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Works system design for patient safety: The SEIPS Model

Most errors and inefficiencies in patient care arise not from the solitary actions of individuals but from conflicting, incomplete, or sub-optimal systems of which they are a part and with which they interact. To improve […]

By |20th June, 2017|Resources, Learning Resources|0 Comments

The Blame Game by Steven Shorrock

In this article Steven Shorrock talks about the Blame Game and Just Culture.  He refers to the recent incident at the Oscars where the wrong winner was read out. Please click here to read […]

The Human Factors in Error Training

The Human Factors of Error Training
Using Effective Investigations to Improve Patient Safety
Bristol Medical Simulation Centre are running an innovative, interactive course incorporating Safety-I and Safety–II thinking into a practical approach to incident investigation.
Delivered by experienced […]

By |28th April, 2017|Learning Resources, Uncategorised|0 Comments

Patient Safety Collaboratives

England’s 15 Patient Safety Collaboratives play an essential role in identifying and spreading safer care initiatives from within the NHS and industry, ensuring these are shared and implemented throughout the system.

They are based in the […]

Emergency Prompt Cards

  • How does a consultant confirm all the initial steps in management have been completed?
  • How does the doctor new to the emergency department learn how to deal with a condition they have never managed before?
  • How does […]

Human Factors in Suicide Prevention

Dr Sangeeta Mahajan, a consultant Anaesthetist, tells her story of how her only son took his own life and her subsequent investigation into what went wrong.

Please click here to listen to her story.

By |12th January, 2017|Learning Resources|0 Comments

CHFG position document on ‘safe space’ practice and legislation in the NHS

In October the Department of Health set out a consultation seeking views on providing a ‘safe space’ in healthcare safety investigations, click here to view the consultation.  The CHFG have been working with James Titcombe, […]

By |13th December, 2016|Learning Resources, Policy and Research|7 Comments

EUROCONTROL Model example Just Culture Policy

The implementation of the concept of “Just Culture” is now widely seen as key for further improvement of aviation safety through more and better reporting of aviation occurrences.  An essential condition for establishing a “Just […]

Circle of Care a model for Compassionate Human Factors in Healthcare

Circle of Care is a model for Compassionate Human Factors in Healthcare, created by the Simulation and Interactive Learning Centre (SaIL) at Guy’s and St Thomas’ NHS Foundation Trust (GSTT) in collaboration with Clod Ensemble’s […]

By |17th October, 2016|Learning Resources|0 Comments

Wrong implant never event report

The NHS strives to learn from its mistakes but is often criticised for failing to investigate incidents properly, and for failing to share lessons learned more widely.

This report is a redacted report from a Never […]

By |20th September, 2016|Learning Resources|0 Comments
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