healthcare
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Do you ever feel like we are missing something? Do you have moments when you are struck by a story or a fact that stops you in your tracks. I was recently reading the annual report from NHS Resolution as part of area of research. Having worked there and seen the exponential growth in litigation…
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In July, the review of patient safety by Dr Penny Dash was published. This was followed by an acceptance of all the recommendations made in the review by the government. Up until then I had not been party to what the findings had been or the recommendations so was somewhat surprised when I read it.…
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I read the review of patient safety by Dr Penny Dash [published in July 2025]. You can find it here: https://assets.publishing.service.gov.uk/media/686bd5d52cfe301b5fb6780c/dhsc-review-of_patient-safety-across-the-health-and-care-landscape.pdf I made six pages of notes as I read it and have a few comments as you can imagine. I think the best thing for me to do at this stage is provide some…
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In reality we do not know what the true quantitive level of safety is. We dont know for sure how many things are going wrong and we definitely dont know how many things go right. I would argue we may never know. We cannot capture everything – that would be impossible. What we do capture…
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Wherever you work in healthcare and whatever role you have you will be wanting to ensure the safety of the patients in your care. You will want to find ways of building safety within your work. However, healthcare is an uncertain world and the difference between safe care and unsafe care can be decided in minutes. Over the…
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Do you need help? As a recognised expert in patient safety, I bring a wealth of experience and insight to every organisation I partner with. Whether it’s guiding leadership teams, providing keynote speeches, or helping you create a culture of safety, my approach is built on evidence-based practices tailored to your unique needs. Here’s how…
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It was an absolute honour and joy to deliver the James Reason Lecture in 2016 at the Patient Safety Congress on what was the 68th Birthday of the NHS. Prof Reason was my supervisor for my doctorate and a source of inspiration for over the last 25 years. I will never forget the words; ‘Dr…
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People “tend to overestimate their ability to function flawlessly under adverse condition, such as under the pressures of time, fatigue or high anxiety” and “We must re-examine all that we do and redesign our many and complex systems to make them less vulnerable to human error” Two quotes from an editorial in the BMJ from 18…
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I have just uploaded a post related to a just culture. That was describing the culture that is for the vast vast majority of incidents and staff. I purposefully left it at that because I didn’t want it confused with this post which is asking some difficult questions that I don’t know the answer to.…
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I have been working with loads of amazing people both here and abroad over the last year. One of the many things that comes up time and time again is measurement: ‘how do we measure success when it comes to patient safety?. The questions we have are challenging to answer with confidence; how safe are we today?…
PATIENT SAFETY NOW 