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The need to develop effective approaches for responding to healthcare incidents for the purpose of learning and improving patient safety has been recognised in current national policy. However, research into this topic is limited. This study aims to explore the perspectives of professionals in mental health trusts in England about what works well and what could be done better when implementing serious incident management systems.

This was a qualitative study using semi-structured interviews. In total, 15 participants were recruited, comprising patient safety managers, serious incident investigators and executive directors, from five mental health trusts in England. The interview data were analysed using a qualitative-descriptive approach to develop meaningful themes. Quotes were selected and presented based on their representation of the data.

Participants were dissatisfied with current systems to manage serious incidents, including the root cause analysis approach, which they felt were not adequate for assisting learning and improvement. They described concerns about the capability of serious incident investigators, which was felt to impact on the quality of investigations. Processes to support people adversely affected by serious incidents were felt to be an important part of incident management systems to maximise the learning impact of investigations.

Findings of this study provide translatable implications for mental health trusts and policymakers, informed by insights into how current approaches for learning from healthcare incidents can be transformed. Further research will build a more comprehensive understanding of mechanisms for responding to healthcare incidents.

The current national patient safety strategy for the National Health Service (NHS) in England states that actions need to be taken to support the development of a patient safety culture. This includes that local systems should seek to understand staff perceptions of the fairness and effectiveness of serious incident management. This study aims to explore the perspectives of patient safety professionals about what works well and what could be done better to support a patient safety culture at the level of Trust strategy and serious incident governance.

A total of 15 professionals with a role in serious incident management, from five mental health trusts in England, were interviewed using a semi-structured interview guide. Thematic analysis and qualitative description were used to analyse the data.

Participants felt that actions to support a patient safety culture were challenging and required long-term and clinical commitment. Broadening the scope of serious incident investigations was felt to be one way to better understand patient safety culture issues. Organisational influences during the serious incident management process were highlighted, informing approaches to maximise the fairness and objectivity of investigation findings.

The findings of this study offer original insights that the NHS safety system can use to facilitate progression of the patient safety culture agenda. In particular, local mental health trusts could consider the findings in the context of their current strategic objectives related to patient safety culture and operational delivery of serious incident management frameworks.

New patient safety frameworks are being implemented to improve the impact of incident reporting and management across the National Health Service (NHS) in England. This study aims to examine the current practices in this domain of patient safety in a sample of mental health trusts, a setting in which limitations in the current practice of serious incident management have been reported. The authors present key recommendations to maximise the opportunities to improve current incident reporting and management practice.

Ethical approval for the study was granted. A Web-based questionnaire was designed to examine current practices concerning incident reporting and management. It was refined based on consultation. Patient safety incident managers within mental health trusts in England were recruited. Twenty-nine mental health trusts responded, from a total of 51. The questionnaire study data were analysed in Statistical Package for the Social Sciences.

Current approaches used to report and manage incidents have been established and variation in practice demonstrated. A key finding for attention is that the training and education that investigators of serious incidents receive falls short of the recommended minimum national standard of 15 h, with a sample mean of 10.3 h and median of 8.0 h.

Recommendations at a local and national level are presented, which, if implemented, can maximise the impact of incident reporting and management practices in mental health trusts. Future qualitative research is indicated, to understand the perceptual experience and meaning behind the findings across a wider group of stakeholders.

Despite repeated policy initiatives, progress in improving patient safety in the National Health Service (NHS) in England over the past two decades has been slow. The NHS Patient Safety Strategy (NHS England and NHS Improvement, 2019), which is being implemented currently, aims to address this problem. The purpose of this study is to identify learning from the implementation of past patient safety policies and thereby suggest means of supporting the NHS in delivering the current policy initiative successfully.

The authors identified key health policies in the domain of patient safety, published since 2000, by searching the United Kingdom (UK) government website. Discussion papers from the research literature concerning these policies were collated and reviewed. The authors then used a thematic analysis approach to identify themes discussed within these papers. These themes represent factors that support the effective delivery of patient safety policy initiatives.

Within the discussion papers the authors collated, concerning 11 patient safety policies implemented between 2000 and 2017, five inter-related core themes of capability, culture, systems, candour and leadership were identified. By evaluating these themes and identifying composite sub-themes, a conceptual framework is presented that can be used to support the delivery of patient safety policy initiatives to maximise their impact.

The conceptual framework the authors illustrate, arising from this new contribution to the body of knowledge, can be translated into a novel self-assessment for individual NHS trusts to understand organisational development areas in the domain of patient safety improvement.

This paper aims to contribute to adaptation research by devising a systematic method for examining the challenges in mainstreaming climate change adaptation (CCA) into local land use planning. It argues that mainstreaming operationalization necessitates a methodology that focuses on the challenges in applying the approach and an analytical framework that can examine the mainstreaming process from an institutional perspective.

This paper applied triangulation by data method (i.e. document review, interview, survey and key informant consultations) and incorporated the scorecard approach in developing the four-stage mixed methodology. It used a modified Institutional Analysis and Development framework as primary analytical guide and applied the case study methodology for structure and focus in relation to data collection activities.

This paper devised the four-stage mixed methodology and successfully applied it in examining the challenges in mainstreaming CCA into local land use planning in Albay, Philippines. Using the methodology, this paper developed 20 quantitative “mainstreaming indicators” and generated qualitative analyses to assess the state of play of the challenges in local mainstreaming of CCA. Results suggest that mainstreaming challenges exist within a certain spectrum, with one end composed of barriers to, and the other, opportunities for CCA. Furthermore, the challenges occur at varying degrees of severity depending on the conditions that surround them.

This paper is limited to illustrating the process involved in developing the four-stage mixed methodology and presents only a brief discussion of the quantitative and qualitative results.

Although the methodology is at its initial stages of development, it generated results that can help analysts, planners and decision-makers: determine the nature of the challenges in mainstreaming CCA, thereby understand the mainstreaming process; prioritize the mainstreaming challenges to address; and design strategies that will maximize the use of limited resources (i.e. utilizing the opportunities to overcome the existing barriers), among others.

The four-stage mixed methodology was developed to aid analysts, planners and decision-makers determine the state-of-play of the challenges in mainstreaming CCA and make informed decisions in overcoming these challenges. Thus, the mixed method can be a useful tool in advancing the operationalization of the mainstreaming approach.

This paper explores the findings from a recent study about the assessment and management of care for older people who may have a sensory impairment. Using qualitative research methods, the work focused on non‐specialist practitioners who are responsible for the assessment and management of care for older people and their carers. The findings are based upon the analysis of in‐depth interviews with non‐specialist practitioners, specialist workers and managers from statutory and voluntary sector agencies. Older people with a hearing impairment or a visual impairment are not a homogenous group of people with a single set of needs or service support networks. It is the existence of non‐specialist practitioners, carrying out the assessment and management of care for older people that draw together in one study the three areas of visual impairment, hearing impairment and dual impairment. The findings relate to practitioners' awareness of sensory impairment in their local community; how practitioners assess and manage care; access to services; staff training and development; and, information strategies. The interface between non‐specialists and practitioners with particular expertise in sensory impairment is also examined. The implications for policy and practice are identified.

In the context of what may be understood as an ‘emotional retreat’ in homelessness research and service provision (Chamberlayne, 2004, p. 347), this chapter canvasses the valuable role of qualitative research in continuing to diversify understandings and evidences of homelessness made available across the field. I work to make sense of the ways, in which the emotional and physical messiness of ‘in situ’ research (Malins, Fitzgerald, & Threadgold, 2006, p. 514) can give rise to new understandings of homelessness that both intervene in and compliment existing research and policy knowledges. While my key focus here will be on the difficult task of actually articulating how it is that particular forms of qualitative research knowledge may provide epistemological leverage to the field of homelessness, it should also be clear that the impetus for this chapter, and indeed for my broader research engagement in homelessness (see for example, Robinson 2002b, 2003, 2005) stems from my concern with the ways in which felt-experience is particularly backgrounded in this field. As I have discussed elsewhere, the ramifications of making relatively silent corporeal and emotional dimensions of homelessness have troublingly included the entrenchment of conceptualisations of, and responses to, homelessness that cannot account for the multidimensional ways in which trajectories of homelessness can unfold and become reinforced. In particular, my focus has been on the ways in which the lack of attention paid within social research to the bodily impacts of cumulative trauma and grief in the lives of homeless people, has in turn been mirrored in the limited framing of social policy and welfare service delivery.

BASED ON TWO POSTAL surveys in 1995 and 1997 of care management practitioners in Wales, this paper examines practitioners' perceptions of change in work roles and tasks over time. Assessment tasks are taking up increasing amounts of care management practitioner time leading to a corresponding decrease in the time set aside for arranging services and for direct work with clients. The results are claims of de‐skilling and the likelihood of a more administrative style of working.

This paper presents some of the key findings from a study about supporting carers in employment. It describes the qualitative experiences of family carers for older people who are in paid employment, paying particular attention to their views on assessment and service provision. The perspectives of other key stakeholders, including staff from statutory and independent sector agencies, are also considered. Support for carers in employment is one of the five priority action areas underpinning the National Strategy for Carers (DoH, 1999). However, the findings from this study reveal that carers in employment have a limited profile at strategic level and their specific needs are rarely addressed in mainstream health and social care planning processes. The findings also suggest that assessment and care management practices are failing to support carers in relation to their employment aspirations. The effectiveness of health and social care assessments in identifying and exploring the needs of carers in employment is limited and very few separate carer assessments are completed. Carers' first‐hand experiences of service provision are described. Deficits in current services are identified and examples of good practice are highlighted. The paper concludes by outlining the implications for policy and practice. It is suggested that flexible support, underpinned by partnerships between employers and staff from statutory and independent sector agencies, is the key to supporting carers in employment.