Produced by the Canadian Patient Safety Institute, this report includes a literature review on effective teamwork and communication in healthcare, a needs assessment of Canadian healthcare organisations, a review of teamwork and communication training programmes, and a consultation with national and international experts in teamwork and communication.
An interview with Dr Kim Holt, Consultant Paediatrician who ‘blew the whistle’ on the Baby P case in Haringey. She also founded Patients First, which is a support group for whistle-blowers.
She discusses her experience and those of other health professionals who have been “whistle-blowers”.
She discusses the need to change the system so that clinical staff feel empowered to speak up.
Achieving High Reliability in NHS Wales is a latest white paper from 1000 Lives Plus. It draws on technical theory and practical work from the NHS and other industries to explore how 'high reliability' could make NHS Wales a better and safer place for both staff and patients.
This guide has been produced to enable healthcare organisations and their teams to successfully implement a series of interventions to improve the safety and quality of care that their patients receive focused around the usage of trigger tools.
This paper describes the use of the “trigger tool”, a relatively low cost and “low tech” technique for capturing medication related harm. The adapted technique appears to increase the rate of adverse drug event detection approximately 50-fold over traditional reporting methodologies.
This report is one of a suite of papers in relation to the measurement of medication-related harm and the evaluation of the electronic medication management (eMM) Programme.
Safety measurement and monitoring in healthcare: a framework to guide clinical teams and healthcare organisations in maintaining safety
This paper summarises the findings of a more extensive report and proposes a framework which can guide clinical teams and healthcare organisations in the measurement and monitoring of safety and in reviewing progress against safety objectives. The framework has been used so far to promote self-reflection at both board and clinical team level, to stimulate an organisational check or analysis in the gaps of information and to promote discussion of ‘what could we do differently’.