Project summary

Background

Healthcare continues to be unsafe despite significant safety improvement efforts over the past decade. With the paradigm shift in patient safety theory to the ‘systems approach’, there are concerns that the pendulum may have swung too far with insufficient attention being paid to the role of the clinician. As frontline staff within complex healthcare systems, clinicians often form the final barrier to harm reaching a patient. They can actively create safety through their technical competence and conscientiousness but they also have the potential to erode safety through errors and violations. In order to enhance the role of the clinician in patient safety there have been increasing calls for the explicit integration of quality and safety into the curricula of all healthcare workers. However the UK evidence-base for educational interventions in quality and safety is lacking.

Aims

To develop and evaluate educational interventions in postgraduate clinical training to improve quality and safety - informed by clinical users, the evidence-base and educational theory.
Post-checklist‌.

Methods

A number of studies targeting doctors of different grades and specialties and employing diverse educational approaches will be conducted including:

1.     Operation Debrief: Improving Performance Feedback in Surgery

There is a high-rate of patient safety incidents in Surgery. Feedback and debriefing is one way in which to optimise learning in the surgical specialty and promote safe surgical practice. Part 1 involves a user needs analysis of core elements of an effective debrief and Part 2 involves the development and testing of an evidence-based, user-informed tool to improve feedback and debriefing in surgery.

2.     Lessons Learnt: Building a Safer Foundation

Junior doctors are considered powerful ‘agents for change’ in promoting quality and safety. As frontline clinicians they are commonly exposed to patient safety incidents and are well-placed to propose potential solutions for improvement. However, there are few formal opportunities for junior doctors to reflect and share learning from such incidents. Part 1 involves an analysis of junior doctor reflections on Patient Safety. Part 2 involves the development and testing of a Deanery-wide training intervention to develop safety competencies in foundation trainees (junior doctors at the very start of their careers).

Lessons Learned Slides CPSSQ Symposium 2014 (PDF)

Outputs

Embedding Patient Safety into Postgraduate Medical Education Outputs (PDF)

Resources