The Rise of Patient Safety-II: Should We Give Up Hope on Safety-I and Extracting Value From Patient Safety Incidents?:Comment on “False Dawns and New Horizons in Patient Safety Research and Practice”

Who could disagree with the seemingly common-sense reasoning that: “We must learn from the things that go wrong.”? Despite major investments to improve patient safety, relatively few evaluations demonstrate convincing reductions in risk, harm, serious error or death. This disappointing trajectory of improvement from learning from errors or Safety-I as it is sometimes known has led some researchers to argue that there is more to be gained by learning from the majority of healthcare episodes: the things that go right. Based on this premise, socalled Safety-II has emerged as a new paradigm. In this commentary, we consider the ongoing value of Safety-I based approaches and explore whether now is the time to abandon learning from “the bad” and re-energise data collection and analysis by focusing on “the good.

Parent and Family Outcomes of PEERS: A Social Skills Intervention for Adolescents with Autism Spectrum Disorder

Raising a child with an Autism Spectrum Disorder (ASD) is associated with increased family chaos and parent distress. Successful long-term treatment outcomes are dependent on healthy systemic functioning, but the family impact of treatment is rarely evaluated. The Program for the Education and Enrichment of Relational Skills (PEERS) is a social skills intervention designed for adolescents with high-functioning ASD. This study assessed the impact of PEERS on family chaos, parenting stress, and parenting self-efficacy via a randomized, controlled trial. Results suggested beneficial effects for the experimental group in the domain of family chaos compared to the waitlist control, while parents in the PEERS experimental group also demonstrated increased parenting self-efficacy. These findings highlight adjunctive family system benefits of PEERS intervention and suggest the need for overall better understanding of parent and family outcomes of ASD interventions

Reporting and learning from patient safety incidents in general practice: a practical guide. Royal College of General Practitioners.

The purpose of this guide is to: • maximise opportunities to learn from patient safety incidents in your practice, and to share learning via organisational or national reporting systems; and, • outline a process for learning from patient safety incidents in your practice

Establishment limitation reduces species recruitment and species richness as soil resources rise

At local spatial scales, species richness tends to fall as productivity rises. Most explanations have focused on increased extinction, but, instead, we test experimentally whether increased soil fertility reduces recruitment. Specifically, we test whether variation in recruitment is due to source limitation, germination limitation or establishment limitation, and how litter accumulation and seed predation contribute to these processes. We established four crossed experimental treatments in a perennial‐dominated early successional plant community over 3 years. We added seed of 30 species, manipulated access by selected seed predators, removed litter and added slow release fertilizer at four levels (0, 8, 16 and 32 g N m−2). Species recruitment and richness both decreased with increasing fertility, but, counter to our expectations, we found that neither seed additions nor litter removal could counteract the negative effects of fertilizer. Seed additions increased seedling density at all fertilizer levels, and seed predation appeared to have no influence on seedling densities. In spite of high seedling densities at all fertilizer levels, final stem density declined by 70% as fertilizer increased. A strong stem density–species richness relationship suggests that declines in final stem density caused more than half of the decline in species richness along this fertility gradient. These results suggest that establishment limitation, i.e. the reduction of growth and survival from seedling to adult, controls species recruitment in highly fertile sites. The high degree of recruitment limitation commonly observed in productive habitats suggests that high productivity causes establishment limitation, thereby isolating these communities from the regional species pool. We suggest that such isolation provides a mechanism to explain why the species composition of productive communities exhibits higher variability than the composition of less productive communities within the same regional source pool

Continuous, risk-based, consultation peer review in out-of-hours general practice:a qualitative interview study of the benefits and limitations

Background: Systems to detect and minimise unwarranted variation in clinician practice are crucial to ensure increasingly multidisciplinary healthcare workforces are supported to practice to their full potential. Such systems are limited in English general practice settings, with implications for the efficiency and safety of care. Aim: To evaluate the benefits and limitations of a continuous, risk-based, consultation peer-review system used for 10 years by an out-of-hours general practice service in Bristol, UK. Design and setting: A qualitative interview study in South-West England. Method: Semi-structured interviews with intervention users (clinicians, peer-reviewers and clinical management), analysed by inductive thematic analysis and integrated into a programme theory. Results: 20 clinicians were interviewed between September 2018 - January 2019. Interviewees indicated the intervention supported clinician learning through improved peer-feedback; highlighting learning needs and validating practice. It was compared favourably with existing structures of ensuring clinician competence; supporting standardisation of supervision, clinical governance and learning culture. These benefits were potentially limited by intervention factors such as differential feedback quality between clinician groups, the efficiency of methods to identify learning needs, and limitations of assessments based on written clinical notes. Contextual factors such as clinician experience, motivation and organisational learning culture influenced the perception of the intervention as a support or stressor. Conclusion: Our findings demonstrate the potential of this methodology to support clinicians in an increasingly multidisciplinary general practice workforce to efficiently and safely practice to their full potential. Our programme theory provides a theoretical basis to maximise its benefits and accommodate its potential limitations