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Patient safety, the ‘safe space’ and the duty of candour
Published in John Tingle, Clayton Ó Néill, Morgan Shimwell, Global Patient Safety, 2018
Addressing medical errors in the National Health Service (NHS) is an area where there have long been concerns raised as to the impact of both internal organisation factors and also external factors upon attempts to effectively identify and resolve such issues.1 Over many years it has been claimed that the investigation of medical errors and adverse incidents in the NHS has been fundamentally inhibited by the hostile environment which existed. In 2010 when the Mid Staffordshire Public Inquiry was announced by Andrew Lansley, the then Secretary of State for Health, he commented that there was: a culture of fear in which staff did not feel able to report concerns; a culture of secrecy in which the Trust board shut itself off from what was happening in its hospital and ignored its patients; and a culture of bullying which prevented people from doing their job properly.2
Health, healing or cure? The person-centred approach to treatment
Published in Rachel Freeth, Brian Thorne, Mike Shooter, Humanising Psychiatry and Mental Health Care, 2017
Rachel Freeth, Brian Thorne, Mike Shooter
My dismay is the way this health care culture of fear and mistrust affects our relationships with patients and with colleagues. We may lose the ability to relate openly and transparently, to see the constructive potential in people, to be forgiving and to be creative. Our relationships become strained, we close down, we are not able to listen and we watch our backs. We lose our sense of well-being and may become sick, decide to work part-time or retire early. The culture of mental health services as I experience it is toxic, psychologically disturbed and dysfunctional. It is often a wonder to me that it can call itself a mental health service.
High Reliability Organisations: Making Care Safer through Reliability and Resilience
Published in Lesley Baillie, Elaine Maxwell, Improving Healthcare, 2017
HROs are sensitive to operations by being attentive to the experience of frontline staff. They recognise that in their complex operating environment, frontline staff have to adapt to the situations on the ground. Managers in HROs encourage staff to report their concerns and to speak up about any errors, safety problems or other potential sources of failure. HROs recognise that a culture of fear might disable the necessary flow of information and prevent the organisation from functioning and adapting effectively.
Letter to the editor in response to “Factors associated with medical students’ speaking-up about medical errors: A cross-sectional study”
Published in Medical Teacher, 2022
Amy de Wolf, Wiktoria Milczynska, Akhil Mohindra
In our experience, medical schools encourage students to speak up but with limited success. Students are pushed to question aspects of care and think of themselves as an additional set of eyes to prevent errors. However, this stance is not always shared by doctors in the clinical setting. The British Medical Association conducted a survey in 2018 which highlighted a ‘persistent culture of fear’ in the NHS (Wise 2018). This leaves students unsure if they should speak out when witnessing a medical error, due to the hostile environment for learners at the bottom of the hierarchical ladder. Work must be done with senior staff members to highlight the importance of student input. Canvassing doctors on their opinion of medical students’ contributions may be beneficial in guiding this intervention, helping them reflect on their role in the clinical environment.
Effects of human performance improvement and operational learning on organizational safety culture and occupational safety and health management performance
Published in International Journal of Occupational Safety and Ergonomics, 2022
Vendy Hendrawan Suprapto, I. Nyoman Pujawan, Ratna Sari Dewi
Trust/learning culture is characterized by efforts to establish an environment of trust at all levels of the organization. Subsequently, it can create a learning organization culture without fear of blame or punishment [2,58,78]. Communication is characterized by addressing safety themes conveniently and in a timely manner through a communication channel between employees and hierarchical superiors [78]. Communication affords the information necessary for managing the safety management system and seeking to better controlling risks [18]. Commitment is characterized by each individual’s responsibility for learning and improving safety and being more accountable for safety [78,81]. Commitment includes renewing practices, processes, procedures, competency and applying lessons learned as safety becomes a way to do business [18]. Real commitment means more than written policies and involves the importance of safety in speech such that leaders are open to listening to workers, particularly when there is conflict with their views [15,78,82]. Employee participation in safety matters characterizes empowerment, involving people closest to the work to identify and find the best possible OSH management implementation from operational knowledge [1,2,37,78].
Patient Experience of Physical Restraint in the Acute Setting: A Systematic Review of the Qualitative Research Evidence
Published in Issues in Mental Health Nursing, 2022
Lisa Douglas, Gráinne Donohue, Jean Morrissey
The findings of two qualitative studies revealed that restraint not only elicited fear in patients but also contributed to a culture of fear on the unit (Knowles et al., 2015; Sequeira & Hallstead Sequeira & Halstead, 2002). In semi-structured interviews conducted by Knowles et al. (2015), physical restraint was seen to exacerbate the power and control held by staff, thus creating a greater power imbalance and more of a sense of ‘them and us’. In contrast, Sequeira and Hallstead’s (2002) study, patients identified restraint as being a positive experience that was calming and helped them to regain control. A minority of patients in this study expressed that they sought out the experience of being physically restrained as it alleviated feelings of fear and insecurity. It is important to note that the ‘alleviation of fear’ experienced by patients in this context, were as a result of clinical characteristics or the positive symptoms associated with psychosis, delusions and hallucinations. These findings bring to light how patients’ experience of restraint is associated with their clinical characteristics. Notably however, clinical characteristics were outlined in only three studies (Haw et al., 2011; Kontio et al., 2012; Larue et al., 2013). Clinical characteristics refer to patients’ demographics, clinical diagnosis and associated symptoms that could be linked to distressing behavior and incidents of violence and aggression resulting in the use of restraint.