In this final episode of our podcast series on the changing climate, this mountainous country is seeing extreme temperature fluctuations, landslides and air pollution, endangering communities and impacting healthcare. But, there are some lessons around adaptation, as our guests who work or have volunteered in Nepal explain.

Dr Bernadette O’Hare hosts a fascinating and wide-ranging conversation with Dr Jamun Singh, a Nepalese paediatrician, and Dr Rashmi D’Souza, a UK-based paediatrician and Heather Watson, a UK-based paediatric nurse, who volunteered with Dr Singh in our Global Links programme.  

Dr Singh gives a powerful account of the dramatic effects climate change is having in Nepal, from extreme temperature fluctuations to the indirect dangers posed by cooking on indoor fires. He highlights the impact of floods, which have triggered landslides, further endangering communities and disrupting daily life. Despite these challenges, Dr Singh shares how Nepal is adapting, including changing school schedules to cope with climate extremes and harnessing the country's hydropower potential as a sustainable energy source. 

In a separate conversation, Bernadette caught up with Dr Camilla Kingdon in her last weeks as RCPCH President to find out more about the impacts of air pollution, as well as find out about her experiences visiting Nepal over the years.  

This episode not only sheds light on the specific challenges faced by children in Nepal due to climate change but also underscores the importance of global cooperation and local adaptation strategies. Tune in to hear these compelling stories and learn how communities are striving to protect their children and future in the face of a rapidly changing environment.

Download transcript (PDF)

Resources:

• The impact of climate change on global child health - position statement
• The impact of climate change on child health around the world: results of a survey of child health professionals outside the UK
• Climate change - resources for child health professionals
• Global Links programme

Floods, heatwaves and wildfires have become increasingly common across Canada. And as retired paediatrician Dr Julian Pleydell-Pearce explains in this episode of our climate change series, this makes a profound impact on the lives of children and young people - and the way health services are delivered.

In episode two of this three-part series, Professor Bernadette O’Hare speaks with guest Julian, who worked as a paediatrician in Canada before his recent retirement. Julian shares his firsthand experiences of how shifting weather patterns has had a drastic impact on the lives of children and young people in Canada. 

Julian explains how heatwaves are causing widespread damage, leading to devastating wildfires that have displaced communities, destroyed vast areas of forest and severely degraded air quality. Beyond the physical dangers, Julian shares the personal challenges he faces in a region increasingly affected by climate change.

Drawing from our recently published survey, this series aims to deepen our understanding of the risks posed by climate change, particularly for the world’s most vulnerable population: children.

We hope this podcast series deepens your understanding of the serious impacts climate change has on children's health. There's an urgent need for action, so tune in to hear about how we can all contribute to creating a safer, healthier future for children everywhere.

Download transcript (PDF)

Resources:

• The impact of climate change on global child health - position statement
• The impact of climate change on child health around the world: results of a survey of child health professionals outside the UK
• Climate change - resources for child health professionals 

Less predictable weather in the past several years in this east African country have made it increasingly difficult to grow crops, leading to food shortages and skyrocketing prices. There are broader consequences for children's health, too, as Eva Odongpiny, a pharmacist in Uganda, discusses with us. These include an increased vulnerability to diseases like HIV and cholera, air pollution and water scarcity.

This is the first episode in our three-part series on the impacts of climate change on children's health around the word. Host, Dr Bernadette O’Hare, chair of the international workstream of the RCPCH climate change working group, speaks with Eva who has firsthand experience of the environmental challenges children - and health services - face. 

Eva explains how the imbalance between supply and demand of food has resulted in widespread hunger and malnutrition. She talks too about how forced migrations due to flooding interrupts normal life routines. And that can impact adherence to medicines, such as antiretrovirals. And, Eva and Bernie explore the mental health toll on children, as the environmental challenges contribute to rising levels of eco-anxiety.

Drawing from our recently published survey, this series aims to deepen our understanding of the risks posed by climate change, particularly for the world’s most vulnerable population: children. We hope to inspire action to tackle climate change to protect children in Uganda and around the globe. So, tune in to learn more about how we can all contribute to creating a safer, healthier future for children everywhere.

Download transcript (PDF)

Resources:

• The impact of climate change on global child health - position statement
• The impact of climate change on child health around the world: results of a survey of child health professionals outside the UK
• Climate change - resources for child health professionals 

Health inequalities are widening in paediatrics. Those that are more disadvantaged experience more safety issues whilst in health care.  If we can make our healthcare systems more equitable for the children and young people we can for, they will be safer in our care.

In episode 5 of our series on paediatric patient safety, we speak with Dr Helen Stewart, Dr Cian Wade and Dr Mimi Malhotra to explore how patient safety and health inequalities are inextricably linked. Tackling healthcare inequalities can improve safety and vice versa. 

Dr Stewart shares her knowledge and experience as the RCPCH Officer for Health Improvement as to how our children are impacted by health inequalities. Dr Wade and Dr Malhotra discuss their BMJ paper, Action on patient safety can reduce health inequalities, and explore some of the improvement avenues that are available to clinicians and service providers.

Thank you for listening.

Dr Natalie Wyatt, RCPCH Clinical Fellow and Jonathan Bamber, RCPCH Head of Quality Improvement | Produced by 18Sixty

Please be advised that this podcast series contains stories relating to child death and harm. All views, thoughts and opinions expressed belong to the guests and not necessarily to their employer, linked organisations or RCPCH.

Download transcript (PDF)

About the Patient Safety series

As doctors we ‘first, do no harm’. However, the systems in which we work are rife with safety issues and resultant harm. In thinking about how to improve this, we have brought together leaders in the field to discuss challenging and thought-provoking issues around keeping our children safe in healthcare settings.

We hope you will be entertained, educated and energised to make strides in improving the safety of the children that you care for.

The RCPCH Patient Safety Portal has lots of resources, including a wealth of learning about paediatric patient safety. The RCPCH health inequalities programme of work can be found on our key topics pages.

It is imperative to turn this knowledge into action through improvement activities. 

About the speakers

• Dr Helen Stewart is a Consultant in Paediatric Emergency Medicine at Sheffield Children’s Hospital. She also has an interest in public health and health inequalities, which has led to her becoming the Officer for Health Improvement at RCPCH.
• Dr Cian Wade completed a National Medical Director Clinical Fellowship with NHS England. He is a Fulbright Scholar who recently completed a Master of Public Health at Harvard University and now consults for health systems and healthcare providers.
• Dr Mimi Malhotra completed a National Medical Director Clinical Fellowship with the Health Foundation. Dr Malhotra continues to work as a respiratory trainee in London with ab honorary clinical lectureship at UCL.

Topics/organisations/papers referenced in this episode

• Wade, C, Malhotra, A.M., et al (2022). Action of patient safety can reduce health inequalities. BMJ
• North West & North Wales critical care transport service
• Michael Marmot
• Royal College of Emergency Medicine (RCEM)
• RCPCH Health Improvement Committee
• National Medical Directors Fellowship
• The Health Foundation 
• RCPCH Child health inequalities driven by child poverty in the UK - position statement
• Increased risk of perioperative pulmonary embolism and sepsis in black patients (Urban Institute)
• Increase risk of adverse drug events in black people (Medical Care)
• MBRRACE study: A comparison of the care of Asian, Black and White women who have experienced a stillbirth or neonatal death
• Racial and ethnic differences in bystander CPR for witnessed cardiac arrest (The New England Journal of Medicine)
• Skin Deep
• WHAM (Wellbeing and Health Action Movement) health inequalities map
• Race-based vs race-conscious model of medicine (The Lancet)
• Decentralisation of public services in Greater Manchester (PDF)
• Sugar tax explained
• Vaping in children (RCPCH response to Government plan to ban disposable vapes)
• Health and Social Care Committee - a Commons Select Committee
• Core20PLUS5 – An approach to reducing health inequalities for children and young people
• Nationwide Children's Hospital (US)
• Shared decision making framework (NICE)
• Closed feedback loop communication
• Ian Sinha: The cost of the clinic visit (European Respiratory Journal)
• RCPCH Engaging children and young people resources
• RCPCH Six step toolkit for child health inequalities and poverty
• WHAM (Wellbeing and Health Action Movement) portal
• Institute for Healthcare Improvement
• Natural language processing (Wikipedia)

It is imperative that children and young people are central to the co-design and co-production of our patient safety improvement interventions.

In this episode, we speak with Dr Jane Runnacles, consultant paediatrician at St. George's Hospital, and Dr Victoria Dublon, paediatric diabetes consultant at the Royal Free Hospital. Both are champions of improvement work that puts the young person and their needs first.

As Jane and Victoria describe, involving children, young people and their families in improvement work improves the experience and outcome for all involved. There are fantastic examples of co-creating and co-producing safety improvements in healthcare.

We discuss the practicalities of how to do this and who to involve in your healthcare setting, and we hear about some of Jane and Victoria’s successes.

Thank you for listening.

Dr Natalie Wyatt, RCPCH Clinical Fellow and Jonathan Bamber RCPCH Head of Quality Improvement  Produced by 18Sixty

Please be advised that this podcast series contains stories relating to child death and harm. All views, thoughts and opinions expressed belong to the guests and not necessarily to their employer, linked organisations or RCPCH.

Download transcript (PDF) 

About the patient safety series

As doctors we ‘first, do no harm’. However, the systems in which we work are rife with safety issues and resultant harm. In thinking about how to improve this, we have brought together leaders in the field to discuss challenging and thought-provoking issues around keeping our children safe in healthcare settings.

We hope you will be entertained, educated and energised to make strides in improving the safety of the children that you care for.

The RCPCH Patient Safety Portal has lots of resources. And our engaging children and young people web pages can help you get started on your engagement journey to effectively work with children and young people to improve their healthcare. 

Dr Victoria Dublon is based at the Royal Free Hospital and part of the Trust-wide diabetes team. She has been a paediatric diabetes consultant for eight years, working primarily at the Royal Free Hospital as well as running clinics at Barnet Hospital and Chase Farm Hospital. As a registrar, she trained in adolescent health as well as endocrinology and diabetes and this continues to be a big part of her work. Victoria is involved in improvement work within the department as well as being a champion of ‘Me First’, striving to put the young person and their needs first.

Dr Jane Runnacles is a consultant in ambulatory paediatrics at St George's hospital NHS Foundation Trust, London and clinical governance lead for her department. She has an interest in acute paediatrics, simulation and quality improvement. During her postgraduate training in London, she was awarded distinction in her MA in clinical education and spent a year as a Darzi clinical leadership fellow at Great Ormond Street Hospital. Jane is a Training Programme Director for the London School of Paediatrics and leads their leadership and QI education programmes.

Topics/organisations/papers referenced in this episode

• Great Ormond Street Hospital
• Royal Free Hospital
• Darzi Fellowship
• Peter Lachman
• RCPCH SAFE Collaborative
• RCPCH QI Central
• Don Berwick
• Whiteboard communication project (on QI Central)
• Yincent Tse
• NHS blog - Asking "What Matters To You?"
• NHS - Co-production
• Paediatric Early Warning System (PEWS)
• St George's Hospital
• St George’s Hospital - Children and Young People’s Council
• Wac Arts
• WHO World Patient Safety Day (17 September)
• ‘Listening to you’ project at Birmingham Children's Hospital
• NHS Patient Safety Incident Response Framework
• Safety huddles (part of Situation Awareness for Everyone)

It is not enough just to collect data on harm occurring to children in healthcare settings. We need the data to be robust, comparable across the NHS and for it to be transformed into effective, meaningful changes in outcome.

In episode 3 of our series on paediatric patient safety, we speak with Dr Damian Roland, a paediatric emergency medicine clinician scientist and head of service for the Children's Emergency Department at Leicester Royal Infirmary.

As Damian discusses on the podcast, in order to learn from harm and prevent it occurring again we need to collect data and investigate what is occurring across the healthcare system rather than looking to individuals. Removing the individual, more punitive approach to harm investigations could improve the quality of how we record and report harm.

There is already a wealth of learning available from a range of sources including national reports, coroner’s findings described in regulation 28 reports to prevent future death and large-scale reviews like those of the Health Services Safety Investigations Body. We can investigate whether the causes of harm identified in these reports are occurring where we work and make proactive steps to avert it.

Damian also shares the progress of the SPOT programme (System-wide Paediatric Observation Tracking). This looks to reduce harm and improve how we learn from harm by creating a standardised common language to identify and discuss children whose health is deteriorating.

Thank you for listening.  

Hosted by Dr Natalie Wyatt, RCPCH Clinical Fellow and Jonathan Bamber RCPCH Head of Quality Improvement | Produced by 18Sixty

Download transcript (PDF)

Please be advised that this series contains stories relating to child death and harm. All views, thoughts and opinions expressed in this podcast series belong to the guests and not necessarily to their employer, linked organisations or RCPCH. 

About the Patient Safety series

As doctors we ‘first, do no harm’. However, the systems in which we work are rife with safety issues and resultant harm. In thinking about how to improve this, we have brought together leaders in the field to discuss challenging and thought-provoking issues around keeping our children safe in healthcare settings. We hope you will be entertained, educated and energised to make strides in improving the safety of the children that you care for.

The RCPCH Patient Safety Portal at https://safety.rcpch.ac.uk has lots of resources. It includes a wealth of information summarising reports and investigations that identify what puts children at risk of harm. It is imperative to turn this knowledge into action through improvement activities.

More about Dr Damian Roland

Damian is a paediatric emergency medicine clinician scientist and is head of service for the Children's Emergency Department at Leicester Royal Infirmary. Among his many achievements, Damian has been focused on addressing the challenges of identifying deterioration in health in children. He created the Paediatric Observation Priority Score for Children's Emergency Care and currently he is instrumental in the NHS England SPOT programme.

Topics/organisations/papers referenced in this episode

• John Madar (PDF)
• Datix
• Health Services Safety Investigations Body
• Royal College of Emergency Medicine
• Royal College of Paediatrics and Child Health
• René Amalberti
• Adrian Plunkett
• Learning from Excellence
• David Sinton (on X)
• POPS (Paediatric Observation Priority Score for Children’s Emergency Care) - (PDF)
• Swiss Cheese Model (on National Library for Medicine)
• NHSE SPOT: System-wide Paediatric Observation Tracking programme - guidance
• Emma Lim
• Critically Careful forums (University Hospitals of Leicester NHS Trust)
• Peter Lachman
• Ronny Cheung
• Eric Hollnagel: From Safety-1 to Safety II (PDF)
• Charles Vincent
• Mary Dixon Woods: How to improve healthcare improvement - BMJ
• The Health Foundation
• Creating Communities of Practice
• Rhizomology - Rhizomatic Knowledge Communities, Edtechtalk, Webcast Academy

Psychological safety in healthcare settings is the condition in which you feel included, safe to learn, safe to contribute and safe to challenge the status quo - without fear of being embarrassed, marginalised or punished. And it's an essential foundation in building a safety culture.

Individually, feeling psychologically safe improves performance and innovation, while feeling unsafe reduces productivity and harms retention. In a highly productive team, it is about feeling safe to take risks, to learn from each other and to feel resilient and able to tackle the difficult and varying challenges of healthcare with a healthy mindset.

This is the second episode in our patient safety series and features Dr Dal Hothi and Dr Jess Morgan. Learn how you can reflect on your own behaviour, champion effective communication and create a psychologically safe space within your team.

Hosts: Dr Natalie Wyatt, RCPCH Clinical Fellow and Jonathan Bamber, RCPCH Head of Quality Improvement

Produced by 18Sixty

Please be advised that this podcast series contains stories relating to child death and harm. All views, thoughts and opinions expressed belong to the guests and not necessarily to their employer, linked organisations or RCPCH.

If you are a healthcare professional and you are worried that you are suffering with burnout please speak to your team, your GP or Practitioner Health.

Download transcript (PDF)

About the speakers

Dr Dal Hothi is a paediatric nephrologist at Great Ormond Street Hospital. She's also a Director of Leadership Development at the Faculty of Medical Leadership and Management, as well as being an Officer for Lifelong Careers at the RCPCH.

Dr Jess Morgan is a paediatric doctor and Dinwoodie RCPCH Fellow who leads on the RCPCH Thrive Paediatrics Project along with Dal.

About the patient safety podcast series

As doctors we ‘first, do no harm’. However, the systems in which we work are rife with safety issues and resultant harm. In thinking about how to improve this, we have brought together leaders in the field to discuss challenging and thought-provoking issues around keeping our children safe in healthcare settings.

We hope you will be entertained, educated, and energised to make strides in improving the safety of the children that you care for.

To learn more, visit the RCPCH Patient Safety Portal and begin your journey in improving your own psychological safety and that of those you work with.

Links for topics/organisations/papers referenced in this episode

• Dinwoodie
• Thrive Paediatrics at RCPCH
• Amy Edmondson and psychological safety
• Tim Clark’s four stage model of psychological safety
• Freedom to Speak Up (The National Guardian)
• Charles Vincent ("Safety is not defined by the absence of negative outcomes") - The Health Foundation: The measurement and monitoring of safety

Healthcare is inherently risky and so as child health professionals we need to make patient safety a priority in all our actions. We need to think about safety all the time. 

In episode 1 of our series on paediatric patient safety, we speak with Dr Peter Lachman, who develops and delivers programmes for clinical leaders in quality improvement at the Royal College of Physicians in Dublin.

As Peter explains on the podcast, we healthcare professionals need to know patient safety theory - but, more importantly, we need to know how to apply it, drive improvement and create a workplace culture that fosters safe working practices.

Everyone - from the most junior member of the team to the most senior paediatric clinical leader - needs to think about patient safety all day every day. A safe culture takes time to build. Shared activities such as handover, huddles and debrief can model good behaviour and benefit performance. Repeating behaviours that represent a safe culture can create a virtuous cycle which can change deeply held attitudes and beliefs, then ultimately the safe culture overall.

Thank you for listening.

Dr Natalie Wyatt, RCPCH Clinical Fellow and Jonathan Bamber RCPCH Head of Quality Improvement

Produced by 18Sixty

Please be advised that this series contains stories relating to child death and harm. All views, thoughts and opinions expressed in this podcast series belong to the guests and not necessarily to their employer, linked organisations or RCPCH.

Download transcript (PDF)

About the Patient safety podcast series

As doctors we ‘first, do no harm’. However, the systems in which we work are rife with safety issues and resultant harm. In thinking about how to improve this, we have brought together leaders in the field to discuss challenging and thought-provoking issues around keeping our children safe in healthcare settings. We hope you will be entertained, educated, and energised to make strides in improving the safety of the children that you care for.

There are lots of resources that expand on this on the RCPCH Patient Safety Portal, including the theory of patient safety culture and examples of how people across the UK are doing this well. Visit at https://safety.rcpch.ac.uk.

More about Dr Peter Lachman

Dr Peter Lachman develops and delivers programmes to develop clinical leaders in quality improvement at the Royal College of Physicians in Dublin. He works with HSE Global in Africa, and he was Chief Executive Officer of the International Society for Quality in Healthcare (ISQua) from 1 May 2016 to 30 April 2021. Peter was a Health Foundation Quality Improvement Fellow at IHI in 2005-2006 and then went on to be the Deputy Medical Director with the lead for Patient Safety at Great Ormond Street Hospital 2006-2016. Peter was also a Consultant Paediatrician at the Royal Free Hospital in London specialising in the challenge of long-term conditions for children.

Peter is the lead editor of the OUP Handbook on Patient Safety published in April 2022; Co-Editor of the OUP Handbook on Medical Leadership and Management published in December 2022; and Editor of the OUP Handbook on Quality Improvement to be published in 2024.

Topics/organisations/papers referenced in this podcast

• ISQUA (International Society for Quality in Healthcare)
• Oxford Professional Practice: Handbook Of Patient Safety
• IHI (Institute for Health Improvement)
• Human factors - on RCPCH Patient Safety Portal
• S.A.F.E. Collaborative - on RCPCH Patient Safety Portal
• Cincinnati Childrens Hospital patient safety
• Paediatric Early Warning System (NHS England)
• BMJ Quality & Safety journal
• Lachman, P., Linkson, L., Evans, T., Clausen, H., & Hothi, D. (2015). Developing person-centred analysis of harm in a paediatric hospital: a quality improvement report. BMJ quality & safety, 24(5), 337–344
• Health Foundation
• A framework for measuring quality, with Professor Charles Vincent et al
• WellChild: the national charity for sick children
• Applied human factors - on RCPCH Patient Safety Portal
• 5 whys
• SEIPS (Systems Engineering Initiative for Patient Safety)
• Psychological safety- on RCPCH Patient Safety Portal
• Situational awareness - on RCPCH Patient Safety Portal
• MaPSaF (Manchester Patient Safety Awareness Framework)
• Top Gun
• Irish Certificate in Essential Leadership for New Consultants
• Rolfe et al's reflective model (PDF) (what now what so what)
• NHS England: Improving patient safety - a practical guide

Richard Burley, Executive Director of Digital talks with Professor Shah about how digital technology can support child health, and how paediatricians can embrace it - with a dose of healthy scepticism.

Professor Sam Shah is Chief Medical Strategy Officer at men's health company, Numan, and Honorary Lecturer at University College London's Global Business School for Health. He spoke at RCPCH Conference 2023 with a session titled, 'Could healthcare technology address the challenges in child health? Richard Burley here at the College was fortunate to be in the audience and invited Sam to discuss further.

As Sam notes on the podcast, there is no shortage of technology from mobile apps to wearables. But, he says there's a challenge, especially as we look to reduce anxieties:

"...how we try and make the environment of child health - really, the treatment end - more accessible to children, young people and their families. And also less imposing, less scary. Especially that moment when families will be scared about accessing treatment, when children will be in unfamiliar environments."

Sam and Richard talk about examples where digital technologies, particularly augmented and virtual reality, are making a real difference. They consider the unique experiences of children and young people as patients, and the differing needs of communities around language, culture and digital maturity. They step into the thorny issues on privacy, security and safety - and how digital tech intersects with real-life clinical care.

Sam finishes with practical advice on how paediatricians can identify, evaluate and use digital technology in their practice.

Download transcript

Climate change poses an existential risk to child health and is exacerbating health inequalities. But, paediatricians can play an important role in sharing information and advocating for action.

Dr Helen Stewart and Dr Alex Lemaigre introduce the College’s new toolkit for paediatricians. Our first tool helps you understand how climate change impacts on children and young people’s health and exacerbates health inequalities. And our second equips you to influence climate change policy locally, regionally and nationally.

Alex and Helen talk about why paediatricians have a role in addressing health inequalities impacted by climate change. And they provide advice on how to start conversations with key decision makers to address this. 

"With climate change affecting food production globally plus the energy crisis and everything else, those households who have more limited income are going to really struggle to maintain the same level of food quality and/or quantity. And that brings all of its own health problems – be that malnutrition, obesity... Familiarise yourself with things locally - you know, if there are food banks or third sector kind of organisations that might be able to help support a household with getting food on the table." - Dr Alex Lemaigre

In this episode, Alex and Helen refer to a condition called eco-anxiety. We now use a preferred term, eco distress.

Download full transcript (PDF)

See our toolkit and take action at www.rcpch.ac.uk/ShiftTheDialOnClimateChange

You can listen to other RCPCPH Podcasts episodes on this topic:

• Child health inequalities part 1 - Talking with families
• Child health inequalities part 2 - interviews with two quality improvement projects
• Our voices: young people and climate change