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This national conference looks at the practicalities of Serious Incident Investigation and Learning. The event will look at the development and implementation of the New Patient Safety Incident Response Framework (previously known as the Serious Incident Framework) a version of which has now been published and which is being tested in early adopter sites. NHS Improvement is working with these early adopters to test implementation, and analysis of this will inform the final version with the revised framework due in June 2022. Local systems and organisations outside of the early adopter areas are free to use the already published version of the PSIRF to start to plan and prepare for PSIRF’s full introduction.
The conference will also update delegates on best current practice in serious incident investigation and learning, including mortality governance and learning from deaths. There will be an extended focus on ensuring serious investigation findings lead to change and improvement, and updates from PSIRF early adopter sites.
“PSIRF supports a systematic, compassionate, and proficient response to patient safety incidents; anchored in the principles of openness, fair accountability, learning and continuous improvement. The approach aims to refocus systems, processes and behaviours on delivering a sustained reduction in risk. It is recognised that national implementation, with fidelity to the principles and thinking behind PSIRF requires information, education and support. The evaluation found enthusiasm for the approach among the vast majority of those involved in the Early Adopter organisations. Interviewees anticipated benefits compared with the previous framework. The value of the pilot has been to provide an opportunity to identify some of the key challenges which will require attention for successful implementation of the wider roll-out.”
“To support the NHS to further improve patient safety, we are preparing for the introduction of a new Patient Safety Incident Response Framework (PSIRF), outlining how providers should respond to patient safety incidents and how and when a patient safety investigation should be conducted.”
“Changing embedded incident management processes will take time, particularly as the NHS is in the midst of intense organisational and system-wide transformation.”
This conference will enable you to:
- Network with colleagues who are working to improve the investigation of serious incidents
- Ensure your approach to Serious Incident Investigation is in line with the NHS Patient Safety Strategy
- Update your knowledge with national developments including the New Patient Safety Incident Response Framework
- Understand developments and learning from the PSIRF early adopter sites
- Reflect on the management and investigation of serious incidents involving Covid-19
- Learn from outstanding practice in the development of patient safety incident investigation and mortality review
- Reflect on the perspectives of a patient who has been involved in a serious incident
- Reflect on the development of mortality governance within your organization and understand the challenges of Covid-19
- Understand how to work with staff to ensure a focus on learning and continuous improvement
- Develop your skills in Patient Incident Investigation and PSIRF
- Apply a human factors approach to move the focus of investigation from acts or omissions of staff, to identifying systems improvement
- Identify key strategies for improving investigation of serious incidents
- Supports CPD professional development and acts as revalidation evidence. This course provides 5 Hrs training for CPD subject to peer group approval for revalidation purposes
