'Systems thinking' is often recommended in healthcare to support quality and safety activities but a shared understanding of this concept purposeful guidance on its application are limited. Healthcare systems have been described as complex where human adaptation localised circumstances necessary achieve success. Principles for managing improving system developed by the European Organisation Safety Air Navigation (EUROCONTROL; intergovernmental air navigation organisation) incorporate...

<h3>Background</h3> The use of checklists to minimise errors is well established in high reliability, safety-critical industries. In health care there growing interest standardise checking processes and ensure task completion, so provide further systemic defences against error patient harm. However, UK general practice limited experience safety checklist use. <h3>Aim</h3> To identify workplace hazards that impact on safety, wellbeing, performance, codesign a standardised process. <h3>Design...

Ensuring effective identification and management of sepsis is a healthcare priority in many countries. Recommendations for primary care have been produced, but complex systems, an in-depth understanding current system interactions functioning often essential before improvement interventions can be successfully designed implemented. A structured participatory design approach to model was employed hypothesise gaps between work as intended delivered inform implementation priorities...

Checklists have been shown to improve care and reduce morbidity mortality in the healthcare setting.[1] Their application safety-critical industries outside of medicine continues offer a strong argument for their medicine.[2] The daily in-patient medical ward round is complex process includes multiple potential risks patient safety. This project aims evaluate effectiveness review checklist on one general district hospital UK. A baseline audit was performed, examining case-notes set...

Participation in projects to improve patient safety is a key component of general practice (GP) specialty training, appraisal and revalidation. Patient training priorities for GPs at all career stages are described the Royal College General Practitioners' curriculum. Current methods that taught employed often use 'find-and-fix' approach identify components system (including humans) where performance could be improved. However, complex interactions inter-dependence between healthcare systems...

Background Patients with heart failure preserved ejection fraction (HFpEF) are a complex and underserved group. They commonly older patients multiple comorbidities, who rely on healthcare services. Regional variation in services resourcing has been highlighted as problem care, few teams bridging the interface between community secondary care. These reports conflict policy goals to improve coordination of care dissolve boundaries specialist community. Aim To explore how is coordinated for...

(1) To ascertain from patients what really matters to them on a personal level of such high importance that it should 'always happen' when they interact with healthcare professionals and staff groups. (2) critically review existing criteria for selecting events' (AEs) generate candidate list AE examples based the patient feedback data.

In general practice internationally, many care teams handle large numbers of laboratory test results relating to patients in their care. Related research about safety issues is limited with most the focus on this workload from secondary and North American settings. Little has been published relation primary health UK wider Europe. This study aimed explore experiences perceptions regards handling by practices. A qualitative approach was used patients. The setting west Scotland practices one...

In the third article in series, we describe outputs from a series of roundtable discussions by Human Factors experts and General Practice (GP) Educational Supervisors tasked with examining GP (family medicine) training work environments through lens systems designed-centred discipline Ergonomics (HFE). A prominent issue agreed upon proposes that setting should be viewed as complex sociotechnical system care service specialty perspective. Additionally, while existing curriculum United Kingdom...

Abstract It is known that the management of chronic gout in relation to serum uric acid (SUA) monitoring, allopurinol dosing, and lifestyle advice often sub-optimal primary care.[1] A quality improvement project form a criterion based audit was carried out an urban general practice improve care patients being treated for gout. Baseline searching EMIS confirmed with who were taking not line current guidance. 51(40%) had SUA checked past 12 months, 88(25%) below target level, recorded. An...

Introduction Warfarin is an effective drug for patients at risk of thromboembolic events, but sub-optimal pharmacological management may cause significant harm. As part the Scottish patient safety programme in primary care, one health board region aimed to determine if international normalised ratio control taking warfarin general practice improved over first 12 months participation. Methods A before and after study a multi-intervention improvement strategy was employed that combined...

Abstract Why is the area important? A sub-group of rare but serious patient safety incidents, known as ‘never events,’ judged to be ‘avoidable.’ There growing interest in this concept international care settings, including UK primary care. However, issues have been raised regarding well-intentioned coupling ‘preventable harm’ with zero tolerance especially around lack evidence for such harm ever being totally preventable. What already and gaps knowledge? We consider whether ideal reducing...

In the first series of related articles, we describe how assurance patient safety in primary care was traditionally viewed by medical profession hierarchy as being wholly dependent at individual level upon a combination education and training, knowledge, skill, experience commitment to professional development. As well summarising evidence underpinning what know about care, outline contemporary thinking has evolved recognise that issue is complex, problematic systemic, it now beginning...

Learning from events with unwanted outcomes is an important part of workplace based education and providing evidence for medical appraisal revalidation. It has been suggested that adopting a ‘systems approach’ could enhance learning effective change. We believe the following key principles should be understood by all healthcare staff, especially those role in developing delivering educational content safety improvement primary care. When things go wrong, professional accountability involves...

The Scottish Patient Safety Programme in Primary Care (SPSP-PC) aims to improve the medicines reconciliation process primary care help reduce number of adverse events causing avoidable harm. [1] aim this project is for handling Immediate Discharge Documents (IDDs) a single practice and develop protocol using bundle approach. consisted of: 1. Medicines reconciled repeat prescription updated 2. Follow up documented 3. Diagnosis coded 4. Were all actions completed? A baseline audit was...

Background and objectives Small-scale quality improvement projects are expected to make a significant contribution towards improving the of healthcare. Enabling doctors-in-training design lead is important preparation for independent practice. Participation mandatory in speciality training curricula. However, provision ongoing support methods practice variable. We aimed deliver package core medical general specialty trainees evaluate impact terms project participation, completion publication...

Background ‘Always Events’ (AE) is a validated quality improvement (QI) method where patients, and/or carers, are asked what so important that it should ‘always’ happen when they interact with healthcare services. Answers meet defined criteria can be used to direct patient-centred QI activities. This has never, our knowledge, been applied in the care of UK homeless population. We aimed test aspects acceptability and feasibility AE inform on its potential application improve for this...