BRAINWRITING What is brainwriting?

This is essentially the same as brainstorming but it allows the group to generate ideas anonymously and in a short time frame. These can then be mapped onto a flip chart and considered by the group.

When to use brainwriting Brainwriting is best used when:

• the anonymity of participants needs to be protected

• there is a mixture of senior and junior personnel in the group

• complex ideas are expected

• it is feared that some people might dominate the brainstorming if it were to be conducted orally

Positive attributes of brainwriting

• it allows people to provide their view anonymously and safely

• it is useful for enabling junior or less confident persons to contribute

• it is useful for exploring sensitive issues

• it uses a quick and simple methodology

• it will limit group thinking

• it is structured and time efficient Negative attributes of brainwriting

• poor facilitation may threaten the anonymity of participants and thus the safety aspects of this technique

• can be unnecessarily ‘secretive’ for staff groups with open and healthy working relationships

• can generate an unmanageable list of ideas, or a list that is difficult to prioritise

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Five Why’s

The Five Why’s is a questions-asking method used to explore the cause/effect relationships underlying a particular problem. Ultimately, the goal of applying the 5 Why’s method is to determine a root cause of a defect or problem.

Why, Why, Why, Why and Why.

The Five Whys is used to question each identified primary cause of a problem, to identify if it is a symptom, an influencing factor or a root cause.

It allows deeper questioning as to the cause of a problem.

Positive attributes of the Five Why’s

allows individuals/groups to drill down the causal pathway

simple and effective tool

works well in groups or individually

Negative attributes of the Five Why’s

causal analysis can be constrained by mind set and lack of breadth and depth.

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Fishbone

Represents contributory factor information related to a single problem. It is a diagrammatic tool used to capture causes contributing to one problem.

Positive attributes of the fishbone:

diagrams are easily constructed

based on verified causal factors

provides a basis for reliable improvement plans

Negative attributes of the fishbone:

not all users feel comfortable with this tool

causal information which has not been verified may lead to inappropriate improvement strategies

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Barrier Analysis

An alternative technique is Barrier Analysis which can be used to establish what barriers, defences or controls should have been in place to prevent the accident or could be installed to increase system safety. Examples of Barrier Analysis questions are ‘Why did the barrier fail? Was it natural, physical, human action or administrative barrier? What else could be put in place?’

Barrier Analysis can offer a structured way to visualize the events related to system failure, help identify missing or failed barriers, help evaluate proposed corrective actions by assessing the strengths of the current controls.

More information can be found on the NPSA website www.npsa.nhs.uk.

Positive attributes of Barrier Analysis:

unbiased analysis of control measures in place

identification of additional control measures that may have prevented the event from occurring

assists in the identification of causal factors

Negative attributes of Barrier Analysis:

inexperienced investigators assume more compliance with human action and administrative barriers than actually occurs

danger in not recognising/identifying all failed barriers

can be possible to overlook the stress on individuals that results from over-reliance on human barriers

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Appendix J – Guidelines for Writing a Statement

There are many circumstances in which staff may be called upon to provide a written statement. This may be as a result of being asked to give a clinical opinion as a healthcare professional, or as part of an investigation into an event.

Reports may be of a factual nature, such as a description of circumstances surrounding an event, or an opinion which is an interpretation of facts such as an evaluation of a service user’s prognosis. The report should be directed to the purpose for which it is required.

These guidelines aim to provide some simple advice on preparing a statement of fact which has been requested for an investigation into an untoward event.

It must assume that the reader of the statement knows nothing of the facts of the case, of the service user’s medical history, or of hospital routines. The statement will thus form a story that will inform a lay person of the circumstances of the untoward event as they are remembered.

Good quality A4 paper should be used (i.e. not scraps of paper, pages from notepads etc.). Ideally, statements should be typed using only one side of each page. Wide margins and double line spacing are recommended. If it is not possible to have a statement typed it should be neatly written using black ink.

Each page should be numbered consecutively in the right hand corner and all of the pages should be securely fastened together.

Each page should be headed with the event reference number.

A statement should begin with the author’s name, professional qualifications, length of service, and post held within the Trust.

The statement should be clear in respect to timeline. Events should be put in the order in which they happened giving precise dates and times (using either am or pm or the 24 hours clock).

The statement should include the names of any other witnesses who were present. Give full names and job titles.

Only record fact. Avoid expressing opinions. Only include facts or conversations actually witnessed or participated in.

Avoid using jargon or abbreviations.

All numbers, including dates, should be expressed in figures, not words.

Statements should be written in the first person, for example, ‘I was asked by Staff Nurse ENE Body to administer Mr X’s medication’.

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Draw a single line through any alterations to a statement and then initial the alteration.

The final paragraph of the statement should read: ‘this statement is true to the best of my knowledge and belief’.

The statement should be signed and dated.

Name and job title should be printed under the signature.

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APPENDIX K – Guidelines on conducting interviews with staff involved in an investigation

Inviting the member of staff to attend for an interview

Where appropriate, a written invitation to the interview can be provided and the details below included. Where this is not practical due to the need to meet with staff as soon as possible after the incident, staff should be advised in advance and be given the following information verbally:

• the purpose of the interview and details of the incident being investigated

• the time, place and estimated length of the interview

• who will be conducting the interview and their role

• how the interview will be conducted and the first-hand account recorded (for example, the interview will be informal, notes will be taken to inform the investigation but these will not act as a formal witness statement and do not need the interviewee’s signature)

• what documentary evidence will be available to them during the interview;

• the fact that they can bring a friend or colleague for support (explanations need to be given regarding the role of the friend/colleague (eg

confidentiality, their involvement)

• advice on what will happen after the interview Interviewer preparation

• the interview should take place in a quiet, relaxed setting and, if possible, away from the interviewee’s usual place of work and not at the scene of the event

• the room should be set out informally with refreshments where available and steps taken to ensure, where possible, no interruptions occur (eg

telephones)

• where possible, the interviewee should have the opportunity to attend the interview in work time and arrangements may need to be made with their line manager to ensure this

• depending on the nature of the event or the interviewee’s personal involvement, they may find the process of recounting the events either upsetting or disturbing. The interviewer should have information available on staff support/counselling

• the interviewer should ensure they have all the relevant documentation available at the interview

Conducting the interview

Introductions (where appropriate) should be made of those present in the room.

Include details on roles and an explanation of the sequence of the interview and approximate length. The RCA process should be explained and an estimate given of how long it will take to complete.

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It is important to reinforce that this is not part of a disciplinary process. The interviewer should explain that notes will be taken throughout for the purpose of informing the investigation. It must be stressed that these notes will not act as a formal witness statement and, therefore, do not need the interviewee’s signature.

If, following the interview, the interviewer feels that the individual member of staff should write a formal statement, advice should be taken from the Trust’s Litigation Lead.

The interviewee should be asked to confirm they have understood all of the above and should be reminded that they should offer only factual information, but include

everything regardless of whether they think it is relevant or not. The interviewee should be discouraged from making ‘off the record’ comments. The interviewee should also be advised that the first-hand account and the final report will be written with due anonymity to staff and the patient.

Completion of the interview

On completion, the interviewer should ensure the interviewee feels appropriately supported and that any further support required is organised. The interviewer should reconfirm what will happen with the information gained from the interview and how this will be used in the RCA process.