David Phillip Wood, Catherine A. Robinson, Rajan Nathan and Rebecca McPhillips
The need to develop effective approaches for responding to healthcare incidents for the purpose of learning and improving patient safety has been recognised in current national…
Abstract
Purpose
The need to develop effective approaches for responding to healthcare incidents for the purpose of learning and improving patient safety has been recognised in current national policy. However, research into this topic is limited. This study aims to explore the perspectives of professionals in mental health trusts in England about what works well and what could be done better when implementing serious incident management systems.
Design/methodology/approach
This was a qualitative study using semi-structured interviews. In total, 15 participants were recruited, comprising patient safety managers, serious incident investigators and executive directors, from five mental health trusts in England. The interview data were analysed using a qualitative-descriptive approach to develop meaningful themes. Quotes were selected and presented based on their representation of the data.
Findings
Participants were dissatisfied with current systems to manage serious incidents, including the root cause analysis approach, which they felt were not adequate for assisting learning and improvement. They described concerns about the capability of serious incident investigators, which was felt to impact on the quality of investigations. Processes to support people adversely affected by serious incidents were felt to be an important part of incident management systems to maximise the learning impact of investigations.
Originality/value
Findings of this study provide translatable implications for mental health trusts and policymakers, informed by insights into how current approaches for learning from healthcare incidents can be transformed. Further research will build a more comprehensive understanding of mechanisms for responding to healthcare incidents.
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David P. Wood, Rajan Nathan, Catherine A. Robinson and Rebecca McPhillips
The current national patient safety strategy for the National Health Service (NHS) in England states that actions need to be taken to support the development of a patient safety…
Abstract
Purpose
The current national patient safety strategy for the National Health Service (NHS) in England states that actions need to be taken to support the development of a patient safety culture. This includes that local systems should seek to understand staff perceptions of the fairness and effectiveness of serious incident management. This study aims to explore the perspectives of patient safety professionals about what works well and what could be done better to support a patient safety culture at the level of Trust strategy and serious incident governance.
Design/methodology/approach
A total of 15 professionals with a role in serious incident management, from five mental health trusts in England, were interviewed using a semi-structured interview guide. Thematic analysis and qualitative description were used to analyse the data.
Findings
Participants felt that actions to support a patient safety culture were challenging and required long-term and clinical commitment. Broadening the scope of serious incident investigations was felt to be one way to better understand patient safety culture issues. Organisational influences during the serious incident management process were highlighted, informing approaches to maximise the fairness and objectivity of investigation findings.
Originality/value
The findings of this study offer original insights that the NHS safety system can use to facilitate progression of the patient safety culture agenda. In particular, local mental health trusts could consider the findings in the context of their current strategic objectives related to patient safety culture and operational delivery of serious incident management frameworks.
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David Wood, Catherine Robinson, Rajan Nathan and Rebecca McPhillips
New patient safety frameworks are being implemented to improve the impact of incident reporting and management across the National Health Service (NHS) in England. This study aims…
Abstract
Purpose
New patient safety frameworks are being implemented to improve the impact of incident reporting and management across the National Health Service (NHS) in England. This study aims to examine the current practices in this domain of patient safety in a sample of mental health trusts, a setting in which limitations in the current practice of serious incident management have been reported. The authors present key recommendations to maximise the opportunities to improve current incident reporting and management practice.
Design/methodology/approach
Ethical approval for the study was granted. A Web-based questionnaire was designed to examine current practices concerning incident reporting and management. It was refined based on consultation. Patient safety incident managers within mental health trusts in England were recruited. Twenty-nine mental health trusts responded, from a total of 51. The questionnaire study data were analysed in Statistical Package for the Social Sciences.
Findings
Current approaches used to report and manage incidents have been established and variation in practice demonstrated. A key finding for attention is that the training and education that investigators of serious incidents receive falls short of the recommended minimum national standard of 15 h, with a sample mean of 10.3 h and median of 8.0 h.
Originality/value
Recommendations at a local and national level are presented, which, if implemented, can maximise the impact of incident reporting and management practices in mental health trusts. Future qualitative research is indicated, to understand the perceptual experience and meaning behind the findings across a wider group of stakeholders.
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David Phillip Wood, Catherine A. Robinson, Rajan Nathan and Rebecca McPhillips
Despite repeated policy initiatives, progress in improving patient safety in the National Health Service (NHS) in England over the past two decades has been slow. The NHS Patient…
Abstract
Purpose
Despite repeated policy initiatives, progress in improving patient safety in the National Health Service (NHS) in England over the past two decades has been slow. The NHS Patient Safety Strategy (NHS England and NHS Improvement, 2019), which is being implemented currently, aims to address this problem. The purpose of this study is to identify learning from the implementation of past patient safety policies and thereby suggest means of supporting the NHS in delivering the current policy initiative successfully.
Design/methodology/approach
The authors identified key health policies in the domain of patient safety, published since 2000, by searching the United Kingdom (UK) government website. Discussion papers from the research literature concerning these policies were collated and reviewed. The authors then used a thematic analysis approach to identify themes discussed within these papers. These themes represent factors that support the effective delivery of patient safety policy initiatives.
Findings
Within the discussion papers the authors collated, concerning 11 patient safety policies implemented between 2000 and 2017, five inter-related core themes of capability, culture, systems, candour and leadership were identified. By evaluating these themes and identifying composite sub-themes, a conceptual framework is presented that can be used to support the delivery of patient safety policy initiatives to maximise their impact.
Originality/value
The conceptual framework the authors illustrate, arising from this new contribution to the body of knowledge, can be translated into a novel self-assessment for individual NHS trusts to understand organisational development areas in the domain of patient safety improvement.
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Abbas Karaağaçlı and Mary Joan Camilleri
Children are the primary group most affected by all sorts of social and political developments in a society, whether negative or positive. The disintegration of the social fabric…
Abstract
Children are the primary group most affected by all sorts of social and political developments in a society, whether negative or positive. The disintegration of the social fabric, the destabilisation of a country and the breakdown of political and social security pose a greater threat to children and expose them to greater harm compared to other social strata. Children, whose family integrity in cities, villages and towns has been reduced to dust by the civil war that has raged in Afghanistan for over 40 years, are the most exposed to this violence. Millions of Afghan children have been deprived of modern educational opportunities. On the other hand, the children have been forced to bear the economic burden of the household due to the loss of the source of income for the families as the fathers died in terror attacks. Add to this the psychological problems suffered by the children, as well as the physical abuse of boys, a bitter and archaic picture emerges. In addition, girls are forced to be married off to influential older men, sometimes the age of their grandfathers, and boys are given weapons at an early age, only to be offered to unlawful organisations as fighters to be deployed in conflict zones after harsh and difficult training. This threatens the very nature of what human and children's rights stand for. In this study, using the figures and statistics from UNICEF, Afghanistan Independent Human Rights Commission and other institutions such situations of human rights and children's rights in this country are analysed.
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The purpose is to offer a critique of the process of decision-making by top university administrators and to analyze how their decisions imposed their preferences and expanded…
Abstract
Purpose
The purpose is to offer a critique of the process of decision-making by top university administrators and to analyze how their decisions imposed their preferences and expanded administrative control.
Design/methodology/approach
In the fall of 2021, the top administrators at Boston-based Northeastern University required that all members of the university community return to fully on-campus face-to-face work. That decision involved a return to what was labeled “normal operations” and followed a year-and-a-half of adjustments to the COVID-19 pandemic. Building on that case example, the analysis then ranges backward and forward in time. Other decisions – by Northeastern University leaders as well as leaders at other schools – are considered as well.
Findings
Leaders impose labels on complex contingencies as a way of constructing meaning. No label is objectively true or indisputable. In the hands of individuals who possess hierarchical power and authority, the application of a label such as “new normal” represents an exercise of power. Through an exploration and analysis of the underlying, unspoken, assumptions behind the application of the “new normal” label, the article suggests how the interests of university leaders were being advanced.
Research limitations/implications
Because of its reliance on labeling, the paper focuses mainly on the words of administrators – at Northeastern University and elsewhere – that are called upon to explain/justify decisions. The multiplicity of interests forwarded by the “new normal” label are explored. No attempt is made – nor would it be possible – to understand what was in the hearts and minds of these administrators.
Practical implications
The article makes a case that any and all pronouncements of leaders should be understood as assertions of power and statements of interests. The practical impact is to suggest a critical analysis to be applied to all such pronouncements.
Social implications
The approach taken in this article is situated within post-modernist analysis that critiques dominant narratives, disputes epistemological certainty and ontological objectivity and takes cognizance of coded messages contained in language.
Originality/value
Everyone has been through a traumatic period of time with the pandemic. The author has focused on a specific community – university administrators and tenure/tenure track faculty – as a window to help explain how decision-makers shaped their response. The author wants to emphasize the labels imposed by leaders and the assumptions behind the application of those labels.