Cat, Dane and Suze

Snippets from an article published on 27 July 2015 in BMJ Qual Saf doi:10.1136/bmjqs-2015-004405 Patient safety reporting: a qualitative study of thoughts and perceptions of experts 15 years after ‘To Err is Human’.  Thanks to: Imogen Mitchell Anne Schuster Katherine Smith Peter Pronovost Albert Wu Over the last 15 years, literally millions of incident reports have been submitted around the world. In the UK alone, 1.5 million reports are submitted each year to their National Reporting and […]

I promised you a list of the top sites that I always go to for evidence, information, latest news, research etc. these are my favourite: NHS Scotland, Quality Improvement Hub (Qi hub) via http://www.qihub.scot.nhs.uk [this one has a whole section on quality and efficiency supporting the business case for safety] Agency for Healthcare Research and Quality (AHRQ) in the US via http://www.ahrq.gov Implementation Science – and open access on line journal via http://www.implementationscience.com/ Risky Business […]

This is the third in a serious title Re(think) Patient Safety. The series started by looking at learning, moved on to thinking about the right culture for safety and now concludes with a discussion around implementation and implementing the right solutions for safer care. Many of us have tried to realise ideas and introduce new methods, but after a while we have been forced to admit that things didn’t turn out as we had originally […]

Learning from incident reports and investigations Embedding the just culture for safety Delivering the right solutions and closing the implementation gap between theory and practice Blog 2 continues the series on Re(think) Patient Safety which are covering the three issues above.  This blog will cover the issue of embedding the just culture for safety. “The single greatest impediment to error prevention is that we punish people for making mistakes” – Lucian Leape 1997 (in a speech […]

Over the last fifteen years I do believe that we have learned a lot about patient safety but I also I think we should press the pause button and before we press play or go forward for another fifteen years we should think about what we have learned and what we should do differently in the future.  I am constantly reading about patient safety, talking to others about patient safety, searching twitter and YouTube for […]

The National Patient Safety Foundation in the US has commissioned an expert panel to assess the state of the patient safety field and to produce a report that would set the stage for the next 15 years of work. Tejal Gandhi the CEO of the NPSF announced on their website that they hoped that this would ‘galvanize the field to move forward over the next fifteen years with a unified view of the future of […]