Course Summary

Virtual Training – Investigating Incidents; A Systems-Based Approach 1 Day Course

This virtual training session will focus on the first crucial steps of any incident investigation.  The emphasis will be on practicality and a process that can be incorporated into the health professional’s working day, as well as one that can be conducted remotely. Mirroring the new Patient Safety Strategy, good practice and factors requiring change will be identified, along with their contributory factors.  All recommendations, reports and action plans will focus on systemic changes, multi-disciplinary working and implementing practical changes.  All learning points are reinforced with real life examples.  Delegates will be provided with a suite of templates to use during an investigation as part of our commitment to an holistic approach to patient safety.

This course can also be run over 2 half-days.

Delegates will learn:

  • How much information to gather and how to gather it
  • The role of human factors and ergonomics in patient safety incidents
  • How to involve patients, families and carers
  • How to organise evidence using Timelines
  • How to critically analyse evidence
  • How to conduct interviews with staff members and families
  • Identification of factors requiring change
  • Including good practice in reports
  • Identification of contributory factors
  • Identification of broken and missing systems
  • Making proportionate and effective recommendations
  • Pulling a report together

Course Timetable

09.00am to 09.15amLogon, timings and housekeeping
09.15am to 10.00amIntroductions and an overview of the investigation methodology.
10.00am to 10.15amHuman factors and ergonomics; this session will explore how human factors can influence an investigator’s approach, the importance of objectivity and tips for achieving neutrality.
10.15am to 10.45amGathering information; a report is only as good as the information it is based on.  Investigators must beyond simply gathering evidence to find out ‘what’ happened – they must find and ‘why’ it happened and remember to gather human factors and ergonomic evidence. This will ensure that Investigators possess enough evidence to make SMART recommendations.
10.45am to 11.00amCoffee Break
11.00am to 11.45amMapping the information using simple and tabular timelines.
11.45am to 12.15amCritical Analytical Skills – How to identify missing or incomplete evidence
12.15am to 12.30pmSummary
12.30pm to 1.00pmLunch
1.00pm to 1.15pmRecap on Module 1
1.15pm to 1.45pmCritical Analytical skills – how to prepare for interviews. How to conduct interviews with staff members and families
1.45pm to 2.30pmIdentification of good practice and factors requiring change.  The importance of standards and precision writing.
2.30pm to 2.45pmTea Break
2.45pm to 3.15pmIdentifying contributory factors, including human factors, broken and missing systems.
3.15pm to 3.45pmFocus on writing excellent recommendations, benchmarking, reasonable/measurable action plans and producing standardised reports.  Example report format provided.
3.45pm to 4.00pmSummary, questions, conclusion and feedback

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