Keeping the Safety Conversation going

Colleagues joined Kim Cox, Divisional Nursing Director, and Dr Simon Edwards, Interim Medical Director, to hear how teams are raising standards and strengthening safety.

Kim introduced the ACE programme, the CNWL designed approach beginning with our 18 acute inpatient wards before rolling out to older adult, community and later specialist services.

All three divisions have contributed to shaping ACE, which connects directly to our safety conversations: shared learning, celebrating great practice and building our readiness for inspection. The presentations that followed brought this to life, showcasing how teams are proactively improving care and cultures.

Pond Ward

Patients told the team they wanted more engaging activities - especially music and dance - to help them relax, ease anxiety and reduce boredom.

In response, the ward introduced new sessions (including at weekends), teaming up with the activity coordinator and music therapists. Patients can request songs in different languages and even contribute to a new “Pond Ward Vibes” Spotify playlist, which they can listen to anywhere on the ward.

The impact has been clear: fewer incidents, better social interaction, and stronger relationships as staff and patients spend more time connecting through activities.

Ellington Ward

The team recognised that frequent checks were taking up huge amounts of staff time and could feel intrusive to patients.

They introduced “Remember I’m Me” posters in bedrooms shaped by carers and patients preferences, alongside an activity logbook to capture what each person enjoys. Clear exit plans were created so patients could move off frequent checks safely and confidently.

There has been a 62% reduction in frequent checks and service users are increasingly spending more time in communal areas, initiating and sharing activities with each other such as dominos.

St Mary’s Hospital Liaison Psychiatry

Dr Hussain Karimjee and Dr Fatima El Shams set out to fix a familiar problem: multidisciplinary (MDT) handovers were running on an outdated Excel sheet that needed to be updated manually. Things were getting missed and productivity took a hit.

They introduced a series of low‑cost digital improvements - automating parts of the spreadsheet, adding a daily MDT chair, and using clinical systems such as SystmOne (CNWL) and Cerner (Imperial) live during meetings. They also created an automatic workload tally so teams can see who is holding what and share work as needed.

These tweaks made a big difference. MDTs dropped from 65 to 48 minutes, saving 102 minutes each week for clinical care. Staff reported better structure, clearer roles and a smoother, more efficient experience overall. 

Shannon Ward

Shannon Ward has introduced a new zoning system that reorganises patient observations by dividing the ward into clear zones, with staff assigned to specific areas. This change has made the ward feel less crowded, improved monitoring, boosting teamwork and staff confidence.

They've seen a 53% reduction in bank shifts, with patients telling us they feel safer and more listened to, with fewer conflicts and a much calmer atmosphere across the ward.

Dr Paul Hopper, Medical Director and William Sakala, Nursing Director, brought teams together to share snapshots of our work - showing the breadth of activity underway to strengthen psychological safety, support staff wellbeing, improve patient experience and enhance clinical safety.

Building psychologically safe teams

Colleagues from the Community Independence Service (CIS) in Westminster began with a staff survey to identify factors contributing to burnout and stress. This led to sessions on difficult conversations, monthly awards, clearer handovers and wellbeing toolkits, all aimed at improving communication and consistency across shifts.

Hillingdon Paediatric Physiotherapy used forums, away days and training on accountability to help the team regroup after significant staff departures. The focus on open discussion has supported morale and contributed to reductions in waiting times for new referrals.

Community Children’s Services explored what gets in the way of “joy at work,” using staff feedback to introduce small changes from paper‑light processes to extra computer screens and launching a dedicated joy at work quality improvement programme.

The big change for Inner London services who worked through financial challenges by bringing staff into the conversation. Regular listening events, co‑designed workshops and shared financial tools have helped teams understand pressures and shape solutions. The approach has supported a move toward break‑even and improved confidence around financial decision making. 

Patient‑centred therapeutic activities

Colne Ward introduced gentle exercise sessions during protected time, co‑designed with patients. This has helped reduce violence and aggression.

Oaktree Ward focused on personalised engagement using interest checklists, sensory activities, group sessions and tailored support for patients with dementia. Staff reported better communication with patients and the need for high level observation decreased, showing calmer ward environments.

Specialist rehabilitation services are introducing formulation as a new tool to help staff better understand service users and reduce incidents. The team is using the 6P model (presentation, predisposing factors, precipitating factors, perpetuating factors, plan and positives) to build a short summary of each person’s history, triggers, strengths and coping strategies. This helps staff see behaviour as communication rather than “problems” and supports more consistent, compassionate responses. Each formulation is created with the service user and their named nurse, uploaded to care records and used in ward rounds to support daily interactions.

Camden Speech and Language Therapy (SLT) team has set up a new pathway for adults with swallowing difficulties to access x‑rays. Until recently, patients couldn’t easily access this test, meaning SLTs often had to rely on clinical judgement alone, which carried safety risks. Working with Whittington Hospital, the team now runs a monthly clinic offering timely assessments. Early results show better safety, more confident decision‑making and improved care for patients.

Co-production with carers and families

Camden District Nursing team is helping carers to recognise and communicate early signs that someone’s health is worsening. Nurses had noticed during reviews that many patients showed subtle changes before becoming unwell, but these “soft signs” weren’t always picked up or passed on.

To fix this, the team worked with carers, supported‑living staff and families to co‑design simple tools: a survey, a prompt sheet using the SBARD communication model, and an easy‑read leaflet on soft signs and how to escalate concerns.

The feedback has been very positive. Carers say the tools make it easier to speak up and explain what they’re seeing, and nurses are receiving clearer, more timely information.

Diggory’s Safety Conversation, led by Dr Shalini Andrews, Interim Medical Director, highlighted three standout projects. The huge number of submissions this year made it clear that colleagues “never stop thinking outside the box”.

Chief Executive, Claire Murdoch, also shared her appreciation, emphasising that the work showcased isn’t just good local practice but carries national significance.

Supporting families on waiting lists: Specialist Children’s Services Milton Keynes

With Autism Spectrum Disorder (ASD) referrals rising by more than 200%, the community paediatrics team set out to improve how families were supported while they waited.

Key elements of the project included:

• 30-minute proactive assessment calls to every family on the waiting list
• Listening first: families were asked about their top concerns, not just clinical details
• Flexible appointment times (evenings and weekends) to fit around working parents

The approach has now become a permanent part of the ASD pathway in Milton Keynes, and the changes led to clearer communication, a reduction in missed appointments and less anxiety for many families, especially older children who appreciated being included in the conversation.

Parents of younger children were less satisfied, often seeking a diagnosis rather than advice.

Reducing restrictive practice: Campbell Centre Milton Keynes

In 2024 the Campbell Centre was under significant strain, with rising violence and unsafe environments for both patients and staff. A CQC visit highlighted concerns about the use of restraint. It was a difficult message, but also a turning point.

The team moved quickly and collectively, introducing:

• Daily joint huddles and strong, visible nursing leadership
• Trauma‑informed and autism‑aware practice as well as two new in‑house trainers to build long‑term skills
• Real‑time learning, including micro‑teaching and simulations
• CCTV review of every restraint within 24 hours, scored for quality and safety
• Reflective, supportive debriefs
• Optional patient involvement so individuals could reflect on their experience

The project helped create calmer wards, fewer incidents and more time for therapeutic care. Staff grew in confidence and patients reported feeling safer and more respected. “This isn’t a project anymore. It’s how we work.”

Making every sample count: STI screening at HMP Bronzefield

Previously at Bronzefield, new arrivals provided urine samples only for pregnancy and drug screening. The team realised this was a missed opportunity.

Their solution was to use the same sample for STI screening. They trained reception nurses on the new process, communicated clearly about the results through the prison ‘pod’ system, and make sure women released or transferred were linked into community care.

The results were striking:

• STI testing rates rose from 69% to nearly 99%
• Earlier detection allowed earlier treatment
• Fewer missed appointments, as the test happened during guaranteed contact

Not a single woman objected to being tested, challenging common assumptions about barriers to sexual health care.