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Found 123 results
  1. News Article
    Dedicated to caring for the sick and vulnerable, junior ­doctors should expect to be ­supported and valued as they carry out their vital work. However, hundreds have revealed they are subjected to bullying and harassment at overstretched hospitals that have been plunged into a staffing crisis by a decade of savage health cuts. A Mirror investigation uncovered harrowing stories of young medics being denied drinking water during gruelling shifts, working for 15 hours on their feet non-stop and of uncaring managers tearing into them for breaking down in tears over the deaths of patients. One was even accused of “stealing” surgical scrubs she took to wear after suffering a miscarriage at work. The distraught woman finished her shift wearing blood-soaked trousers, instead of going home to rest. Doctors are now quitting in their droves, leaving those left ­struggling to cope with a growing ­workload. The Mirror investigation reveals the reality of working for an NHS which has been subject to a record funding squeeze and is 8,000 medics short. Health chiefs vowed to ­investigate the Mirror’s evidence from 602 ­testimonials submitted to the lobbying group Doctors Association UK. Chairman Dr Rinesh Parmar said: “These heartbreaking stories from across the country show the extent of bullying and harassment that frontline doctors face whilst working to care for patients". Read full story Source: The Mirror, 12 February 2020
  2. News Article
    One in three trainee doctors in Australia have experienced or witnessed bullying, harassment or discrimination in the past 12 months, but just a third have reported it. That's according to a national survey of almost 10,000 trainee doctors released today by the Australian Health Practitioner Regulation Agency (AHPRA). The results of the survey, co-developed by the Medical Board of Australia (MBA), send a "loud message" about bullying and harassment to those in the medical profession, said MBA chair Anne Tonkin. "It is incumbent on all of us to heed it," Dr Tonkin said. "We must do this if we are serious about improving the culture of medicine." "Bullying, harassment and discrimination are not good for patient safety, constructive learning or the culture of medicine," Dr Tonkin continued. "We must all redouble our efforts to strengthen professional behaviour and deal effectively with unacceptable behaviour." Read full story Source: ABC News, 10 February 2020
  3. News Article
    The former police chief who investigated mental health services in a crisis-hit health board was “shocked” by the poor working relationships and “blame shifting” he uncovered. David Strang, who led the independent inquiry into the issues in NHS Tayside, said staff felt isolated and unsupported and people complained about each other’s practices without coming together to sort the issues out. He described asking staff questions based on information he had received and being met with the response: “Who told you?” He added: “A lot of staff felt there was a real blame culture and that risk and blame fell to the front line.” Read full story (paywalled) Source: 6 February 2020, The Times
  4. Community Post
    Restorative justice brings those harmed by crime or conflict and those responsible for the harm into communication, enabling everyone affected by a particular incident to play a part in repairing the harm and finding a positive way forward. This is part of a wider field called restorative practice. Restorative practice can be used anywhere to prevent conflict, build relationships and repair harm by enabling people to communicate effectively and positively. This approach is increasingly being used in schools, children’s services, workplaces, hospitals, communities and the criminal justice system. What are your thoughts on how this approach would work in a healthcare setting? Does anyone have any experience of using restorative practice?
  5. Content Article
    Often, there are many perspectives that we need to consider before we have a complete picture. 'The Blind Men and the Elephant', and earlier versions of this parable, show us the limits of perception and the importance of complete context. This also applies when we are facing a difficult or complex issue in relation to patient safety. As part of the Patient First programme at Brighton and Sussex University Hospitals NHS Trust, we used A3 problem solving. Many others do too. It’s a structured problem-solving tool, first employed at Toyota and typically used by 'lean' manufacturing practitioners. Flexible and succinct, it captures everything you need on a single piece of paper – A3 in size, hence the name. It also brings together some widely used improvement tools – cause and effect diagrams (fishbone diagrams) the 5 whys and small change cycles (Plan, Do ,Study, Act). Most recently, I've had the pleasure of using it with teams wanting to improve elements of their services such as time to triage, discharge or wanting to minimise avoidable harm (e.g. patient falls). I have also used it with families and clinical teams wanting to take forward a key service change. Its’ real power is that, rather than jumping in with solutions in hand (which are, more often than not, shopping lists of resources required), you don’t move forward until you have absolute clarity on what the ‘problem’ is you are trying to solve. Plus, this is a team activity. It is rare we know everything about our issue and the power of an A3 derives not from the report itself, but from the development of the culture and mindset required for its successful implementation. There are several formats around – just google A3 problem solving. I have summarised the first 4 steps below: Step 1: Problem Statement Set out why this is important? A couple of sentences about the size of the issue, how long it has been going on, impact on patients, their families and staff. For example Over the last 4 months we've seen a reduction in patients triaged from X% to Y%. There was a near miss event last week that would have been averted had triage been in place on that shift and staff are concerned that there is no single process for them to follow. OR Our surveys over the last 6 months indicate that only X% of our clients are fully engaged in the development of their care plans. We need to address this urgently in order to ensure best outcomes for our clients and support family members and carers who are willing and able to participate. This is your call to action – if it isn’t making your staff and clients sit up and want to engage then it needs more work. Step 2: Current Situation What you know about the issues, what staff are saying, what patients and their families are saying (small surveys are great), what the data is telling you, any protocols or algorithms, and anything else that you need to know. Step 3: Vision & Goals Vision: A softer statement of quality AND Goal(s) : Measurable goal(s) and when you are aiming to deliver, for example: From June 2020: ‘X% of patients to be triaged within Y minutes of arrival‘ AND ‘Y % of patients triaged to the correct clinical pathway’ Step 4: Analysis: Top Contributors & Root Causes Use a cause and effect (fishbone) diagram to ensure you are capturing the many causes For example, the methods in place that may not be working quite so well, things to do with the environment, equipment and the people, both patients and staff. Once these are all out on the table then you can use root cause analysis to get underneath them. It’s only at steps five and six that you start to think about the actions that you will take forward and how you might fix some of these big issues. The full A3 is pasted below: And finally, it goes without saying that step nine, ‘insights’, is key. In my experience, people get best benefit if they complete this as they go along. There is always learning, for example people you might have engaged sooner, early identification of others who are already on top of the issue and able to share their work with you so you can adapt for your own use – we used to call it ‘assisted wheel re-invention’ when I worked for the NHS Modernisation Agency. Please leave a comment below or message me through the hub @Sally Howard if you want to know more. I'm very happy to talk further about this approach.
  6. Content Article
    Vanessa Sweeney, Deputy Chief Nurse and Head of Nursing – Surgery and Cancer Board at University College London Hospitals NHS FT decided to share a example of positive feedback from a patient with staff. The impact on the staff was immediate and Vanessa decided to share their reaction with the patient who provided the feedback. The letter she sent, and the patient’s response are reproduced here: Dear XXXXX, Thank you for your kind and thoughtful letter, it has been shared widely with the teams and the named individuals and has had such a positive impact. I’m the head of nursing for the Surgery and Cancer Board and the wards and departments where you received care. I’m also one of the four deputy chief nurses for UCLH and one of my responsibilities is to lead the trust-wide Sisters Forum. It is attended by more than 40 senior nurses and midwives every month who lead wards and departments across our various sites. Last week I took your letter to this forum and shared it with the sisters and charge nurses. I removed your name but kept the details about the staff. I read your letter verbatim and then gave the sisters and charge nurses the opportunity in groups to discuss in more detail. I asked them to think about the words you used, the impact of care, their reflections and how it will influence their practice. Your letter had a very powerful impact on us as a group and really made us think about how we pay attention to compliments but especially the detail of your experience and what really matters. I should also share that this large room of ward sisters were so moved by your kindness, compassion and thoughtfulness for others. We are now making this a regular feature of our Trust Sisters Forum and will be introducing this to the Matrons Forum – sharing a compliment letter and paying attention to the narrative, what matters most to a person. Thank you again for taking the time to write this letter and by doing so, having such a wide lasting impact on the teams, individuals and now senior nurses from across UCLH. We have taken a lot from it and will have a lasting impact on the care we give. The patient replied: Thank you so much for your email and feedback. As a family we were truly moved on hearing what impact the compliment has had. My son said – “really uplifting”. I would just like to add that if you ever need any input from a user of your services please do not hesitate to contact me again
  7. Content Article
    Over the past ten years, I have helped dozens of organisations in the NHS, higher education and in corporate contexts start using AAR to improve the quality of learning after events. Yet despite the proven value of AAR to patient safety and team performance,1 AAR has still not made the impact it can and should. This short article explains some of the barriers to implementation that I have encountered during this time so that you can mitigate for them in your own context. In 2009, I joined a team at University College London Hospitals (UCLH) that had adapted the AAR concept from the military for use in the NHS. AAR provides a deceptively simple vehicle to structure healthy blame-free team interactions and the aim was to improve patient safety, clinical practice and team behaviours.2 The AAR approach has since become business as usual at UCLH where it is now widely understood and frequently used. What my colleagues at UCLH recognised so well is that AAR is so much more than the four questions you get when you type After Action Review into a search engine3 and, thus, designed the introduction of the approach with this in mind. A paper in the Harvard Business Review4 describes why AAR has so often failed in the corporate environment and this gives useful insights, but I have witnessed three particular challenges in the healthcare setting. 1. Fear The organisational and psychological barriers to being able to talk honestly about errors in multi-professional teams are accentuated by the hierarchical nature of the clinical context. Put simply, this means, despite everyone’s best intention to learn from a near-miss or an unexpected event, there will be fear about being fully open in front of those more senior or junior and those from other disciplines. If we are being really honest with ourselves, we know this to be true. Fear of what others think about what we have done, and whether it will affect our standing in some way, is a universal human trait which is increased when the boss is in the room. This fear is in direct tension with the AAR concept of openness and cross-disciplinary learning and will act as a barrier to calling AARs unless leaders act as role models in AARs and set the scene by being honest and open themselves. 2. Blame The emotive nature of clinical care heightens the response when things go wrong meaning the tendency to find something or someone to blame is increased. Not only do we have institutional demands pressing hard for straightforward answers, meaning we look for something obvious to blame, we also have our own human reaction to distance our self from responsibility. This traditional reaction again lies in direct tension with the very idea of AAR, where the process is not to blame but to learn. The research is clear, that in this most complex of operating environments there is rarely a single point of failure or a single individual who is to blame, instead there are multiple causes and effects, which ,when better understood, provide a firm place from which to make effective changes. 3. Responsibility The concept of clinical professionalism is centred around the individual’s’ responsibility to deliver safe effective care and it is rooted in the very foundations of how the NHS was created. Clinicians are raised in the belief that they should know the answers to problems and the whole structure of career progression is based around acquiring more knowledge, research papers and letters after your name. AAR is a process of learning as a group and taking responsibility together to find out how to improve, so it is not surprising that it sits in tension with the historical emphasis on the individual healthcare professional and the value of their existing knowledge. AARs allow for the creation of new knowledge through a collaborative process. The joint guidance from the General Medical Council (GMC) and Nursing & Midwifery Council (NMC) on the professional duty of candour states: “Clinical leaders should actively foster a culture of learning and improvement.”5 AAR is one of the best mechanisms to both foster and drive a culture of learning and improvement, but the simplicity of the AAR process itself should not blind you to the need to be very considered in how you mitigate and manage the barriers in a clinical setting. If you would like to discuss AARs further, I'd love to hear from you. Contact me at: judy.walker@its-leadership.co.uk References 1. Tannenbaum SI, Cerasoli CP.  Do team and individual debriefs enhance performance? A meta-analysis. Hum Factors 2013;55(1):231-45. .2. Walker J, Andrews S, Grewcock D, Halligan A. Life in the slow lane: making hospitals safer, slowly but surely. J R Soc Med 2012;105(7):283-7. doi: 10.1258/jrsm.2012.120093. 3. NHS Improvement. Online library of Quality, Service Improvement and Redesign tools: After Action Review. 4. Darling M, Parry C, Moore J. Learning in the Thick of It. Harvard Business Review: July-August 2005 issue. 5. Nursing and Midwifery Council. Openness and honesty when things go wrong: the professional duty of candour. June 2015. Read Judy's previous blog: How can After Action Reviews improve patient safety?
  8. Content Article
    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
  9. Content Article
    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.
  10. News Article
    Warring between two surgeons at Great Ormond Street Hospital could put patients at risk, a review suggests. A board paper released by the leading children's hospital said a "fractured" relationship between two consultants in the paediatric surgical urology team was affecting the service last year. The London hospital said steps were being taken to resolve the problems. This has included mediation, mentoring and away days. The board paper from a meeting in November set out the findings of a two-day inspection by the Royal College of Surgeons last May. The college was invited in by the trust itself after reports of problems. The summary of the report said there were "significant difficulties" between two surgeons in the team. It described a "lack of trust and respect" which meant they did not work collaboratively and led to significant competition for work. If this continued it would have the "potential to affect patient care and safety" as well as longer waits for surgery, it said. The "dysfunction" between the two senior doctors caused problems for the wider team with evidence support staff had also been treated inappropriately. Great Ormond Street said it took the issue "extremely seriously" and good progress was being made. Read full story Source: BBC News, 15 January 2020
  11. Content Article
    In this study published in the Joint Commission Journal on Quality and Patient Safety, a large US health system devised a tool to evaluate disruptive behaviour among its ranks, measure its effect on teamwork, burnout and patient safety, and used that data to define improvement targets. In the sample, researchers found disruptive behaviour to exist in approximately 98% of work settings.
  12. Content Article
    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.
  13. Content Article
    This short video, by Abertawe Bro Morgannwg University Health Board, demonstrates the Soothing Patient Anxiety (SPA), a unique approach to co-production in meeting the needs of complex patients requiring a surgical intervention.
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