When posting travel photos, the “universal” side of the subject often leads to wanting to post in two languages … and at the same time, we necessarily favor one (if only because it appears first in the caption). In other words, larger droplets travel further than what we’ve been led to believe. At the beginning of the pandemic, in the absence of any scientific studies, the WHO said the virus was spread by “large droplets” and promoted handwashing. Dear Missguided, who really paid for your £1 bikini? We took each of the eight wards involved in turn, and gathered as many people together as possible who were associated with that ward and fall prevention. The aim was to spend time discussing how issues relating to falls prevention could be addressed. At the same time they leveraged social capital acquired over 30 years of practice to co-opt a senior nurse occupying the hybrid middle manager role of clinical quality, risk and safety manager, into prioritising falls as an organisation-wide issue.

By the time I went home that evening, Sophie was in the maternity ward recovering from surgery and Edith was in the NICU. That’s what makes this disease so horrendous: you never know how it’s going to manifest itself,” says Jessica, who apologises needlessly for briefly losing her composure. “Bella recently went into hospital crying, and now she doesn’t cry. The incident would be dealt with in a relatively tokenistic way, a tick-box exercise going through the motions to satisfy the patient, patient carer or relative. If, for example, an elderly person falls over on the ward and fractures their hip, this is recorded as a SUI; an incident which results in unexpected or avoidable death, or moderate or serious harm to a patient. NCSA analyzed over 790 four-year colleges with men’s college soccer programs across four division levels (D1, D2, D3 and NAIA) to develop a list of the Best Men’s Soccer Colleges for Student-Athletes. Regardless of the elaborate mechanisms and processes in place to deal with SUIs and despite there being a formal mechanism designed to elicit knowledge sharing and brokering, you got compliance at best. In that space, the usual hierarchical norms of behaviour that were discouraging knowledge brokering would be in operation.

We suggested a number of initiatives to help improve the knowledge brokering and dissemination of good practice. Thus, our studies highlighted possible HR mechanisms, such as job designs, performance management systems, and training and development interventions that could create opportunities for knowledge brokering interaction, and motivate individuals to engage. On governance our studies have revealed two significant flaws in existing practice. The idea that many patients with dry eye symptoms have chronic pain, then, is “completely new and radical”, black playboy bunny costume she says. What a great idea that is. When this happens, I feel it’s important to remember what our priorities really are, and to place our focus there. At present the climate within which the governance process took place left people feeling that they were on trial and therefore promoted defensiveness and reduced the prospects of knowledge dissemination. This climate needed moderating, which would involve subtle changes in the ways in which the clinical governance committee interacted with the ward manager and deputy ward manager and other team members at ward level.

An important part of our work involves stepping into the medical practitioners’ world, relaying our findings, and working with them in a practice setting, to implement changes that will improve existing practices. The challenge was to implement measures that would lead to learning and service improvement. What was the learning in service improvement? However, managerial identity remains an issue for doctors when positioned in hybrid middle manager roles, suggesting that they would benefit from greater learning and development opportunities focusing on this aspect of their role. Two other coronaviruses—the ones that cause MERS (Middle Eastern respiratory sydrome) and SARS (severe acute respiratory syndrome)—are also spread this way. Ultimately this serves to empower hybrid nurse middle managers to influence practice for patient safety improvement. Although the organisation of clinical practice might fail to provide opportunities for individuals to broker knowledge upward to higher-status clinicians, motivated individuals can step in to create opportunities to champion and influence change. It is the people working in the hospitals who are best able to identify how those solutions might be translated into practice and implemented. The routine clinical practice is a professional space.

The importance of effective performance management and targets were also highlighted, especially in a professional context where considerable emphasis is placed on evidence-based decision making and meeting targets. Our work in the group meeting dealt with the professional organisation – the wards and other associated medical professionals delivering the care. However, a second key aspect of our work in the NHS Trust was our engagement with the managerial organisation in the hospital, specifically the clinical governance committee. We realize, however, that this is often not enough. However, the learning centre was seen as a neutral space. Because when doctors talk to clinical teams in front of their peers, and other associated professionals, they do not want to be seen as dismissing patient safety and the measures that might be taken to improve it. What tended not to happen were any remedial measures being acted upon, or any suggestions included in the action plan actually implemented.

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