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Showing results for tags 'Organisational culture'.
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Content ArticleEast Lancashire Hospitals NHS Foundation Trust share their guide on human factors. It describes what human factors is and why it is so important alongside example case studies of how human factors is being used within the Trust.
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Content Article
National Guardian Freedom to Speak Up: Case studies
Patient Safety Learning posted an article in Speak Up Guardians
Read the latest case studies from the National Guardian’s Office. -
News Article
Midwives call women in labour ‘Asian princesses’ amid ‘hostile’ environment fears
Patient Safety Learning posted a news article in News
The NHS Race and Health Observatory has raised fundamental concerns about racism towards maternity patients after several cases have come to light in recent months, including midwives branding patients as “Asian princesses”. The watchdog’s intervention follows regulators identifying patterns of racist and discriminatory behaviour at the maternity departments of two large hospital trusts and a smaller general hospital in the last six months. The observatory’s CEO Habib Naqvi told HSJ he was “deeply concerned” by the seriousness of the issues raised. He added that “discriminatory behaviours and ways of working… [can] lead to hostile and unsupportive learning environments… impact patient care and safety, and also seriously undermine the NHS’s goal of attracting and retaining its workforce”. Examples given included the term “Asian princess” being used by midwives in reference to brown-skinned women requesting pain relief during labour. The students also described a “disregard” from some midwives towards black and brown-skinned women, particularly where English was not their first language. It was also reported when Asian women verbalised their pain during labour, some midwives responded with “Oh, they are all like this”, while additional derogatory comments were made towards asylum seekers, that “they are playing the system”, the NHSE team’s report said. Read full story (paywalled) Source: HSJ, 28 June 2024 -
Content ArticleNurses, midwives and paramedics make up over half of the healthcare workforce in the UK National Health Service and have some of the highest prevalence of mental ill health. This study in BMJ Quality & Safety explored why mental ill health is a growing problem and how we might change this. The authors identified the following key themes:It is difficult to promote staff psychological wellness where there is a blame cultureThe needs of the system often over-ride staff psychological well-being at workThere are unintended personal costs of upholding and implementing values at workInterventions are fragmented, individual-focused and insufficiently recognise cumulative chronic stressorsIt is challenging to design, identify and implement interventions.They suggest that healthcare organisations need to rebalance the working environment to enable healthcare professionals to recover and thrive. This requires:high standards for patient care to be balanced with high standards for staff mental well-being.professional accountability to be balanced with having a listening, learning culture.reactive responsive interventions to be balanced by having proactive preventative interventionsthe individual focus balanced by an organisational focus.
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Content Article
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In this blog, Katy Fisher, Senior Nurse Quality & Improvement at NHS Professionals, explains how she became involved in Appreciative Inquiry and asks the question: what could Appreciative Governance start to look like in the NHS and what small steps can we all do to achieve that together? -
Content ArticleCaring Corner is a podcast hosted by Katy Fisher and Kayleigh Barnett sharing real stories of Appreciative inquiry in health and care.
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News Article
Northern Ireland: Medics who withhold information 'should face court'
Patient Safety Learning posted a news article in News
Healthcare staff who deliberately withhold information should face criminal prosecution in cases involving patient safety and deaths, according to Northern Ireland's human rights commissioner. In her first public interview on duty of candour, Alyson Kilpatrick told BBC News NI there was an obligation on doctors to be fully truthful in order to protect lives. A duty of candour is an onus on staff to be open and transparent with patients and families when mistakes are made in a patient's care. However, the British Medical Association (BMA) does not agree that criminal sanctions should be linked with a duty of candour, and has said it would go against creating a culture of openness and transparency. Alan Roberts, whose daughter's death was examined by the Northern Ireland hyponatraemia inquiry which found there had been a "cover-up" into how she died, said doctors must be legally bound to tell the truth. Claire Roberts was one of five children whose deaths at hospitals in Northern Ireland were examined by the 14-year-long inquiry. It was heavily critical of a health service it deemed to be "self-regulating and unmonitored". Mr Roberts said "the public will be shocked to find there is no legal binding duty on a doctor to tell a patient when there have been failures or when they've been at fault". Read full story Source: BBC News, 25 June 2024 -
Content Article
The original National Safety Standards for Invasive Procedures (NatSSIPs) were published in 2015. In 2023 the standards were revised (NatSSIPs 2) with the Centre for Perioperative Care (CPOC), with a focus on bolstering of the organisational standards (people, processes and performance) in addition to the sequential steps that teams follow. The standards are intended to share the learning and best practice to support multidisciplinary teams and organisations to deliver safer care. Patient Safety Learning spoke to Annie Hunningher and Claire Morgan about the changes to the revised NatSSIPs 2, how NatSSIPs 2 is being implemented and what more needs to be done to promote and engage leadership for action. -
News Article
‘Deficient’ processes and ‘poor’ safety culture found in trust review
Patient Safety Learning posted a news article in News
A trust’s drugs control department was found to have a “significant under-appreciation of safety” and “a culture of unwillingness”, after it lost track of at least two bags of fentanyl. The Royal Free London Foundation Trust launched an internal incident investigation after two rejected bags of the controlled drug were reported missing from a quality control quarantine store. Fentanyl is a strong opioid used to treat severe and/or long-term pain. But its effect is similar to heroin, it is highly addictive, and there is therefore significant illicit use of it. While it was not possible to ascertain if foul play contributed to the incident, the review said the incident “is most likely to represent a failure in documentation and of subsequent escalation”. Investigators said there appeared to be a “culture of unwillingness” to train and develop staff due to the fear of losing them to other organisations. They said a “culture of fear” was inhibiting the team’s ability to “progress, innovate, and grow”. Read full story (paywalled) Source: HSJ, 24 June 2024 -
Content ArticleIn healthcare, 'speaking up' refers to when healthcare workers raise concerns regarding patient safety through questions, sharing information, or expressing their opinion to prevent harmful incidents and ensure patient safety. Conversely, withholding voice is an act of not raising concerns, which could be beneficial in certain situations. Factors associated with speaking up and withholding voices are not fully understood, especially in strong authoritarian societies, such as Malaysia. This study aimed to examine the factors associated with speaking up and withholding the voices of healthcare workers in Malaysia, thus providing suggestions that can be used in other countries facing similar patient safety challenges.
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News Article
Trust ‘exited’ 170 staff in three years due to poor behaviour
Patient Safety Learning posted a news article in News
An ambulance chief has said his trust “exited” more than 170 staff due to culture and behavioural problems in the last three years. East of England Ambulance Trust chief executive officer Tom Abell gave the figure while speaking publicly about his team’s efforts to get a grip on the organisation’s long-standing cultural problems. Mr Abell, who is leaving the trust next month to lead Mid and South Essex Integrated Care Board, told a session at the NHS Confed Expo conference that the trust’s leadership knew suspending a large number of staff would create challenges in providing services. But he said it was the only way to ensure the right cultural standards were met and he did not want to “bottle” the decision to tackle this issue. Mr Abell, who became CEO in 2021, said: “The decision we had to make was do we suspend [the staff] and recognise the fact that’s potentially going to have a significant impact in terms of our ability to deliver services, or do we bottle it? “And [so] we suspended and dismissed [the staff in question]. Staff told me after that, ‘we never thought the organisation would ever do that’. “We’ve tried to be consistent. We’ve exited, probably over 170 people from the trust, since I started, for issues around culture and behaviour. It’s not just about being fluffy and engaging, it’s around actually taking practical symbolic action.” Read full story (paywalled) Source: HSJ, 17 June 2024 -
News ArticleA scandal-hit hospital trust has come under fire yet again after advertising for a maternity doctor with "a desire to promote normal birth". Hampshire Hospitals NHS Foundation Trust said it was seeking an obstetrics and gynaecology consultant in its high risk baby unit who would support "active" labour. Yet safe birth campaigners have reacted with fury online, claiming 'normal' has become a codeword for 'natural' birth — a fixation which has led to many midwives frowning on medical intervention and caesareans, even when needed. This 'obsession', they add, has been linked to failures at a number of maternity units in recent years where hundreds of babies died, major inquiries have found. The trust was embroiled in a similar controversy last year after Winchester's Royal Hampshire County Hospital faced a claim of unfair dismissal by a former consultant obstetrician and gynaecologist. Martyn Pitman, who had worked at the hospital for 20 years, was sacked last March after raising concerns about midwifery care and patient safety at the hospital. In a post on X, Catherine Roy linked to the advert, adding: "Where Martyn Pitman used to work. The takeover by normal birth is now complete I think. What a scandal." In response, consultant paediatrician Dr Ravi Jayaram, whose evidence helped catch convicted serial baby-killer Lucy Letby at Countess of Chester Hospital, said: "Anyone who applies for this should be immediately excluded from consideration for the post." He added: "[It] should read 'desire to support and promote safe birth' — if it needed to be said at all." Read full story Source: The MailOnline, 13 June 2024
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News Article
‘Burdensome’ patient safety inquiries taking up too much time, says NHSE chief
Patient Safety Learning posted a news article in News
NHS England’s head of patient safety has suggested too much time and resource is being spent on “burdensome” inquiries to investigate failings in the system. Aidan Fowler said national chiefs want to see a shift away from “looking back 10 years and asking ‘what did we miss’”, and instead wants teams to be resolving problems in real time. At trusts where safety concerns have been highlighted, he said “people descend, and there are a lot of asks, and the pressure mounts, and they end up with an action list of hundreds of things, and it becomes very burdensome – we have to avoid that”. Speaking at a session at the NHS Confederation Expo event in Manchester this week, he encouraged organisations to report concerns early so NHSE can respond more quickly, supporting them and working through problems to prevent public inquiries from needing to happen in the first place. Mr Fowler added: “We have to get more proactive. We will spend less of our time in the future, is the plan, than we are now – doing what I call driving in the rear view mirror. “We don’t want to be looking back 10 years and asking, ‘what did we miss’, we want to be seeing things in real time… we don’t want to be spending our time in big inquiries into failings in the system.” Read full story (paywalled) Source: HSJ, 14 June 2024 -
News Article
Three staff disciplined over death at ‘culture of impunity’ trust
Patient Safety Learning posted a news article in News
Three staff have been put on “improvement plans” after a patient’s death which a coroner said nurses had been dishonest about, HSJ has learnt. North East London Foundation Trust was heavily criticised over the death of Winbourne Charles at an inquest last year. Coroner Graeme Irvine said staff “had not told the truth” about how Mr Charles came to take his own life in an inpatient unit at Goodmayes Hospital, in east London. Two witnesses refused to give evidence, citing a rule that they could not be compelled to incriminate themselves. Mr Irvine recorded a verdict of “suicide, contributed to by neglect, to which failures in medical intervention contributed and to which failures to respond to an obvious risk of self-harm contributed”. His prevention of future deaths report also noted “observation records appeared to have been created utilising a ‘cut and paste’ function” while there were “factually inaccurate entries” stating Mr Charles “was alive and well” up to two days after his death. In comments reported by the Barking and Dagenham Post last year, Mr Irvine said: “I think witnesses who have given evidence to me in this inquest have not told the truth. “It seems to me that this remarked upon a culture of impunity and that, unless someone sees there are consequences to their actions, nothing is going to change.” Read full story (paywalled) Source: HSJ, 14 June 2024 -
Content ArticleOn 11 April 2021 an investigation into the death of Winbourne Gregory Charles, aged 58, was carried out. Winbourne was admitted into hospital under section 2 of the Mental Health Act 1983 in November 2020 following an attempt to take his own life. In December 2020 on a diagnosis of depressive illness incorporating psychotic symptoms, Mr Charles was made subject to an order under section 3 of the Mental Health Act 1983. On 10 April 2021 Mr Charles was found unresponsive, suspended on the mental health ward. The Court returned a conclusion of: “Suicide, contributed to by neglect, to which failures in medical intervention contributed and to which failures to respond to an obvious risk of self-harm contributed.” Mr Charles’ medical cause of death was determined as 1a Suspension.
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News Article
Bullying still on the rise at troubled trust
Patient-Safety-Learning posted a news article in News
An ambulance trust with a long history of cultural problems saw the proportion of staff reporting being bullied or harassed increase in 2023. The survey by East of England Ambulance Service Trust found 35 per cent of staff who responded said they had experienced bullying or harassment over the last 12 months—up from 32 per cent in 2022, and 25 per cent in 2020. The work commissioned by the trust also found that many staff who had experienced or seen bullying, or racial or sexual harassment, did not report it, with fear of retaliation being a key factor in their decision. Less than 40 per cent said they would speak to a Freedom to Speak Up Guardian about concerns. The trust—which has made high-profile efforts to address cultural issues in recent years—said it was normal to see a rise in complaints as staff became aware poor behaviour would not be tolerated, and felt safer to speak out. Hein Scheffer, the trust’s director of strategy, culture and education, said: “Bullying, harassment and poor behaviour have no place in our organisation and we regularly survey our people’s experience of workplace behaviours to help us root this out. We are working hard to improve our culture and we are among the most improved NHS organisations in England for staff feeling confident in speaking out – with 63% describing the trust as supportive." Read full story (paywalled) Source: HSJ, 12 June 2024 -
Content ArticleThis publication describes East London NHS Foundation Trust’s 10 years of experience with learning how to apply quality improvement throughout the organisation and embed a culture of improvement, in partnership with the Institute for Healthcare Improvement (IHI).
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Content ArticleIncivility or rudeness is a form of interpersonal aggression. Studies suggest that up to 90% of healthcare staff encounter incivility at work with it being considered ‘part of the job’. Interviews were undertaken between June and December 2019. Four themes were identified: paramedics reported a lack of respect displayed both verbally and non-verbally from other professional groups. The general public and interdisciplinary colleagues alike have unrealistic expectations of the role of a paramedic. In order to deal with incivility paramedics often reported taking the path of least resistance which impacts on ways of working and shapes subsequent clinical decision-making, potentially threatening best practice. Finally paramedics report using coping strategies to support well-being at work. They report that a single episode of incivility is easier to deal with but subsequent episodes compound the first. This study highlights the effect incivility can have on operational paramedics. Incivility from the general public and other health professionals alike can have a cumulative effect impacting on well-being and clinical decision-making.
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Content Article
This is part of our series of Patient Safety Spotlight interviews, where we talk to people working for patient safety about their role and what motivates them. Making Families Count is an organisation that offers practical training based on lived experience to healthcare professionals. Rosi talks to us about how MFC training benefits patient safety and improves the way in which patients and families are involved in incident investigations. She explains how she came to be involved in MFC after the death of her son Nico and outlines the vital importance of seeing patient and family voices as equal to those of people working for healthcare organisations. -
EventDelivering high-quality care and ensuring the best patient outcomes and safety levels should be the goal of all health care providers; however, these can only be achieved if staff are able and encouraged to work to the best of their abilities. Leaders play a crucial role in creating a culture that drives good staff and patient experience and, in turn, quality across the system. In this context, this session from the King's Fund will: help to provide understanding about the relationship between working culture and high-quality patient care explore how leaders can create a safe and supportive work culture that drives quality discuss how a culture of quality can improve staff wellbeing and resilience provide insight into how successful quality-improvement strategies place a strong focus on staff engagement and staff experience. Register
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Content Article
In 1990, 10-year-old Robbie Powell died due to undiagnosed Addison’s disease. Tragically, his death was preventable. Concerns that Robbie may have had Addison’s disease had been raised following a previous hospital admission and a diagnostic test requested, but this was not followed up or shared with his parents, Will and Diane. In the two weeks before Robbie died, Robbie was seen by five GPs on seven occasions, but his parents were consistently told that there was nothing seriously wrong with their son. Robbie’s father Will has worked for decades to uncover why his son died and how the doctors and organisations involved responded following Robbie’s death. In this long-read interview, Will describes the events that led to Robbie’s death and his subsequent fight for justice, including his role in the successful campaign which resulted in organisational legal duty of candour. He talks about the devastating impact that having the truth withheld continues to have on his family and other families. Will then outlines what needs to be done to better protect families and ensure they get the full truth when a child dies due to avoidable harm. Please note: readers may find the following content distressing. -
Content ArticleIn this paper, published by Healthcare, authors proceed in two steps. First, they expand the existing base of literature on the interpersonal aspect of a safety climate by presenting a conceptual model of psychological safety and joint problem-solving orientation and proposing how, individually and together, they promote safety improvement and worker retention in healthcare. Second, they conduct an exploratory test of these relationships using empirical data from a large healthcare organization in the US.
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Content ArticleThe last two decades have seen substantial advancement in the practice of team-based, safe care delivery. In parallel, burnout has been recognised as prevalent among US doctors and influenced by workplace structure and experiences. This study assessed US doctors’ perceptions of team-based care delivery and safety climate within their institutions and how these domains were associated with burnout.
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Content Article
Justice for Doctors is a not-for-profit organisation. Their aim is to provide support and guidance to doctors and other healthcare professionals who have experienced or are experiencing discrimination, harassment, and bullying, and feel targeted because of whistleblowing. On 16 May 2024, Justice For Doctors held a landmark conference about doctors speaking up for patient safety at the Royal Society of Medicine. This opinion piece by Dr Annabel Bentley is part of a series on “safe spaces”. In it she reflects on the conference and some of the experiences shared by the doctors, journalists and patients who attended.- Posted
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Content Article
In the past, long before Covid, doctors used to openly discuss complex cases and unexpected deaths on an anonymous basis either in the doctors' mess or in medical grand rounds hosted by their hospital’s clinical education department. What's happened to these forums for learning? Are these clinical conversations alive and well, and helping doctors and nurses alike to learn from safety incidents? Or have medical grand rounds disappeared from practice?- Posted
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