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Content Article
Patient falls are a significant concern in healthcare settings, often leading to severe injuries, prolonged hospital stays and increased healthcare costs. The importance of fall prevention extends beyond patient safety—it reduces hospital liability, enhances patient outcomes and improves overall healthcare efficiency. By proactively assessing and addressing fall risks, healthcare providers can significantly lower the incidence of falls, ensuring a safer environment for patients. Given the aging population and increasing chronic disease burden, fall prevention remains a top priority in improving patient care and quality of life. This blog from Augustine Kumah, Deputy Quality Manager at The Bank Hospital, Accra, Ghana, explores the significance of fall risk assessment, its implementation and its role in reducing fall-related incidents in healthcare settings. Introduction Falls among patients, particularly in healthcare facilities, remain a pressing concern worldwide. These incidents not only lead to injuries, prolonged hospital stays and increased healthcare costs, but can also have lasting psychological impacts on patients. Preventing patient falls necessitates a multifaceted approach, with fall risk assessment at its core.[1] Understanding the impact of patient falls Patient falls are defined as unintentional descents to the ground that occur in healthcare facilities, including hospitals, nursing homes and rehabilitation centres. According to the World Health Organization (WHO), falls are the second leading cause of unintentional injury deaths globally, with older adults being most at risk.[2] In healthcare facilities, the consequences of falls extend beyond physical injuries; they also affect a patient’s confidence, independence, and quality of life. The financial burden of falls on healthcare systems is substantial. Costs include direct expenses such as treatment for fall-related injuries and indirect costs like litigation, reputation damage and loss of trust. Additionally, healthcare providers experience emotional distress and professional repercussions when preventable falls occur under their watch. Hence, fall prevention is not just a patient safety priority but also an ethical obligation and a cost-saving measure. The role of fall risk assessment Fall risk assessment is a systematic process to identify patients at risk of falling. Healthcare providers can implement targeted interventions to mitigate these risks by evaluating intrinsic and extrinsic factors. Intrinsic factors include age, medical history, mobility impairments and cognitive status, while extrinsic factors encompass environmental hazards, medication side effects and inadequate assistive devices. Risk assessment tools, such as the Morse Fall Scale, Hendrich II Fall Risk Model and STRATIFY Risk Assessment Tool have been widely used. These tools provide a structured approach to assess risk levels and guide preventative measures. However, their effectiveness depends on accurate application and regular updates based on patient conditions. Implementing effective fall risk assessments To maximise the efficacy of fall risk assessments, healthcare facilities must adopt evidence-based strategies and integrate them into their workflows. Key steps include: Standardised assessment protocols: Developing and adhering to standardised protocols ensures consistency in evaluating fall risks across different departments and shifts. Protocols should specify the frequency of assessments, criteria for reassessment and documentation requirements. Staff training: Comprehensive training programme for healthcare workers are essential to enhance their competency in conducting fall risk assessments. Training should cover assessment tools, recognition of risk factors and communication of findings to the care team. Patient and family education: Involving patients and their families in fall prevention efforts fosters a collaborative approach. Educating them about potential risks and preventive measures empowers them to contribute to safety. Technology integration: Advanced technologies such as wearable sensors, predictive analytics and electronic health records (EHRs) can augment traditional fall risk assessments. For instance, sensors can monitor patient movements and alert staff to potential falls, while EHRs can flag high-risk patients for closer observation. Challenges in implementing fall risk assessments Despite its benefits, implementing fall risk assessments is not without challenges. Common barriers include: Resource constraints: Limited staffing, time pressures and inadequate funding can hinder comprehensive risk assessments. Overburdened staff may struggle to prioritise fall prevention alongside other responsibilities. Inconsistent application: Variability in applying risk assessment tools can lead to inaccurate results. Subjective judgment, incomplete data collection and lack of protocol adherence contribute to inconsistencies. Resistance to change: Resistance from staff and administrators to adopt new practices or technologies can impede the integration of fall risk assessments into routine care. Patient non-compliance: Some patients may resist interventions such as bed alarms, mobility aids or supervision, increasing their risk of falling. Strategies to overcome the challenges To address these challenges, healthcare facilities can adopt the following strategies: Leadership support: Strong leadership commitment is crucial to allocating resources, establishing accountability and creating a safety culture. Interdisciplinary collaboration: Engaging multidisciplinary teams, including nurses, physicians, physical therapists and pharmacists, ensures a holistic approach to fall risk assessment and prevention. Continuous Quality Improvement: Regular audits, feedback sessions and performance evaluations help identify gaps in fall prevention efforts and drive improvements. Tailored interventions: Personalising interventions based on individual patient needs and preferences increases their acceptability and effectiveness. Conclusion Preventing patient falls requires a proactive and comprehensive approach, with fall risk assessment as a foundational element. Healthcare facilities can significantly reduce fall-related incidents and their associated consequences by identifying at-risk individuals and implementing tailored interventions. However, the success of fall prevention efforts hinges on overcoming implementation challenges through leadership support, interdisciplinary collaboration and continuous improvement. As healthcare systems evolve, leveraging technology and prioritising patient-centred care will be instrumental in advancing fall risk assessments. By embracing these advancements, healthcare providers can create safer environments that uphold all patients' dignity, independence, and well-being. References The Joint Commission. Fall Reduction Program - Definition and Resources, 28 August 2017 WHO. Falls Factsheet. World Health Organization, 26 April 2021.- Posted
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In this article for the Journal of mHealth, Victoria Betton looks at the importance of a user-centred design approach to developing electronic patient records (EPRs). She highlights four key principles, based on human factors, that should be considered when designing an EPR: Start early with user needs—take time to build user needs and goals into your thinking from the start of your business case and keep them at the core of your requirements. Use observation, interviews and analysis of data (for example, clinical incident reports) to give you the insights you need. Bake in adoption from the get-go—make sure there is sufficient resource and time in the business case to engage and involve EPR users at each stage of the process, from defining needs through to procurement, implementation and ongoing optimisation over time. Get it right before you configure—use wireframes and simulation to test out before you start to configure the EPR. Make it as easy as possible for users to enter data in the right place the first time. Iterate—create a process that allows for ongoing iteration, learning and optimisation of the EPR. Don’t send floor walkers in for two weeks and ask them to leave. Ongoing adaptation and improvement are key.- Posted
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This blog shares extracts and learnings from 'A user centred design blueprint for NHS trusts', a dissertation written by Tracey Watson for her Degree Master of Science in Digital Health at Imperial College. In her dissertation, Tracey sought to answer the question: "What are the key success elements of user centred design that need to be understood in order to gain use and optimise digital transformation?" She investigated her question through semi-structured interviews with NHS Trust executives, change practitioners and user centred design experts. This blog summarises Tracey’s exploration of the challenge and context for user centred design in NHS trusts.- Posted
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Community Post
Better use of data for medication safety in hospitals
Kenny Fraser posted a topic in Medicine management
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NHS hospital staff spend countless hours capturing data in electronic prescribing and medicines administration systems. Yet that data remains difficult to access and use to support patient care. This is a tremendous opportunity to improve patient safety, drive efficiencies and save time for frontline staff. I have just published a post about this challenge and Triscribe's solution. I would love to hear any comments or feedback on the topic... How could we use this information better? What are hospitals already doing? Where are the gaps? Thanks- Posted
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- Safety assessment
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- Medication - related
- Patient identification
- Patient safety strategy
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- protocols and procedures
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- Staff engagement
- Training
- Time management
- Allergies
- Deep vein thrombosis
- Falls
- Parkinsons disease
- Substance / Drug abuse
- Urinary tract infections
- Antimicrobial resistance (AMR)
- Benchmarking
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- Indicators
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- Task analysis
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Content Article
This YouTube playlist containing 12 short vlogs (each lasting 10 minutes or less) is a cut-down version of Continuing Professional Development work commissioned by the NHS in England. These are part of our patient led clinical education work and involved working with patients, carers, and relatives as equals to produce the videos. These vlogs are based on the (UK) Royal Pharmaceutical Society Competency Framework for all Prescribers, and related guidelines from professional bodies in the UK. They are designed for clinicians (across all disciplines and specialities), patients, carers, parents, relatives and the public. The short videos focus on providing refresher information, updates on hot topics and materials that can be used for reflection both individually and within clinical teams. They cover: Shared decision making Information mastery Interpretation of numerical data Root causes on medicines and prescribing errors Taking a history Basic pharmacology Risk areas and red flags Ethics, the law and prescribing Deprescribing Remote prescribing Prescribing for frailty and multimorbidity Prescription writing and safe prescribing The original materials were accompanied by live sessions, questions for reflection (some of which are included here), separate refresher questions, detailed prescribing scenarios, and competency assessments.- Posted
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Community Post
Bricks and Mortarboards
Pete Smith posted a topic in Patient engagement
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When you enter a hospital, be it as a patient or a member of staff, an interesting thing happens. The glass doors close behind you and you are irretrievably in a different existential space. Outside, beyond that threshold is the material world. But inside you are a new Jonah having been swallowed by a mammoth whale I’m interested in exploring that existential space in the interests of quantifying the healing environment.- Posted
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News Article
The NHS has announced that Dr Hilary Cass OBE, former President of the Royal College of Paediatrics and Child Health, will lead an independent review into gender identity services for children and young people. The review will be wide-ranging in scope looking into several aspects of gender identity services, with a focus on how care can be improved for children and young people including key aspects of care such as how and when they are referred to specialist services, and clinical decisions around how doctors and healthcare professionals support and care for patients with gender dysphoria. It will also set out workforce recommendations for specialist healthcare professionals and examine the recent rise in the number of children seeking treatment. Dr Cass will then make clear recommendations for children and young people’s gender identity services reporting back next year. The Gender Identity Development Service for Children and Adolescents is managed by the Tavistock and Portman NHS Foundation Trust. The Care Quality Commission (CQC) is due to carry out a focused inspection of The Tavistock and Portman NHS Foundation Trust, Gender Identity Services for children and young people, during the autumn. The inspection will cover parts of the safe, effective, caring, responsive and well-led key questions and will include feedback from people using the service, parents, relatives, carers, and staff. Separately, Dr Cass will also review the service’s clinical practice with the support of the Royal College of Paediatrics and Child Health and engagement of other professional bodies to provide multi-professional insight working closely with the CQC. The review includes an examination of the issues surrounding children and young people who are prescribed puberty blocking and cross sex hormone drugs. Dr Hilary Cass OBE, independent chair, said: “It is absolutely right that children and young people, who may be dealing with a complexity of issues around their gender identity, get the best possible support and expertise throughout their care.” “This will be an inclusive process in which everyone will have the opportunity to make their views known. In particular I am looking forward to hearing from young people and their families to understand their experiences. “This review provides an opportunity to explore the most appropriate treatment and services required.” Read full story Source: NHS England, 22 September 2020- Posted
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Content Article
Error traps: Let’s raise awareness
Patient Safety Learning posted an article in Error traps
An error trap is a situation that could lead into avoidable harm if not mitigated. It is a situation where the circumstances in combination with human cognitive limitations make errors more likely.[1] Error traps can be found throughout health and social care in medicines, equipment and devices, in documentation, and in many other areas we see every day while going about our daily jobs in health and social care. We want to raise awareness of these error traps on the hub but more importantly we want to hear your suggestions of what needs to be done to prevent them and examples of where action has been take and worked. View our error trap gallery and share your examples. How many times have you been to the drug cupboard/trolley at work and looked at it with despair? How many times have you looked at a written prescription or plan of care and were unable to read the writing? How many times have you gone into the storeroom and spent ages looking for what you want as everything looks the same or it has moved to a different spot? These are what we call error traps. It is as if you have an annoying brother/sister that is trying to catch you out! Sometimes in healthcare, no matter where you work, there are times when it is not easy to do the right thing. Often, we know about these traps and have become used to living with them. We may set up processes that mitigate us making the mistake. This is great, but is this addressing the problem? We have diagnosed the problem, but we haven’t stopped that potential error from happening again. In the world of ergonomics it is the forcing function commonly cited in human factors case studies as recommendations for error-prevention in health and safety contexts. It means forcing users to do something in a certain way in order to proceed on a journey. A great example is how banks have prevented customers from leaving their card in the ATM. The forcing function is that the machine will bleep to prompt the customer to remove the card from the machine before the money is released. This prevents cards being left in the machine. Whereas if there was just a sign saying ‘remember to take your card’ there will always be a risk that people will not read the sign – the sign may fall off or be removed or it will become invisible as people rush about in their daily lives. So how can we solve these error traps in health and social care? We have created an error trap gallery for hub members to share examples of error traps they have come across and also examples of where action has been take and worked. View our error trap gallery and share your examples Reference 1. Steve Highley. An Encounter with an Error Trap. 6 August 2015. https://www.hastam.co.uk/an-encounter-with-an-error-trap/- Posted
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Content Article
Maryanne Mariyaselvam, Clinical Research Fellow at Queen Elizabeth Hospital, presenting at this year's Improving Patient Safety & Care 2020 conference: Safer culture, safer systems, safer patients.- Posted
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Following the first confirmed case of COVID-19 in Pennsylvania, facilities began submitting patient safety reports to the Pennsylvania Patient Safety Reporting System related to management of this emerging infection. Events in the analysis most often took place in the Emergency Department, on a Medical/Surgical Unit, or in the Intensive Care Unit. This is a study of 343 Event Reports From 71 Hospitals in Pennsylvania. The table within this document outlines the factors associated with patient safety concerns within COVID-19.- Posted
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To get the safest—and not just the cheapest—devices, the NHS needs to start taking ergonomics seriously, experts say. In March 2020, the UK government commissioned non-medical manufacturers, including Dyson and Renault, to produce ventilators for the excess number of patients expected to have respiratory failure as a result of COVID-19. Because the machines would be used by non-specialist clinicians during the pandemic, NHS England commissioned guidance1 on ergonomic (also known as human factors) design of the ventilators, aimed at achieving “optimum human safety and performance.” However, the commissioning of the ventilator guidance remains an exception rather than the rule. There are, however, signs that the NHS is starting to take human factors seriously—and COVID-19 is a driver.- Posted
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UK Standards for Public Involvement
Claire Cox posted an article in Patient engagement
The UK Standards for Public Involvement are designed to improve the quality and consistency of public involvement in research. Developed over three years by a UK-wide partnership, the standards are a description of what good public involvement looks like and encourages approaches and behaviours that are the hallmark of good public involvement, such as flexibility, sharing and learning and respect for each other. The standards are for everyone doing health or social care research and have been tested by over 40 individuals, groups and organisations during a year-long pilot programme. They provide guidance and reassurance for users working towards achieving their own best practice. The National Institute for Health Research (NIHR), Chief Scientist Office (CSO) Scotland, Health and Care Research Wales, and the Public Health Agency Northern Ireland invites people to use the UK Standards for Public Involvement in all types of research activity. People, teams and organisations in health research often ask "What does good public involvement in research look like?". High quality public involvement can make a real difference to research and healthcare; however, it needs to evolve and improve over time. The UK Standards for Public Involvement provide clear, concise statements of effective public involvement against which improvement can be assessed.- Posted
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Content Article
Many people with learning disabilities are not getting their annual health check, facing increased risk factors to a number of diseases as a result. This article, by Jim Blair and published by the British Journal of Family Medicine, considers what more can be done to help those most at risk- Posted
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Healthcare is advancing at a quicker rate than ever before. With the introduction of Artificial Intelligence (AI), you can now get a cancerous mole diagnosed with a mobile device. The reliance on technology has never so great. With technology predicted to replace as much as 80 per cent of a physician’s everyday routine, we must question what the new threats posed to patient safety are? This article, written by CFC Underwriting, explains some of the pitfalls of the new technology. CFC is a specialist insurance provider. and a pioneer in emerging risk.- Posted
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Inpatients could play an important role in identifying, preventing and reporting problems in the quality and safety of their care. To support them effectively in that role, informatics solutions must align with their experiences. The authors of this research paper published in the Journal of the American Medical Informatics Association set out to understand how inpatients experience undesirable events and to surface opportunities for those informatics solutions.- Posted
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Annette McKinnon is a patient with chronic disease. Her experience has led her to be involved in trying to change healthcare so that the voice of the patient is included in decisions. She is a volunteer member of many groups and committees and is a patient partner on several Canadian research teams. In her blog, published by the BMJ, Annette discusses the importance of patient-centred care, information sharing and the barriers to achieving this.- Posted
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We can use what we’ve learned from the crisis to make a 21st-century service fit for patients and staff alike, says Joel Schamroth in a blog to the Guardian. This pandemic is forcing us to rethink how we deliver healthcare. For too long patients have experienced fragmented services, administrative hurdles and unreliable lines of communication. The “patient experience” often remains an afterthought in the NHS, leading to worse health outcomes, and costing the NHS dearly. The lesson the public is learning is that money can be made available when it’s deemed to be important. In a matter of weeks COVID-19 has shown us that change is possible. -
Content Article
Using human factors science increases the likelihood of obtaining well-designed and easy to use products to deliver safe patient care. Poor designs, by contrast, can cause unintended harm to patients. This guide, developed by the Clinical Human Factors Group, is to help staff working in procurement or with medical devices and equipment, to use human factors to specify and select the best and safest products to use in healthcare. This is important because conformity with regulations and standards does not always guarantee safe outcomes when products are used in practice. This guide is particularly relevant to medical devices but can be used for other healthcare products.- Posted
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'The Productive Ward: Releasing time to care' was a quality improvement programme developed by the NHS Institute for Innovation and Improvement (NHSI) and introduced in 2007. It was designed to improve efficiency, productivity and performance at ward level in acute hospitals. It was based on three principles: good ward organisation so that materials were readily accessible displaying ward-level metrics such as patient safety and experience use of visual aids to understand patient status at a glance. This NIHR (National Institute for Health Research) funded study, published in the Health Services and Delivery Research journal, used quantitative and qualitative methods to evaluate the programme in six acute hospitals in England. It found some evidence of a lasting impact, such as wards continuing to display metrics and using equipment storage systems. But most hospitals that adopted the programme had stopped using it after three years, often due to a change in their approach to quality improvement. Productive Ward resources are still available from NHS England’s Sustainable Improvement team, but are under review. This evaluation may be helpful in designing future similar schemes.- Posted
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Listening to patients is hugely important as they are at the very the heart of what we do. We need to listen to them more, as they help us all move the conversation on safety forward. This short video from the Health Service Journal includes patients, relatives and patient advocates and staff who speak about their experiences from being in the healthcare system.- Posted
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This model from NHS Improvement will help you understand the demand and capacity needs of services with a complex pathway. The high complexity model is intended for services that have more complex pathways e.g. chronic (more than one year) services in acute, mental health or community services, where patients may return for several follow up appointments at intervals which may change depending on how their condition progresses. You can use this model to inform decision making and planning, in supporting delivery of timely care to patients. This web page includes the following tools: high complexity model user guidance demand and capacity: high complexity model (blank) demand and capacity: high complexity model (populated).- Posted
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Research shows that when patients are engaged in their healthcare, it can lead to measurable improvements in safety and quality. To promote stronger engagement, the Agency for Healthcare Research and Quality (AHRQ) has developed a guide to help patients, families, and health professionals in primary care settings work together as partners to improve care. The Guide to Improving Patient Safety in Primary Care Settings by Engaging Patients and Families (the Guide) is a resource to help primary care practices partner with patients and their families to improve patient safety. The Guide is composed of materials and resources to help primary care practices implement patient and family engagement to improve patient safety.- Posted
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A Learning Disabilities service in Leicester found that Experience Based Co-Design (EBCD) was the ideal way to bring together users, families and staff to share experiences of care and design and implement change.- Posted
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Assistive technology: definitions, examples and safe use
Claire Cox posted an article in Equipment
The phrase ‘assistive technology’ is often used to describe products or systems that support and assist individuals with disabilities, restricted mobility or other impairments to perform functions that might otherwise be difficult or impossible. An assistive technology product can be classed either as a medical device, which needs a CE mark and is regulated by the applicable legislation, or it can be an ‘aid for daily living’. It depends on the claims made by the manufacturer. This guidance set out by the Medicines and Healthcare products Regulatory Agency (MHRA) helps manufacturers and healthcare professionals understand the definition of assistive technology and the difference between medical devices and aids to daily living. -
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The Clinical Human Factors Group (CHFG) had a fantastic one-day conference looking at how design and procurement in medical devices and systems can proactively improve patient safety. Here are the presentations, slides and interviews. Presentations include: Martin Bromiley talking a little about his story and the impact of design, followed by discussion with Francois Jaulin and Frederic Martin from the Anaesthesia Network. Dr Tom Clutton-Brock, Clinical Director of Trauma Management, discussing regulations in design safety and usability. Tracey Herlihey, Head of Safety Intelligence, HSIB, looks at the consequences of bad design. Colette Longstaffe, Product Assurance Specialist, Clinical and Product Assurance, NHS Supply Chain, looks at what the NHS is doing differently in procurement. Panel discussion with Martin Bromiley, Colette Longstaffe and Tracey Herlihey joined by Rob Turpin from the BSI and chaired by John Pickles, CHFG Chair. Dan Jenkins, Head of Research (Human Factors and Interaction), DCA Design International, looks at how we can use Human Factors to design better medical devices. Professor Chris Frerk, Anaesthetist, gives real life examples of the impact of poor design. Richard Featherstone, Director of Human Factors Research & Design at Emergo by UL, talks about medical devices and user errors. Panel discussion by Professor Chris Frerk and Dan Jenkins plus Duncan McPherson from the MHRA, Chaired by Professor Rhona Flin, CHFG Trustee.- Posted
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