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What is PSIRF
NHS England has published the new Patient Safety Incident Response Framework (PSIRF) outlining how NHS organisations should respond to patient safety incidents for the purpose of learning and improvement
The framework will replace the current Serious Incident Response Framework by Autumn 2023, and represents a significant shift in the way the NHS responds to patient safety incidents, centring on compassion and involving those affected; system based approaches to learning and improvement; considered and proportionate responses; and supportive oversight.
PSIRF is a major step towards improving safety management across the healthcare system in England and will greatly support the NHS to embed the key principles of a patient safety culture. It will ensure the NHS focuses on understanding how incidents happen, rather than apportioning blame on individuals; allowing for more effective learning and improvement, and ultimately making NHS care safer for patients.
PSIRF removes the requirement that all/only incidents meeting the criteria of a ‘serious incident’ are investigated. It allows for other incidents to be reviewed and for a learning response to focus on areas with the greatest potential for patient safety improvement.
What does PSIRF hope to achieve?
Improved experience for those affected:
Expectations are clearly set for informing, involving, and supporting those affected by patient safety incidents, particularly patients, families and staff.
Aligned with ongoing research around improving patient and family involvement
Better range of methods for learning:
Promotes a range of methods for responding to and learning from patient safety incidents
Moves away from Root Cause Analysis (RCA) , towards a system-based approach to learning.
Timelines are more flexible and set in consultation with the patient and/or family.
Quality of response and resulting improvement work is the priority
More proportionate and effective response:
Changes blunt rules to determine what to learn from and what not to learn from.
Resource planning based on thorough understanding of patient safety incident profiles and ongoing improvement activity. Supports organisations to be more proportionate, sensitive and considered in their approach.
Strengthened governance and oversight:
Regulators and bodies like Integrated Care Board (ICB) and Commissioners will consider the strength and effectiveness of organisations’ incident response processes. Makes leaders of organisations providing healthcare accountable for how their organisation responds and improves following patient safety incidents
