Workforce and patient safety

We’ve completed five investigations that consider how working conditions in the NHS can be optimised to support patient safety, while maintaining and improving staff wellbeing:

• Workforce and patient safety: temporary staff – involvement in patient safety investigations.
• Workforce and patient safety: digital tools for online consultation in general practice.
• Workforce and patient safety: temporary staff – integration into healthcare providers.
• Workforce and patient safety: primary and community care co-ordination for people with long-term conditions.
• Workforce and patient safety: electronic communications on patient discharge from acute hospitals.

The workforce challenges faced by the NHS in England present a significant risk to patient safety and staff wellbeing.

These challenges include inadequate interoperable IT infrastructure, skills shortages in key areas of the NHS and a mismatch between demand for hospital care and the supply of staff and other resources to meet that demand.

National reports and research have highlighted that these challenges are influenced by a shortage of NHS staff, and that there is a need to focus on recruitment and retention and consider the most appropriate workforce models for health and care in the future. To address these previously identified challenges, we can use our unique system-level perspective to propose ways to improve working conditions for NHS staff. We anticipate this in turn can help to improve patient safety.

Closure notice

The prioritising patient care investigation, which was part of the wider programme of work on the theme of workforce and patient safety, has been closed.

HSSIB suggests that integrated care boards support collaboration between primary, community and secondary care providers across their local systems to:

• jointly validate the quality of discharge correspondence
• plan for the constraints and challenges faced by different parts of their local systems
• assure themselves that risks to patient safety on discharge from hospital are mitigated as far as is practicable.

HSSIB investigations include local-level learning where this may help providers/organisations and staff to identify and think about how to respond to specific patient safety concerns at the local level. HSSIB has identified learning to help consider and mitigate risks around creating, sending and processing discharge correspondence.

For providers creating and sending discharge correspondence

• How does your organisation ensure staff recognise discharge correspondence as safety-critical information for the clinical handover of care?
• Do your staff know who are the recipients of and users of your discharge correspondence, particularly discharge summaries?
• How does your organisation know that its correspondence meets the needs of those receiving and acting on the information?
• How does your organisation ensure important information about medication changes are reliably and accurately described in discharge correspondence?
• How does your organisation support staff to ensure the contents of discharge correspondence meets the needs of all likely recipients and is of high quality?
• How does your organisation know that all required discharge correspondence is reliably produced, sent and received by all necessary recipients, not just GPs?
• How does your organisation ensure patients and their families/carers (if appropriate) are given an accessible copy of any discharge correspondence?
• How does your organisation ensure discharge correspondence is updated if a patient has further clinical input after the correspondence was written?
• Do your staff recognise that capacity and resource issues in primary and community care mean time-critical actions after discharge may be delayed or unable to be actioned?
• How does your organisation support staff to communicate time-critical actions to providers of ongoing care so they are undertaken within the required time?
• Does your organisation have pathways for primary and community care to troubleshoot incomplete or ambiguous information in discharge correspondence?
• How does your organisation involve staff in the development and testing of EPR templates to ensure they are easy to use and do not contribute to incidents?
• Does your organisation include digital and clinical input in the training of staff to write discharge correspondence to help them understand what ‘good’ looks like?

For providers receiving and processing discharge correspondence

• Does your organisation have processes for identifying and prioritising safety and time-critical actions requested by secondary care?
• How does your organisation manage seemingly ‘duplicate’ correspondence to ensure it is not an updated version with further information or actions?
• Does your organisation have processes for effectively feeding back concerns and incidents to secondary care when discharge communications do not meet your needs?
• How does your organisation involve staff in the development and testing of software and processes to ensure they are easy to use and do not contribute to incidents?
• How does your organisation assure your internal processes for the administration of correspondence to ensure thoroughness of review while looking to be efficient?