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.

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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

Talking about the intentionality behind what the College does to train and support paediatricians: RCPCH Vice President for Training and Assessment, Dr Cathryn Chadwick interviews Trainees Committee Chair, Dr Emma Dyer.

Our College Strategy 2021-24 outlines four strategic aims to support our mission of improving health outcomes for children and young people. In this series we look at our College Strategy in action. Hearing stories from clinicians, children and young people and staff about the impact our work has made on the community and within paediatric clinical practice.

In this episode we learn about what it takes to build a paediatrician. The intentional decisions that have been made to train members and set them up for a long and rewarding career. The new Progress+ curriculum and our Thrive Paediatrics initiative and learning hubs are some of the examples of the work being done to support trainees at each level of their career.

Download transcript (PDF)

Two paediatricians share thoughts around vulnerability, compassion and belonging at work. Jess and Anna talk about brave spaces, the importance (and limits) of self-care and those "small moments of human connection".

Dr Jess Morgan is a paediatrician and working as a Dinwoodie RCPCH Fellow on an exciting new project, Thrive Paediatrics, which aims to create meaningful change in the working lives of paediatricians. She speaks with Dr Anna Baverstock, a consultant paediatrician at Somerset NHS Foundation Trust.

Find out more about Thrive Paediatrics on the RCPCH website at https://www.rcpch.ac.uk/thrive. We're creating Wellbeing and Innovation Networks (WINs), communities where paediatricians come together and, using our newly published roadmap, draw from each other’s experiences to activate change.

We’re organising some Thrive 'listening events', so look out for those soon. And if you're a College member and interested in this project, email us at [email protected].

Download the transcript (PDF)

Links to people mentioned in the podcast:

• Amy Edmondson
• Mary Freer (Welcome to Freer Thinking)
• Brené Brown 

In a first for our podcasts, we delve into the world of government and parliament. RCPCH President Camilla Kingdon speaks with Dame Andrea Leadsom MP, Conservative Member of Parliament for South Northamptonshire about her experiences of advocating for infant and child health.

Dame Andrea wants every baby to have the best start in life - a message shared by the College. She chaired the Government's Early Years Healthy Development Review and its March 2021 report, The best start for life, a vision for the 1001 critical days, outlines areas for action to improve the health outcomes of all babies in England, including new Family Hubs.

She now chairs the Start for Life Unit, a team of civil servants tasked with implementing the review's recommendations.

Dame Andrea talks with Camilla about her experiences of championing infant and child health in Parliament, and why she's so passionate and focused on this early period of life. Camilla asks how paediatricians can use their voice to support policy change, particularly where there are competing priorities, and how to consider poverty's impact on child health outcomes.

Ensuring decision-makers introduce the best public policy for children and young people is an important part of our work at RCPCH. We engage regularly with Ministers, senior civil servants, MPs, Lords and advisers on a wide range of matters. On some occasions, like this one, that will mean engaging with individuals from specific political parties. However, we never endorse political parties or movements, and work with representatives of all parties equally and that remains the case with this podcast.

We are grateful to Dame Andrea for sharing her views as someone with a central role in government policymaking on early years. Do keep an eye out on our podcasts for future conversations with policymakers from across the political spectrum.

Family Hubs and Start for Life programme (GOV.UK)

The best start for life: a vision for the 1,001 critical days (GOV.UK)

Rt Hon. Dame Andrea Leadsom website

RCPCH work in public affairs

RCPCH toolkit on child health inequalities

RCPCH position statement on breastfeeding

We hear from two teams doing innovative work to better understand the impact of poverty on children and young people’s health, and design NHS services that provide targeted support for families.

RCPCH Officer for Health Improvement Dr Helen Stewart interviews the two teams.

First, two trainee paediatricians in Belfast, Dr Naomi Kirk and Dr Anne-Marie McLean, tell Helen about their observational study. This looked at the effects of the cost-of-living crisis on the home and social environment and the health of primary school-aged children in Northern Ireland.

• "We really wanted to identify which children and families are most vulnerable to poor health due to financial strain in the hope that we could then raise awareness and offer support."

Next is a team in Birmingham that's put child health care services right in the heart of the community – to better access the families who need support most. Dr Fran Dutton, a General Practitioner, and Dr Caroline Wolhuter. Head of Innovation, Impact and Early Help at GreenSquareAccord, a national housing and care provider, explain how they have introduced health promotion at every opportunity, liaising with multidisciplinary health professionals and local community services.

• "Think about health promotion in whichever department you're in, be that the community or in the hospital. Think about the experience for the family...Do you offer them a solution?... We need to be helping families access the support that is there for them."

Interested in learning more about child health inequalities? Take a look at the College’s toolkit. This includes advice on how to run your own quality improvement project around the topic, as well as speaking with families about poverty and doing advocacy at a local level. You’ll also find more written case studies.

Download full transcript (PDF)

Summary

00:00 Start and introduction from Helen

02:02 Understanding the effecs of the cost-of-living crisis on primary school children in Belfast - interview with Naomi and Anne-Marie

16:24 Putting child health care services in the heart of this Birmingham community - interview with Fran and Caroline

 37:31 Concluding remarks and how to learn more about child health inequalities

Contacts for our speakers

Naomi and Anne-Marie's study:

• Naomi's email: [email protected]
• Anne-Marie's email: [email protected]

Fran and Caroline's project:

• Twitter: @SparkbrookCZ
• Email: [email protected] 

In our second series of College Strategy 2021-24 podcasts we look at the Strategy in action. Hearing stories from clinicians, children and young people and staff about the impact our work has made on the community and within paediatric clinical practice.

The National Diabetes Quality Programme (NDQP) was established in collaboration with the National Children and Young People’s Diabetes Network in April 2018. In the last five years, the programme has supported quality improvement programmes attended by thousands of clinicians, helped to improve services at several NHS trusts across the UK and performed multiple peer reviews to identify good clinical practice. The impact of this programme has been seen in the number of Trusts whose standards of care have risen as a direct result of the NDQP as well as the number of clinicians whose practice has improved to better deliver for children affected by Diabetes. Read our final report that highlights impact in England and Wales.

Now that the programme has ended, Clinical Lead Dr Fiona Campbell, OBE Chair of the National Children and Young People’s Diabetes Network in England and Wales and Consultant Paediatric Diabetes Leeds Children’s Hospital and members of the project team discussed the achievements and the lasting legacy of the programme on integrated care services (ICS) and Trusts across the UK.

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In this first of a podcast series from the Medicines for Children team, we speak with Fiona, a young person with epilepsy, and her mum, Karen. It's an honest and lively discussion from their fear at first diagnosis to working out the right medication, to learning to live well with the condition.

The Medicines for Children team is pleased to share this first episode in a series of podcasts on epilepsy. With thanks to a grant from the Alison Hillman charitable trust, the podcasts will aim to improve the resources available for young people with epilepsy. 

We publish this episode just before Purple Day this Sunday, 26 March, an annual international event dedicated to increasing awareness of epilepsy.

Evalyn Usher, a medical student who interned with the Medicines for Children team in summers 2021 and 2022, interviewed Fiona and Karen. Fiona was diagnosed with epilepsy when she was 11 years old. Her seizures have no obvious trigger and she's tried different anti-epileptic drugs to manage these, and help her live a full and sociable life. Her mum, Karen was at first worried about the misconceptions and stigma around epilepsy, the 'terrifying seizures' and how the condition would affect her daughter's future. But now she's learned more and what to do. 

It's a fascinating discussion, and we hope it's both reassuring and inspiring to families. 

Download transcript

More about the podcast

Fiona was diagnosed with epilepsy at around 11 years of age, which is much later than for some children, and her seizures have no obvious trigger – Fiona doesn’t know when she is going to have one. Fiona has tried five or six different anti-epileptic drugs and is currently taking two. Whilst these have not stopped her seizures altogether, they have reduced the frequency. Nevertheless, it is clear from the podcast that Fiona lives a full and sociable life.

As an “older mum”, Karen was initially worried about the misconceptions and stigma that used to surround epilepsy and how the diagnosis might affect Fiona’s future. She is frank about how difficult she found the diagnosis and the period when Fiona had frequent seizures and they were trying different medicines. While she described early seizures as “terrifying”, and the fear of not knowing when one might happen, she has learnt to cope, and is now more matter of fact because she knows what is happening and what to do. 

Fiona’s strategy has always been to be open about her epilepsy. In primary year 7 she did a presentation to her class explaining different types of epilepsy and what to do if someone has a seizure. Fiona is now active in the RCPCH Epilepsy12 Youth Advocates and is keen to increase awareness of epilepsy among children and young people, and to develop suitable information leaflets, as existing information is mostly for young children and adults. Fiona also wants to raise awareness of epilepsy in schools, as well as the mental health issues that young people living with epilepsy may face; she talks about the valuable support she received from a clinical psychologist.

Fiona and her mum talk about practical measures they take: Fiona’s friends know she has epilepsy, and what to do if she has a seizure. Fiona always has her mobile phone with her and a medical alert bracelet with her Dad’s phone number. She also has an Epilepsy Seizure Plan that she can share with school and college for example. 

Karen’s advice to parents of a child with epilepsy is to be open about the condition. She emphasizes the value of talking to friends, family and health professionals for support and to develop coping mechanisms. Fiona finds talking with other people who live with epilepsy very useful and supportive – and she counsels against scary stories on the internet!

We hope this podcast will be useful and reassuring to families living with epilepsy or who are adjusting to a new diagnosis. Fiona and Karen are honest about how they have learnt to live with the condition, which we hope will inspire other families.

This podcast is created by young volunteers with RCPCH &Us and is all about climate change, with some international guests from Ghana and others closer to home from the RCPCH Climate Change Working Group and RCPCH members.

Listen to find out how doctors and young people can work together to make sure that we face the climate change crisis head on.

This is a special edition collaboration with the RCPCH Climate Changers group: Aisling, Ali, Ally, Beth, Demi, Ethan, Kirsten, Jeanette and Noor.

Download transcript

In this episode we interviewed:

Members of the Ghana Youth Environmental Movement

• Perk
• Gloria
• Anokyewaa

RCPCH Climate Change Working Group members

• Dr Katy from Leeds
• Dr Shunmay from London

RCPCH Conference attendees 

• Dr Emily, Dr Ella, Dr Chrysoula, Dr Ella, Dr Ian, Dr Carol, Dr Lucy, Dr Anastasia

Who are we?

RCPCH &Us are a network of children and young people from all over the country (UK) who volunteer together to help improve health, awareness and information/education around what matters to children and young people. We have lots of different projects which bring together young volunteers to make a difference on topics like epilepsy, asthma, mental health and more.

The podcasters are young people from RCPCH &Us who have a passion for engagement and volunteering in child health. They will be creating different podcasts over the year on topics that matter to children and young people. We have been learning how to create a podcast, creating and reviewing content, editing and getting it ready to launch.

Wondering why you keep hearing a moo?

In the summer of 2022, young people were helping out with interviews for staff at RCPCH and in the break time, learnt to moo. Another young person remixed it and that's why we have a moo as a jingle! It means a lot to us and we hope you enjoy it too!

Links mentioned in the episode

• RCPCH &Us
• Our Voices:Engagement Done Well
• RCPCH &Us Climate Changers
• RCPCH Conference
• Ghana Youth Environmental Movement 
• Milestones "Heal our patients and our planet" page 11
• RCPCH Climate Change Working Group 
• RCPCH Climate Change programme
• LSHTM Children, Cities and Climate
• Good Climate Stories (Twitter)
• Caesar Cipher Code

Thank you for joining us for the second RCPCH &Us podcast and to everyone who took part. If you want to get in touch to find out more about the RCPCH &Us projects including the Podcasters or the Climate Changers, email [email protected].