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Found 1,234 results
  1. Content Article
    The Australian Open Disclosure Framework provides a nationally consistent basis for open disclosure in Australian healthcare. The framework is designed to enable health service organisations and clinicians to communicate openly with patients when healthcare does not go to plan.
  2. Content Article
    The author of this article, published in Health Issues, argues that the experience and wisdom of consumers positively impacts on improvement in every dimension of health care quality. From a consumer perspective, those dimensions of quality can be described as care that is: accessible equitable safe effective efficient timely appropriate consumer-centred.
  3. Content Article
    The objective of this systematic review, published by JBI database of systematic reviews and implementation reports, is to synthesise the eligible evidence of patients' experience of engaging and interacting with nurses, in the medical-surgical ward setting.
  4. Content Article
    Suicide rates for doctors, nurses and allied healthcare workers are rising and being involved in a safety incident increases this risk. The need to support staff when things go wrong is evident. We come to work to do the very best we can for our patients, often ignoring and at the cost of our own health. Most adverse incidents happen, not because we are bad at what we do, but because of system failure. As professionals who care passionately about our work, we blame ourselves when things go wrong. Albert Wu (2000) recognised this phenomenon and coined the term second victim. In this series of blogs I will share my own experiences of setting up and developing Safety Incident Supporting Our Staff (SISOS). In this first blog I explain the catalyst that led to developing SISOS.
  5. Content Article
    Karen Harrison from Hull University Teaching Hospitals NHS Trust writes about her experience of winning the Patient Safety Learning Culture Award and what she plans to do next.
  6. News Article
    The number of concerns reported to the NHS’s Freedom to Speak Up Guardians has been steadily increasing since the guardians were introduced in England in 2017. Since April that year thousands of concerns have been reported to the guardians at NHS trusts, data from the National Guardian’s Office shows. View full story (paywalled) Source: BMJ, 19 November 2019
  7. Content Article
    The process of clinical consultation defines diagnosis and is crucial to patient safety and patient outcomes However the process is frequently weak resulting in care erring off path. These indicators (taken from a paper in Postgraduate Medical Journal) could provide a way to identify weaknesses and areas for improvement.
  8. Content Article
    The language we use in healthcare can have a huge impact on our patients and families. What we say and how we say it could have a negative or a positive impact. As clinicians we need to be mindful in how we say things and relay information. This short blog illustrates this.
  9. Content Article
    ‘Victim wellbeing’ is a phrase often linked to restorative justice, but what does that look like in practice? In this article, Greg Smith (restorative justice development manager at Thames Valley Restorative Justice Service (TVRJS)), Diana Batchelor (PhD researcher at Oxford University and independent evaluation researcher for TVRJS) and Becci Seaborne (assistant director for restorative justice at TVRJS) consider why, and how, restorative justice could become a default option for health service providers.
  10. Content Article
    Healthcare systems are operating in an environment that is increasingly moving toward value-based payments that reward good health outcomes and patient experience. An impediment to success in this environment, however, is that both health care delivery systems and health information are extremely complicated. The level of complexity stymies many people and hinders them from making informed preventive care and self-management decisions. Health systems are finding that they cannot achieve improved patient outcomes or experiences without improving how health care professionals communicate with and support patients. Health systems have begun to respond to the mismatch between patients’ capabilities and the health literacy-related demands of the healthcare system. A new term has emerged – the health literate organisation – that describes organisations that aspire to make it easier for people to navigate, understand, and use information and services to take care of their health. Health literate organisations, in turn, need healthcare professionals who have health literacy knowledge and skills, such as being able to communicate effectively, break down health goals into manageable steps, and connect people with the resources they need to be successful Harris et al. explores health literate care in this Commentary for the National Academy of Medicine.
  11. Community Post
    "There is an aspect of information exchange that has attracted less attention and fewer resources: that patients are experts in their experience and know much more than clinicians about their own health and the needs and goals important to them." From: https://catalyst.nejm.org/information-asymmetry-untapped-patient/ Such an important point to see patients as knowledge hubs on their own care experiences.
  12. Community Post
    Following the posting of the recent anonymous blog by a brave nurse - a discussion was started on Twitter about the aspect of accountability, duty of candour mixed with a no blame culture. If there has been a drug error: The person who did the error needs to feel secure in the knowledge that there is a no blame culture, otherwise they may not report it in the first place. The patient needs to be told that they has been an error with their care The person who did the error needs to be held to account So, can these three points coexist or are we wanting the impossible?
  13. Content Article
    Our experience of attending the Patient Safety Learning Annual Conference and entering our patient safety initiative into the awards.
  14. Content Article
    The nature and consequences of patient and family emotional harm stemming from preventable medical error, such as losing a loved one or surviving serious medical injury, is poorly understood. Patients and families, clinicians, social scientists, lawyers, and foundation/policy leaders were brought together to establish research priorities for this issue. I recommend that all those involved in 'engagement with harmed patients and families' read this and in particular, commit to making sure they are doing the '20 things organisations can do now' that is listed in table 3. This paper was published in the Joint Commission Journal on Quality and Patient Safety. Register for free to view the full article. 
  15. Content Article
    This patient passport template designed by East Sussex Healthcare NHS Trust, can be used by any patient, although primarily aimed at patients with a learning disability. The passport is to be kept and updated by the patient/carer/family, brought in to healthcare settings to help staff  deliver appropriate, safe care.
  16. Content Article
    The North West London Integration Toolkit is intended to support communities, people and partners as they work towards the shared vision of integrated care. The toolkit is the culmination of over 200 individuals and organisations across North West London coming together to share knowledge and develop ideas as to how to implement whole systems integrated care. The toolkit is a living document and repository of collective learnings. It will evolve and be updated as local areas start to implement their plans and lessons are learned and shared.
  17. Content Article
    A US based study to determine whether medical errors, family experience and communication processes improved after implementation of an intervention to standardise the structure of healthcare provider-family communication on family centered rounds.
  18. Content Article
    Examples and recommendations around how to implement some aspects from the Royal Pharmaceutical Society's report: Getting the medicines right.
  19. Community Post
    A question posed by a delegate at our Patient Safety Learning conference 2019: 'Does your employer praise staff and patients for reporting safety concerns?' Tell us about your experiences of how reported concerns are received. Does it differ depending on whether they are raised by staff or patients? Are there any examples of great practice you can share where people are really praised for raising patient safety concerns?
  20. Content Article
    Patients who are actively involved in their health and health care tend to have better outcomes and care experiences and, in some cases, lower costs. Implementing patient and family engagement strategies has led to fewer hospital-acquired infections, reduced medical errors, reduced serious safety events, and increased patient satisfaction scores. After reviewing best practices and evidence-based strategies for increasing patient and family engagement in direct care settings, hospitals, health systems, the community, and through policy, the Task Force on Patient and Family Engagement developed and refined a set of 16 recommendations that will catalyse patient and family engagement and improve health and health care systems in North Carolina.
  21. Content Article
    Studies comprehensively assessing interventions to improve team communication and to engage patients and care partners in intensive care units are lacking. This study from Dykes et al. examines the effectiveness of a patient-centered care and engagement program in the medical ICU. They found implementation of a structured team communication and patient engagement program in the ICU was associated with a reduction in adverse events and improved patient and care partner satisfaction.
  22. Content Article
    John Dobbin is the editor of Thinking Digitally. Here he has written a blog on some of the barriers to psychological safety and why it is being ignored in the work place.
  23. Content Article
    Reacting to a never event is difficult and often embarrassing for staff involved. East Lancashire Hospitals NHS Trust has demonstrated that treating staff with respect after a never event, creates an open culture that encourages problem solving and service improvement. The approach has allowed learning to be shared and paved the way for the trust to be the first in the UK to launch the patient centric behavioural noise reduction strategy ‘Below ten thousand’. Published in the Journal of Perioperative Practice.
  24. Content Article
    EAST for Health & Safety: Applying behavioural insights to make workplaces safer is a report from the Behavioural Insights Team. The EAST framework focuses on four simple principles to encourage a behaviour: make it Easy, Attractive, Social and Timely (EAST).
  25. Content Article
    This report was prepared for the World Health Organization (WHO) Patient Safety’s Methods and Measures for Patient Safety Working Group. 
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