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Abstract
Background Learning in the NHS has evolved to focus on the analyses of mistakes: adverse incident reporting; serious incidents requiring investigation; complaints. An alternative approach, focussing on the behaviours, processes and systems, which deliver safe, high quality care often in complex, time pressured and resource-constrained settings does exist [1]. As yet this approach, Safety II, is underused in the NHS. While we recognise that it is essential to learn when things go wrong, we hope to balance the culture of learning in the NHS by promoting the recognition and reinforcement of positive practice.
Method We have adapted the Favourable Event Reporting Form (FERF) initiative from a neighbouring trust [2]. A FERF (see Figure 1) can be written by anyone (from porter to patient to professor) who notes an event that has made a positive difference to a patient’s care (see Figure 2: FERFs Submitted and Received by members of the MDT). We collect data from all FERFs completed for further evaluation. Events are collated monthly into clinical and practice themes as well as quality domains and trust values. Summaries are displayed on the FERF notice boards and fed back via departmental meetings. When named, teams and individuals receive a letter of recognition.
A FERF
FERFs submitted and received by membeers of the MDT
Practice themes identified by FEREF
Results Between January and August 2015 sixty seven favourable events were reported. Managing the sick child and deteriorating child escalation have been the most common clinical situations. The most frequent practice themes are team work, preparedness and ensuring a positive experience of care (see Figure 3 Practice themes identified by FERF). Patient centred care is by far the most popular quality domain. As a division we are commencing root cause analysis on some FERFs each month to fully understand why things went well and how we can ensure replication of such positive events.
Discussion Positive deviance and appreciative enquiry approaches such as this encourage organisations to emphasise and learn from positives, transforming the culture into one where positive becomes the norm [3–5]. The recognition of positive events undoubtedly raises morale and our initiative has been well supported. The next stage is to determine how we measure the impact in improving patient care and staff morale.