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Safer Systems, Cultures and Practices Theme: A focus on equity, diversity and inclusion

By 25/01/2024January 29th, 2024No Comments

Update from the Safer Systems, Cultures and Practices Theme: A focus on equity, diversity and inclusion

In this blog, Dr Lauren Ramsey shares important plans within the safer systems, cultures and practices theme to focus on the equity, diversity and inclusion of approaches to 1) incident investigations and 2) safety improvement work. These are just two of three safety activities that will be explored within the theme.

Hello, I’m Dr Lauren Ramsey – Senior Research Fellow working within our Safer systems, cultures and practices theme of work. Our theme is led by Professor Jane O’Hara and Professor Carl Macrae, and supported by a brilliant team of contributing researchers including national and international collaborators, our Research Fellow (Charlotte Overton) and our Lay Leader (Pam Essler).



As you will see from our EDI strategy, one of the broad missions of the centre is to “embrace diversity and inclusiveness across the research continuum to develop solutions that make care safer for all”. Throughout this blog, I will describe important plans within our theme to focus on equity, diversity and inclusion specifically.

A little background information about our theme…

As a theme, for the first 18 months of the Patient Safety Research Collaboration (PSRC) we are focussed on exploring the multiple cultural, contextual and institutional factors that shape the conduct of three key safety activities within the health service:

– Responding to safety events

– Safety improvement work

– De-implementing safety practices.

For the purposes of this blog, I am only focussing in detail on two of those safety activities – responding to safety incidents, and safety improvement work.

Safety Activity 1 – Responding to safety events

We are keen to understand how this important activity is supported, as it is one of the cornerstones of safety management within healthcare. Here we will be drawing upon rich evidence generated from two key programmes of work:

1a) The Response Study

The Response study began in May 2022 and will end in July 2025. The aim is to understand, in real time, how the roll-out of new policy, the Patient Safety Incident Response Framework (PSIRF), happens across the NHS in England, and what impact it has.

PSIRF aims to support NHS organisations to be more flexible in the way they respond to safety events. One of the key changes to policy is that NHS organisations will no longer be required to investigate every event that results in harm, which is likely to have important effects. You can find out more about the Response study here.



1b) The Learn Together Study


The Learn Together study began in October 2019 and formally ended in June 2023. The aim was to develop and test new guidance for involving and engaging patients and their families in incident investigations.




Importantly, ‘co-design’ methods were employed throughout the study, meaning that everything was developed together with patient and family representatives, engagement leads, managers, healthcare staff, policy makers and other important stakeholders.

In 2023, final versions of the guidance were launched to support i) patients and families to be involved and engaged in patient safety incident investigations; and ii) investigators to involve and engage patients and families in patient safety incident investigations.









The guidance has been tested within health services, redesigned based on the evidence and incorporated into national policy – PSIRF. The guides complement each other, and support both engagement leads and patients and families through the same five-stage process.



The five-stage process has been designed to support organisations and engagement leads to undertake patient safety incident investigations, in ways that ultimately reduce compounded harm – that is, not the harm caused by the original safety incident, but the harm caused by the processes that follow. You can download the guidance, as well as a series of supporting videos, and explore the background evidence here.

Safety Activity 2 – Safety improvement work

In addition to safety incidents, we are keen to understand how patient safety culture emerges, and is influenced by, the implementation and sustaining of safety improvement. Importantly, it remains unclear how cultural practices, norms and assumptions interact and impact safety across complex organisational and care boundaries.

Given the well-documented focus on safety in maternity care over the last decade in the UK, we propose to use Practical Obstetric Multi-Professional Training (PROMPT) as a useful vehicle to explore safety culture and understand how safety is situated in the healthcare system in the context of maternity care.

The evidence-based PROMPT  approach was originally developed at Southmead Hospital Bristol in 2000, centering on effective multi-professional communication via innovative approaches, including ‘in situ’ simulation of obstetric emergency.

Since development, PROMPT  has been implemented and iterated in maternity units across the globe seeing significant improvements in some cases, but with varying successes in others.

To date, research has specifically explored the success of PROMPT at Southmead hospital which was identified as an example of positive deviance (Liberati et al., 2019; Lawton et al., 2014). PROMPT has also been evaluated across eight maternity units in Victoria, Australia, in which benefits were evidenced to a lesser extent (Shoushtarian et al., 2014) and explored the rollout of PROMPT  across Scotland, but found no effect in the clinical indicator Apgar (Appearance, Pulse, Grimace, Activity, and Respiration) test scores (Lenguerrand et al., 2020)

However, research is yet to evaluate, compare and contrast the wider contextual factors which influence the relative successes of the PROMPT approach across contexts and healthcare economies, and from a broad range of perspectives. This is an evidence gap we plan to address via an empirical study.

A focus on equity, diversity and inclusion when learning from incidents and improving safety

To kick start some of this work within our theme, we are advertising two fellowships via the Brad-ATTAIN scheme. The scheme is run by the University of Bradford and is specifically committed to addressing systemic inequality and disadvantages experienced by Black, Asian and Minority Ethnic staff and students.

As part of the fellowships we are keen to explore opportunities to enhance the equity, diversity and inclusivity of the current Learn Together guidance further. While the guidance sets the foundations for engagement leads to come together with patients and their families to truly understand them and their needs following safety incidents – we recognise that this will look different, for different people. Health care organisations may also need further guidance to provide more tailored support to communities of people in these sensitive circumstances.

In addition, we are also keen to explore the disproportionate effects of obstetric emergency in maternity care, for groups such as women with intellectual and developmental disabilities, and for  Black, Asian and Minority Ethnic women, and how that can inform the setup and delivery of our study.

What next?
By developing a better understanding of fundamental issues related to these key safety activities, and via the lens of safety equity, we will develop a clearer and practically-grounded understanding of the wider cultural processes. This will then be used to develop a framework that can support organisations and regulators to design and implement the systems, structures and processes that enable strong and sustainable cultures of safety.

Get in touch

If you have any thoughts or questions about the plans shared here, or any other aspects of our theme, please do get in touch. You can drop me an email ( or contact me on X – previously Twitter (@laurenpramsey). You can also follow the wider PSRC account for regular updates (@YHPSRC).