about concerns. It found overseas staff face disproportionately higher scrutiny, are given limited support and are often penalised before they have had time to settle into their role. International recruits often felt “invisible”, the report concluded. The report states the responsibility for adapting, including the implications for speaking up, was often on overseas-trained staff and “a lack of cultural intelligence” was a “repeated theme”, according to the body which leads, trains and supports a network of Freedom to Speak Up Guardians in England. It said this highlighted the need for better understanding and outreach by employers. The NGO calls for “a meaningful approach to cultural competence” which goes “beyond superficial gestures like cultural exchange days”. It stated that: “A two-way process of cultural intelligence is needed, where organisations actively seek to understand and adapt to the experiences and perspectives of overseas-trained workers.” Most FTSU Guardians said training on speaking up was available in their organisations, however, only 16.9% surveyed said their organisations provided training to managers on how to support overseas-trained workers. More than half said they did not know if any such training existed. The report recommends NHS England includes “cultural intelligence training” for NHS staff, managers and leaders as part of its Leadership and Management Framework programme by April 2026. Read full story (paywalled) Source: HSJ, 1 May 2025- Posted
-
- Organisational culture
- Speaking up
- (and 3 more)
-
Content Article
Overseas-trained healthcare workers are reluctant to speak up about issues such as patient safety fearing it could lead to losing their right to work in the UK, according to a review from the National Guardian Freedom to Speak Up Listening and learning: Amplifying the voices of overseas-trained workers, a review of the speaking up experiences of overseas-trained workers in England highlights the unique challenges faced by NHS workers trained outside the UK when speaking up. Overseas-trained workers are a vital part of the NHS workforce. The National Guardian Freedom to Speak Up review sheds light on their experience, looking at the specific issues faced by overseas-trained workers in speaking up. The report also highlighting examples of good practice. The review finds that overseas-trained workers experience additional barriers to speaking up compared to domestically trained colleagues. To make it easier for overseas-trained workers to speak up, we are calling for action to: Make recruitment and retention guidance support speaking up. Design speaking up arrangements that work for everyone. Use better data to understand and improve experiences. Build cultural competence and awareness to remove barriers to speaking up.- Posted
-
- Speaking up
- Staff support
- (and 3 more)
-
Content Article
Insulin prescribing in the UK has tripled in the past decade, in particular due to an increase in use among those living with type 2 diabetes, now the largest group of insulin users. As a result, nurses in general practice and the community are increasingly expected to be skilled in supporting people living with type 2 diabetes with insulin therapy and associated glucose monitoring. The management of insulin therapy requires knowledge of the type of diabetes it is being used for and appropriate dosing, as well as correct injection technique, to prevent complications and medication errors. Diabetes nursing specialist Debbie Hicks shares key points on the management of insulin therapy for nurses in primary care.- Posted
-
- Diabetes
- Medication
-
(and 4 more)
Tagged with:
-
News Article
Oliver McGowan training 'lifted scales from my eyes'
Patient Safety Learning posted a news article in News
A senior doctor says he is shocked at how many deaths of people with learning disabilities and autism are "potentially preventable by really basic things". Dr Andrew Kelso is a consultant neurologist and the executive medical director at the Suffolk and North East Essex Integrated Care Board (SNEE ICB). The ICB, which commissions all health services, has rolled out the Oliver McGowan Mandatory Training on Learning Disability and Autism, external to its health and social care professionals. "That's the thing that keeps me awake at night," Dr Kelso told the BBC. "How little I knew before I went and how much I knew afterwards, and what a missed opportunity that might have been for me." The mandatory training - for all NHS staff who work with the public - is named after Oliver McGowan, an 18-year-old from Bristol who died in 2016 after he was given an anti-psychotic drug he was allergic to, despite repeated warnings from his parents. His mother Paula had lobbied for mandatory training to potentially "save lives". Dr Kelso, a consultant specialising in epilepsy, said: "I thought I knew quite a lot about learning disability. "But the scales fell off my eyes when I was in the training and realised how much I didn't know - and that's in a career where I see people with learning disability all the time. "How many gaps are there in the knowledge of people that don't spend their entire career with learning disability and may just come across them every now and then?" Read full story Source: BBC News, 25 April 2025 Related reading on the hub: Video: The Oliver McGowan Mandatory Training on Learning Disability and Autism How can GP practices help improve health outcomes for people with learning disabilities? Interview with a Community Learning Disability Nurse Top picks: Breaking down the barriers faced by people with learning disabilities- Posted
-
- Learning disabilities
- Training
-
(and 1 more)
Tagged with:
-
Content Article
This Health Services Safety Investigations Body (HSSIB) report follows on from HSSIB's launch report, ‘Fatigue risk in healthcare and its impact on patient safety’, which introduced the concept of fatigue and outlined the risk posed to patient safety from staff fatigue. The International Civil Aviation Organization’s definition of fatigue was adopted by this investigation, where fatigue is defined as: “A physiological state of reduced mental or physical performance capability resulting from sleep loss, extended wakefulness, circadian phase [the natural daily internal body clock], and/or workload (mental and/or physical activity) that can impair a person’s alertness and ability to perform safety related operational duties.” The investigation engaged with a wide range of healthcare staff to learn what impact fatigue had on patient safety in acute NHS hospitals. The investigation explored the NHS systems and processes in place to capture and learn from the risk posed by fatigue on patient safety and staff safety. It also considered the main factors that contribute to healthcare staff being fatigued. The investigation shares findings from staff interviews, discussions and observational visits to several acute hospital trusts, combined with evidence from national bodies, forums and networks with insight on this topic. The report also refers to supporting surveys and literature. While the investigation focused on staff working in acute hospitals, the findings will be relevant to providers and staff in other health and care settings. Findings Staff fatigue contributes directly and indirectly to patient harm. However, there is little evidence available to help understand the size and scale of the risk, how it impacts on patient safety, and those staff groups who may be most at risk of fatigue. There was variation in how the concept of fatigue was understood and the impact it could have on patient safety and staff safety across the healthcare system. This inconsistent understanding prevented fatigue risks being addressed. The risks posed by staff fatigue are not always clear to trusts. The systems and processes needed to provide the information to assess staff fatigue risk are not always well developed or well used. However, some trusts were starting to explore these risks. A positive safety culture was a key enabler to support healthcare organisations to recognise and manage fatigue risk. Staff fatigue is not routinely captured as part of patient safety event reporting or routinely considered as part of patient safety event learning, or other governance processes. Fatigue was perceived by organisations and staff as an individual staff risk, with limited organisational accountability. This sometimes led to a blame culture and punitive actions when staff were fatigued, and limited actions to drive improvement. Fatigue arises from a number of personal and organisational factors, which can overlap. Organisational factors that contributed to staff fatigue included workload, long shifts, insufficient rest facilities and inadequate rest breaks during and between shifts. Personal factors that contributed to an increased risk of fatigue included caring responsibilities, menopause, pregnancy, religious practices and socioeconomic factors. Fatigue was found to have a negative impact on staff safety. A key risk related to this was staff driving home after a long shift and being involved in fatal car accidents or near misses. There are barriers to acknowledging the risk posed by staff fatigue. These include historical beliefs and norms around working long and additional hours, pride and ‘heroism’ of NHS staff. The demands on healthcare services, and workforce and financial constraints, limited the ability of some organisations to address fatigue risks. There is limited regulatory and national oversight of the risks posed to patient safety by staff fatigue in healthcare. There was limited consideration of the risk of staff fatigue in national initiatives addressing workforce challenges and care delays. The systems-based approach and supporting materials provided to trusts implementing the NHS England Patient Safety Incident Response Framework (PSIRF) helped to prompt consideration of staff fatigue in safety event learning, but this was not routine in all organisations. Safety recommendations HSSIB recommends that NHS England/Department of Health and Social Care identifies and reviews any current processes that may capture staff fatigue related data. The output of the review should identify how information about factors impacting on staff fatigue can be collated and further enhanced to aid the understanding of fatigue risk in healthcare. This data will help inform the development of any future strategy and action to address staff fatigue risk and its impact on patient safety. HSSIB recommends that the NHS Staff Council, via the Health, Safety and Wellbeing subgroup, convenes fatigue science experts and other key stakeholders to develop and test a consensus statement defining fatigue for all healthcare staff. The group should work with existing networks to promote the definition and a shared understanding of the causes and impacts of fatigue. This will help to support a consistent understanding of fatigue among healthcare providers and improve the understanding of factors that may impact on staff fatigue and patient safety. Safety observations Research funding and commissioning bodies can improve patient safety by prioritising future research to measure and assess the impact of staff fatigue on staff and patient safety. This should include patient experience and the health economics of staff fatigue due to reduced performance and productivity. Healthcare organisations and professional bodies can improve patient safety by including aspects of fatigue when conducting staff surveys in order to help build an understanding of the level of fatigue and any impact on staff performance and patient safety. This will help organisations assess and understand the risks associated with staff fatigue, and to monitor and manage the risk of staff fatigue. Healthcare regulators and professional bodies can improve patient safety by: considering how they can contribute to driving improvement in the understanding and awareness of staff fatigue; considering how they can support and share best practice on mitigations for the risk of staff fatigue; considering organisational and individual factors that may have contributed to staff fatigue when making decisions about regulatory assessment and action. Government and national organisations can improve patient safety by accounting for the impact of staff fatigue on patient safety when developing national priorities for NHS services. Healthcare organisations can improve patient safety by considering the principles and activities for a systems approach to fatigue risk management and the roadmap to implement this as described in the Chartered Institute of Ergonomics and Human Factors white paper ‘Fatigue risk management for health and social care’. Related reading on the hub: Managing fatigue as part of a safety culture – a blog from Nancy Redfern, Emma Plunkett and Roopa McCrossan Why we need to manage fatigue in the NHS – a blog from Nancy Redfern and Emma Plunkett CIEHF: Fatigue risk management for health and social care- Posted
-
- Fatigue / exhaustion
- Staff safety
- (and 5 more)
-
Content Article
*Trigger warning: content related to suicide Rachel Gibbons is the Vice Chair of the Psychotherapy Faculty at the Royal College of Psychiatrists. In this opinion piece she draws on personal and professional experience to explore the complex relationship between patient safety and inpatient suicide. Rachel argues that fantasy-driven ideas of control and simplistic blame narratives do profound harm—both to clinicians and those bereaved. I'm a consultant psychiatrist whose professional trajectory was profoundly shaped by a harrowing experience early in my career. In 2009, during my first 18 months as a consultant, four of my patients died by suicide. The intense aftermath—serious incident inquiries, coroner's court appearances, and the emotional fallout—fundamentally changed who I was, both personally and professionally. Before this, I was someone different; afterward, thoughts about suicide dominated my consciousness. Since then, I've dedicated my professional life to deeply understanding suicide, it’s devastating impact on those bereaved, and the complex interactions involved in patient safety. Central to my work is the question of truth in patient safety—how to engage honestly and realistically with this complex subject. Too often, safety is driven by fantasies of control rather than by realistic expectations and honest acknowledgment of uncertainty. When our expectations are unrealistic, it harms clinicians and bereaved families alike. The profound trauma of inpatient suicide When suicide occurs within inpatient settings, its impact can be especially devastating. These tragedies unfold in two distinct scenarios: deaths occurring off the ward, and those taking place directly on the ward itself. Deaths on the ward can be especially traumatic—sometimes violent and occurring in the immediate presence of staff and other patients. I have personally been involved in such cases, witnessing first-hand the traumatic ripple effect across an entire organisation. The sudden, shocking nature of an inpatient death reverberates, intensifying every response, from the serious incident inquiry to appearances at the coroner’s court. Unfortunately, we don’t often give sufficient attention to the profound trauma staff and patients experience when exposed to inpatient suicide. If not effectively addressed, this trauma can linger unresolved for years, manifesting repeatedly in patterns of care—a phenomenon Freud described as "repetition compulsion". Unprocessed trauma can harm staff and affect the safety and wellbeing of future patients. The double-edged sword of patient safety investigations It’s essential that every inpatient death prompts a thorough patient safety investigation. However, the issue isn’t the investigation itself; it’s how easily the concept of patient safety can become distorted following a traumatic death. When a suicide occurs, intense emotions and destructive forces are unleashed within an organisation. This often results in attempts to create a simplistic causal narrative for the tragedy—a narrative that can never truly capture the complexity of suicide. In the aftermath of suicide, people’s ability to mentalise—to think clearly and compassionately—is severely compromised. The intense emotional turmoil often triggers a search for blame. As the deceased patient’s agency is often discounted, blame shifts rapidly towards clinicians. I've seen distressing examples where clinicians become scapegoats, absorbing an organisation’s collective anxiety and guilt. Organisations can behave almost like sentient beings, attempting self-preservation by shifting blame onto individual staff, often with devastating personal and professional consequences. Improving support for bereaved families The anxiety surrounding inpatient suicides can make it challenging for organisations to engage compassionately and openly with bereaved relatives. Defensive postures, though understandable given potential repercussions, ultimately harm those grieving. One proven way to mitigate confrontation and provide genuine support is appointing Family Liaison Officers. These dedicated individuals advocate for bereaved families, offering emotional support, clarity, and careful communication, thus alleviating confrontational dynamics. Supporting staff in caring for the bereaved Staff must not be left unsupported in their interactions with grieving families. Effective engagement with bereaved relatives requires thoughtful, organisational leadership and strategic planning. I've witnessed harmful situations where clinicians, driven by guilt, rush prematurely to communicate with bereaved families. Such impulsive actions, however well-intentioned, can cause unintended harm. Again, Family Liaison Officers are instrumental in mediating this delicate and emotionally charged communication, providing guidance and helping staff navigate difficult interactions more safely. Creating reflective spaces for staff Mental health work, particularly in inpatient environments, is intensely emotional and psychologically demanding. In the aftermath of a patient suicide, it becomes vital for organisations to provide reflective spaces—dedicated times and places where clinicians can safely process traumatic experiences. Without such spaces, unprocessed trauma can manifest as "acting out," leading to harmful patterns in care delivery and clinician burnout. Embedding regular reflective practice is essential, enabling staff to maintain their psychological wellbeing and enhancing patient safety through thoughtful, compassionate care. Final thoughts: seeking truth and compassion in patient safety Throughout my career, my core interest remains the truthful engagement with suicide and patient safety. We need honest, realistic frameworks that acknowledge limitations, complexity, and uncertainty. Fantasy-driven ideas of control and simplistic blame narratives do profound harm—both to clinicians and those bereaved. True safety comes from authentic, reflective practice, compassionate communication, and careful systemic support. Further reading on the hub: Rethinking suicide prevention: from prediction to understanding- Posted
-
1
-
- Self harm/ suicide
- Investigation
- (and 3 more)
-
Content Article
This poster forms part of the resources to support the implementation of the Safe Learning Environment Charter. NHS England Safe Learning Environment Charter (SLEC) has 10 priorities, they are: Respect and feeling valued Positive identity Wellbeing Raising concerns & speaking up Placement induction Communication Flexibility Supervision Teaching and learning needs Time and space for learning. The SLEC priorities and solutions present clearly to education and placement providers, assessors, supervisors and learners, as well as others working in the health and care system, what must underpin the culture of our learning environments. The SLEC is written for the use of education and placement providers, assessors, supervisors and learners, however it must be actioned by everyone, everywhere, every day and the behaviours and principles embedded into our culture. Equality, diversity and inclusion (EDI) and patient safety is the golden thread that runs through the SLEC Charter.- Posted
-
- Organisational culture
- Behaviour
-
(and 3 more)
Tagged with:
-
Content Article
'Creating team joy and wellbeing: a guide for leaders' is a resource, designed by leaders in health and care, to help teams and leaders assess where they are at, identify how to grow as a team and make meaningful changes to improve team wellbeing. It includes practical change ideas, coaching strategies and ways to engage teams in this work.- Posted
-
- Team culture
- Team leadership
-
(and 2 more)
Tagged with:
-
News Article
Tens of thousands of doctors across India are being trained to promote the HPV vaccine, in a push to eliminate cervical cancer in the country. They will check with mothers attending medical appointments that they intend to vaccinate their daughters, and visit schools and community centres armed with facts and slideshows to counter vaccine disinformation. One in five cervical cancer cases worldwide occur in India – and the overwhelming majority of those are caused by the human papillomavirus, or HPV. HPV vaccination has become routine practice in many countries and has been available in India privately since 2008, but with low take-up. Sutapa Biswas, co-founder of the Cancer Foundation of India, said imported vaccines were expensive and people were reluctant to spend money on prevention. Misinformation surrounding deaths during, but unrelated to, an HPV vaccine trial in the country had left it with “baggage”, she said. However, India has recently started manufacturing its own cervical cancer vaccine, and the government is expected to make it part of the national vaccination programme later this year or early next year. Last year about 11,000 members of the Federation of Obstetric and Gynaecological Societies of India (Fogsi) underwent virtual training. About 100 of those trainees have now become the National HPV Faculty and will each train 500 general physicians from the Indian Medical Association over the next six months. The idea, Biswas said, “is to build confidence”. Training includes practical information on dosages, details of the World Health Organization’s push to eliminate cervical cancer, and advice on how to answer common questions. The implementation of India’s cervical screening programme had been sluggish, she said. Most cancers are diagnosed late, and most people’s experiences of the disease relate to death. Many non-specialist doctors “didn’t even know that a cancer could be eliminated and vaccination could be such a gamechanger”, Biswas said. Read full story Source: The Guardian, 1 April 2025- Posted
-
- India
- Staff support
-
(and 4 more)
Tagged with:
-
Content Article
On 27 February, NIHR held a SafetyNet webinar on the Impact of shift work on safety outcomes for patients with Dr Chiara Dall’Ora, Associate Professor of Health Workforce at the University of Southampton. The recording of the webinar is now available. During this webinar, you will learn about the impact of a variety of staffing and shift work configurations on safety outcomes for patients. The body of research relies mostly on objective nurse roster data, as well as patient outcomes extracted from hospital systems. Using robust longitudinal methods, we have uncovered how working long shifts and high proportions of night shifts jeopardises patient safety. You will also learn what are the ongoing research projects that the team are leading on. -
Event
This Hospital at Night Summit focuses on out of hours care in hospitals, delivering high quality safe care at night, and supporting the wellbeing of those working at night. Through national updates, networking opportunities and case studies this conference provides a practical guide to delivering a high-quality hospital at night service and transforming out of hours services and roles to improve patient safety. The 2024 conference will focus on developing an effective Hospital at Night service and focus on the practicalities of supporting staff at night, improving wellbeing, and fighting fatigue. For further information and to book your place visit: https://www.healthcareconferencesuk.co.uk/virtual-online-courses/hospital-at-night-summit or email [email protected] Follow on X @HCUK_Clare #HospitalAtNight hub members receive a 20%. Email [email protected] for discount code.- Posted
-
- Staff support
- Fatigue / exhaustion
-
(and 1 more)
Tagged with:
-
Content Article
More than 1 in 6 physicians have thought about or attempted suicide. 38% of them knew of at least one fellow doctor who had suicide ideation. A Medscape survey asked physicians what factors they saw behind the suicide issues, the role their job stress plays and where doctors in a crisis can turn for effective professional help.- Posted
-
- USA
- Staff safety
- (and 6 more)
-
News Article
The lonely death of Dr Jagdip Sidhu
Patient Safety Learning posted a news article in News
Jagdip Sidhu was the platonic ideal of an NHS doctor. He took very little private work, despite it being common for consultants. His only exception was for those who needed urgent care that couldn’t get treated on the NHS. It was a point of ethics. “He said: I’m only going to do it for people who clinically cannot wait,” explains Amandip, Jagdip's brother. “I’m not going to sit and profit off people’s adverse health and misery.” But the hospital was impossible to get away from. On days and nights off, he would get urgent messages from the managers at his NHS trust asking him to clear more beds on the ward or hit new performance targets. Gradually, he had less time for anything outside of work. He’d developed “tunnel vision”, as Amandip describes it. By 2017, something had broken in him. “He had just suddenly aged,” recalls his brother, pausing for a moment before continuing. “It’s very hard to explain. But for someone who had a lot of vitality in life and charisma about him, it started to drain away.” His hair began to turn grey. He was constantly tired, surviving on just three or four hours of sleep each night and often working more than 14 hours a day. “He’d come and see mum and literally just pass out on the sofa,” recalls Amandip. He spoke less and less. Jagdip was also losing faith in the medical system whose values he once embodied, and confided to his brother that he thought the struggling NHS was “finished”. One day, Amandip got a call from his brother. “I saw his number flash up, and I knew something was wrong,” he recalls. Jagdip explained that he had been signed off work on medical leave after nurses he worked with noticed he was struggling to function. He was petrified. “He said: ‘I can’t ever go back to that hospital. They’ll crucify me. They’ll say ‘you made mistakes’, and I’ll be struck off’,” recalls Amandip. “Because he was signed off sick, he felt that he couldn’t be a doctor anymore. That was his identity as an adult human being forcibly stopped, outside of his control.” One afternoon, Amandip received an email from Jagdip. It was a confusing list of instructions, including how to access his financial accounts, life insurance policies, when to get the car MOT’d. There was no explanation. It ended with a short sign-off — he had gone to Beachy Head, a beauty spot atop the cliffs of the South Coast, with the car. As call after call went straight to voicemail, the panic started to set in. Jagdip called Jagdip’s wife — there was no sign of him at home. He had left without taking his wallet and house keys. Amandip raced across London to his brother’s house. When he arrived, it was already crawling with police. They had found the car by Beachy Head, but there was no sign of Jagdip. An agonising two hours later, he heard the crackle of the officers’ radio as they walked into the room and started to speak. “I remember them saying ‘This is the part of the job I really hate’,” Amandip recalls. They had found his brother’s body, identified by the car keys that were still in his pocket. Jagdip was 47 years old. There were a lot of questions in the blur of weeks and months afterwards. But above all, one thought haunts Amandip: did his brother’s job in the NHS play a role in his death? Read full story Source: The Londoner, 15 March 2025- Posted
-
- Doctor
- Staff safety
- (and 3 more)
-
Content Article
In this blog, Patient Safety Learning looks at the results of the NHS Staff Survey 2024, focusing on responses relating to reporting, speaking up and acting on safety concerns. We highlight that, alongside other evidence, the survey results point to a lack of progress in improving safety culture in the health service. In its major restructure of healthcare governance in England, Patient Safety Learning argues that the Government needs to prioritise decisive, practical action to create cultures in which staff feel safe to speak up. On 13 March 2024, the NHS published the results of its 2024 staff survey. 774,828 staff from 263 organisations took part and the results provide a snapshot of their experiences of working in the health service.[1] The survey included a range of questions specifically about reporting, speaking up and acting on patient safety concerns. Unfortunately, the responses show little positive progress on these areas from previous years, underlining the persistence of blame cultures and a fear of speaking up in significant parts of the NHS. Survey results Reporting of errors, near misses and incidents Two-fifths of survey respondents, over 300,000 NHS staff, were unable to say with confidence that their organisation treats them fairly if they are involved in an error, near miss or incident. This is set against a much higher number of respondents, 86.43%, who said their organisation encourages staff to report errors, near misses or incidents. Responses to both these survey questions have not significantly changed in the past three years. This demonstrates that staff see a significant disconnect between what their organisation tells them about reporting patient safety issues and how they feel they will be treated if they actually raise concerns. There is also a significant problem when it comes to what staff think about how their organisations respond to patient safety issues. 68.21% of staff said that when errors, near misses or incidents are reported, their organisation takes action to ensure that they do not happen again. It is a major concern that over 240,000 NHS staff feel unable to agree with this statement. Connected to this, nearly two-fifths of respondents, 38.71%, did not agree that they are given feedback about changes made in response to reported errors, near misses and incidents. When staff are unable to clearly see their organisation’s approach to learning and acting on safety concerns, it is understandable that they might not have confidence these are being acted on. This issue is likely to be amplified further for patients and the public who do not have an inside view of the NHS. We need to see action for improvement being shared transparently within organisations and with the wider public. Concerns about clinical safety and speaking up The percentage of staff who say they would feel secure raising concerns about unsafe clinical practice has changed very little in the past five years, hovering at just above 70%. The response rate in 2024 means that over 200,000 NHS employees, 28.47% of survey respondents, could not say that they would feel secure raising concerns about unsafe clinical practice. When asked if they were confident that their organisation would address these concerns, only 56.83% of staff responded positively, a figure very similar to last year’s results and down nearly 4% from 2020 (56.87% in 2023, 60.57% in 2020). When it comes to speaking up about broader issues, 38.18% of respondents, nearly 300,000 NHS staff, could not say that they felt safe to speak up about anything that concerns them in their organisation. When asked about their confidence in their organisation acting on any concerns, the picture looks worse, with half of all respondents not having confidence that their concerns would be addressed (50.48%). Published in July 2019, the NHS Patient Safety Strategy identifies a patient safety culture as one of the two foundations required in working towards its safety vision “to continuously improve patient safety”.[2] This ambition clearly remains a long way out of reach when, for four consecutive years, nearly two-fifths of NHS staff surveyed have said they do not feel safe to speak up about concerns. No signs of culture change The 2024 staff survey results show no significant change from recent years in responses to questions on reporting incidents, clinical safety and speaking up about patient safety issues. While the survey only provides an annual snapshot of what it is like to work in the NHS, its findings are reinforced by evidence elsewhere. Blame cultures are a recurring theme echoed across many different inquiries into major patient safety scandals.[3] [4] [5] By creating an environment in which staff fear retribution if they are involved in a patient safety incident, blame cultures encourage staff to cover up the causes of avoidable harm rather than reporting them. The shocking experiences and testimonies of whistleblowers in healthcare are further evidence of staff not feeling safe to speak up and suffering severe repercussions when they do. Too often, staff raising patient safety concerns to their organisation are met with a hostile and aggressive response, rather than one that welcomes challenge and scrutiny. Staff who speak up for patient safety often receive personal threats, vexatious referrals to regulatory bodies, pay cuts and demotions, disciplinary action and contractual changes. We are highlighting these issues as part of a new interview series, Speaking up for patient safety, in partnership with Peter Duffy, an NHS whistleblower and Chair of the Healthcare Working Group at WhistleblowersUK.[6] The series looks at how people who speak up in healthcare are treated by organisations, leaders and regulators, and how this acts as a barrier to staff raising patient safety concerns. In each interview, Peter and Patient Safety Learning’s Chief Executive Helen Hughes, talk to with someone who has spoken up about patient safety in healthcare or who works to help staff raise concerns. We need to move from ambition to action At Patient Safety Learning, we believe it is vital that we create a culture in healthcare that supports raising, discussing and addressing the risks of unsafe care. It is difficult to imagine that this type of evidence of an unsafe culture in other safety-critical industries—where the consequences of incidents may also be serious injury or loss of life—would be considered acceptable. Responses to patient safety questions in this year’s NHS Staff Survey were very similar to the 2023 results, which we analysed in our report, We are not getting safer: Patient safety and the NHS staff survey results.[7] This year’s survey results indicate that in too many parts of the health service, staff don’t feel safe to speak up and don’t have confidence that their concerns are being listened to and acted upon. These results support our view that the health service needs a more transformative effort and greater commitment to creating a safety culture. As detailed in ‘We are not getting safer’, NHS England has made some positive progress by introducing new guidance and information that aims to help develop a safety culture in the NHS.[7] However, there is little detail about how to effectively implement safety culture guidance and best practice across NHS-commissioned health and social care providers. There is also a lack of clarity about how improvements in culture will be monitored, evaluated and shared for wider adoption. The way that the NHS will operate in future years is currently subject to significant change. The forthcoming 10-Year Health Plan and the recent announcement that NHS England will be incorporated back into the Department of Health and Social Care are signs of significant structural change.[8] Patient safety must be at the centre of this new operating model, with organisations supported and held to account in creating a culture where staff feel safe to speak up. We need to move beyond rhetoric and into practical action. References NHS Staff Survey. Results, Last Accessed 13 March 2025. NHS England. The NHS Patient Safety Strategy: Safer culture, safer systems, safer patients, July 2019. Department of Health and Social Care. Independent review of maternity services at Shrewsbury and Telford Hospital NHS Trust. Ockenden Report: Findings, conclusions and essential actions from the independent review of maternity services at The Shrewsbury and Telford Hospital NHS Trust, 30 March 2022. Department of Health and Social Care. Independent Investigation into East Kent Maternity Services. Maternity and neonatal services in East Kent – the Report of the Independent Investigation, 19 October 2022. The Mid Staffordshire NHS Foundation Trust Public Inquiry. Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry, 6 February 2013. Patient Safety Learning. Speaking up for patient safety: An interview series with Peter Duffy & Helen Hughes, 15 January 2025. Patient Safety Learning. We are not getting safer: Patient safety and the NHS staff survey results, 26 March 2024. Department of Health and Social Care. World’s largest quango scrapped under reforms to put patients first, 13 March 2025- Posted
-
- Staff safety
- Psychological safety
- (and 5 more)
-
Content Article
The Royal College of Surgeons of Edinburgh’s Patient Safety Group is dedicated to upholding patient safety and ensuring that the highest standards of care remain central to the College’s mission. These core values are at the heart of everything the College does. Learn more in the attached e-flyer, including some resources available on page 2.- Posted
-
- Surgeon
- Surgery - General
- (and 6 more)
-
News Article
India's frontline health workers fight for better pay and recognition
Patient Safety Learning posted a news article in News
Thousands of frontline healthcare workers in southern India's Kerala state, who have been holding demonstrations for the past month seeking better pay and recognition, have vowed to continue their protest. Kerala's 26,225 female workers, known as Accredited Social Health Activists or Ashas (Hindi for hope), have been holding protests near the state government headquarters in the capital city of Thiruvananthapuram. The protesters, who provide crucial medical support in the country's rural areas, say they plan to "lay siege" to the state secretariat in the coming week, if authorities continue to ignore their demands. The Ashas, who number more than a million across the country, are fighting for better salaries and for official "worker" status. The women are currently categorised as volunteers, which means they are not guaranteed any benefits from the government, despite playing a crucial role in delivering healthcare in rural and underserved areas. In a country where millions of Indians, especially in the remote areas, do not have access to quality healthcare, the Asha workers have played a vital role over the years. Their job involves going door-to-door to raise awareness about nutrition, sanitation, immunisation and providing neonatal and antenatal care, among other things. They played a crucial role during the Covid pandemic, especially in Kerala which was first to report a Covid case, and have been credited for successfully containing outbreaks of Zika and Nipah viruses. Dr Joe Thomas, a Melbourne-based public health policy analyst, believes India should change its perception of these community health workers whose contribution to primary health is universally recognised. These workers are doing the job of midwives in Kerala after the state's health authorities froze recruitment of midwives, he told the BBC. "The maternity care support has slowly been shifted to Ashas." Read full story Source: BBC News, 13 March 2025- Posted
-
- India
- Staff factors
-
(and 1 more)
Tagged with:
-
Content Article
NHS Staff Survey National Results 2024 (13 March 2025)
Mark Hughes posted an article in Culture
The NHS Staff survey is one of the largest workforce surveys in the world and is carried out every year to improve staff experiences across the NHS. It asks staff in England about their experiences of working for their respective NHS organisations. Of the 1.5 million NHS employees in England, 731,893 staff responded to the survey in 2024. Responses to key patient safety questions in this year’s survey included: Reporting of errors, near misses and incidents 33.60% of staff have seen errors, near misses, or incidents that could have hurt staff and/or patients/service users in the last month (2023: 33.47%, 2022: 33.69%). 59.71% of staff said their organisation treats staff who are involved in an error, near miss or incident fairly (2023: 59.51%, 2022: 58.21%). 86.43% of staff said their organisation encourages staff to report errors, near misses or incidents (2023: 86.40%, 2022: 86.14%). 68.21% of staff said that when errors, near misses or incidents are reported, their organisation takes action to ensure that they do not happen again (2023: 68.22%, 2022: 67.42%). 61.29% of staff said that they are given feedback about changes made in response to reported errors, near misses and incidents (2023: 61.05%, 2022: 59.91%). Concerns about clinical safety 71.53% of staff said they would feel secure raising concerns about unsafe clinical practice (2023: 71.45%, 2022: 72.05%, 2021: 75.13%, 2020: 72.82%). 56.83% of staff said they were confident that their organisation would address their concern (2023: 56.87%, 2022: 56.76%, 2021: 59.51%, 2020: 60.57%). Speaking up about concerns 61.82% of staff said they feel safe to speak up about anything that concerns them in their organisation (2023: 62.34%, 2022: 61.53%, 2021: 62.07%, 2020: 65.70%). 49.52% of staff said they were confident that their organisation would address their concern (2023: 50.08%, 2022: 48.67%, 2021: 49.77%). Care for patients and service users 74.38% of staff said that care of patients or service users is their organisation's top priority (2023: 75.16%, 2022: 74.07%, 2021: 75.65%, 2020: 79.54%). 70.92% of staff agree that their organisation acts on concerns raised by patients or services users (2023: 70.64%, 2022: 69.17%, 2021: 72.12%, 2020: 75.03%). Workload and resources 47.26% of staff said they are able to meet all the conflicting demands on their time at work (2023: 46.59%, 2022: 42.85%, 2021: 42.91%, 2020: 47.53%). 58.08% of staff said they have adequate materials, supplies and equipment to do their work (2023: 58.40%, 2022: 55.51%, 2021: 57.20%, 2020: 60.24%). 34.01% of staff said there are enough staff at their organisation for them to do their job properly (2023: 32.28%, 2022: 26.24%, 2021: 26.93%, 2020: 38.16%).- Posted
-
- Staff safety
- Staff support
- (and 8 more)