Index of the cards

L1. Safety as a priority

L1-a. How do you perceive the priority of safety for national and organisational senior leaders compared to other objectives?

L1-b. Are we getting the balance right within our organisation? Regionally? Nationally?

L1-c. How do leaders, management and supervisors encourage staff to use the safety processes available?

L1-d. When safety issues are raised by front-line care staff to what extent are they given appropriate priority within the organisation or practice?

L1-e. How can we ensure that safety issues raised get the priority they deserve?

Reflection form

L2. Trust and credibility

L2-a. How much do you and others trust leaders, management and supervisors with regards to safety?

L2-b. How do leaders, management and supervisors demonstrate commitment to safety in what they say and do?

L2-c. How can leaders, management and supervisors ensure that they are perceived as credible?

L2-d. How can trust be nurtured?

Reflection form

L3. Responding to concerns

L3-a. How do your leaders, management and supervisors respond to staff safety concerns? If necessary, how can this be improved?

L3-b. How can staff feel more supported when they report safety concerns?

Reflection form

i1. Safety culture is everyone's responsibility

i1-a. What is your role in assessing and responding to risks?

i1-b. How can you and your team increase your involvement in safety-related activities?

i1-c. Do others understand how your job contributes to safety?

i1-d. Do you understand how others contribute?

i1-e. How can we improve understanding of our contributions to safety?

Reflection form

i2. Speak up

i2-a. Would you speak up to your line manager or others if you had safety concerns?

i2-b. How can we ensure that we feel safe to speak up when we need to?

i2-c. What would you do if you felt your safety concerns were not being listened to or acted upon?

Reflection form

i3. Our work procedures

i3-a. What is the role of frontline staff in changes to existing work procedures or the design and introduction of new work procedures?

i3-b. How can we ensure the right level of input, from the right people, to get the design and usefulness of the work procedures right?

Reflection form

T1. Working together

T1-a. How well does your team work together?

T1-b. What are you doing well, and what could you improve?

T1-c. Do you have confidence in the people that you interact with?

T1-d. If you have lost confidence in a colleague(s), how would you address this?

Reflection form

T2. Sharing information critical for safety

T2-a. How well does your team work with other teams?

T2-b. How does your team interact with other teams?

T2-c. How well do you, your team and your organisation share information critical for safety?

T2-d. What can you do to better open the lines of communication?

Reflection form

T3. Talking about systems

T3-a. How do frontline staff consult with relevant others to maintain equipment and work procedures so that quality and safety of care is not negatively affected?

T3-b. How do staff share information about system problems with colleagues (and vice versa) in order to keep systems working properly?

Reflection form

T4. Onwards and upwards

T4-a. How well do staff at different levels of your organisation communicate about safety?

T4-b. How would you like vertical communication about safety to be shared?

T4-c. How well does your team communicate with other relevant teams and organisations?

T4-d. How can we improve our communication with external stakeholders?

T4-e. Do you know the future plans for the development of the services you provide, however major or minor?

T4-f. How would you like to be informed about future plans?

Reflection form

J1. Learning culture

J1-a. Do you and your team incorporate lessons from trends, incidents, good practice and recommendations into your work?

J1-b. How could you learn from events in your work?

J1-c. A just culture is an organisational approach that balances accountability and fairness, viewing individual mistakes as an opportunity to improve systems rather than punish people? Do you talk about just culture? Is just culture the way you do things or is it viewed as just a policy?

J1-d. If a colleague regularly took unacceptable risks, what would happen?

J1-e. What is the best way for the organisation to deal with different types of unacceptable behaviour?

Reflection form

J2. Focus on the issue and avoid blame

J2-a. When a safety issue is raised, do you focus on the message or messenger? How can we ensure that we focus on the message rather than the messenger?

J2-b. How can we support leaders so that ‘normal errors’ are not identified as ‘causes’ during incident investigation and learning reviews?

J2-c. When people report safety-related occurrences, are they blamed or treated in a just and fair manner?

J2-d. How can we encourage a just culture within the organisation, department, care practice and the team?

J2-e. Does the language used by the organisation support a just culture or a culture of blame?

Reflection form

J3. Safe reporting and confidentiality

J3-a. How can we make sure incident reporting makes a visible difference and so motivates people to participate in reporting and learning to increase safety?

J3-b. Do you know how to report situations that may compromise care safety and your own wellbeing?

J3-c. How can incident reporting be simple and easy enough for everyone to understand and do?

J3-d. Do people get timely feedback on the safety issues they raise?

J3-e. What kind of feedback is best suited to the needs of those who raise safety issues, and when should this be given?

J3-f. How confidential is the incident reporting and learning review system?

J3-g. What level of confidentiality is needed, and how can this be maintained?

J3-h. Is incident reporting sometimes abused or used inappropriately? How can we address this?

Reflection form

J4. Sharing the learning

J4-a. Are reports of safety incidents readily available to you? How would you like to receive or have access to such reports?

J4-b. How well do we review, analyse and learn from safety incidents at the organisation and team levels?

J4-c. How do we talk about safety incidents?

J4-d. How can we create the right environment for these discussions, so that we learn from experience?

Reflection form

R1. Knowledge, skills, preparedness for change

R1-a. Do you have basic knowledge of systems thinking and just culture principles, and how these should direct learning from safety events?

R1-b. How can the organisation support you to develop the knowledge and skills in this area?

R1-c. How is adequate training provided when new systems and work procedures are introduced?

R1-d. How can we be better prepared for future changes?

Reflection form

R2. Getting work procedures right

R2-a. Which processes are working well, and which are not?

R2-b. How can we give safety the attention it deserves and balance with other objectives? (e.g. performance, cost effectiveness, targets)?

R2-c. Is there enough focus on safety? Is there too much focus on safety?

R2-d. How can we make safety as practical as possible?

R2-e. How do work procedures compare with the way you actually do your job?

R2-f. How can we ensure the work procedures remain realistic and accurate enough?

Reflection form

R3. Right people

R3-a. How can we ensure we have the right number of staff to deliver a service as safely as possible?

R3-b. How can we ensure that we get the right staff with the right skills, at the right time?

R3-c. How can you raise concerns about safe staffing levels?

Reflection form

R4. Right equipment

R4-a. How do we ensure we have adequate resources (e.g. time, specialist advisers, work procedures, training, funding) for safety where they are most needed?

R4-b. Does the equipment you use support safe working?

R4-c. How can we ensure that equipment is supporting safety?

Reflection form

M1. Safe work procedures

M1-a. Do you often have to deviate from work procedures? If so, why?

M1-b. How do you ensure the design and implementation of work procedures support safe work?

Reflection form

M2. Balancing safety

M2-a. How do you balance safety against other requirements of your job (e.g. being efficient or striving to be person-centred)?

M2-b. How can we get the balance right?

Reflection form

M3. Know your hazards and risks

M3-a. How are you aware of the hazards in your work?

M3-b. Are you aware of the risks of these causing harm and how to minimise these? If so, how effective is this?

Reflection form

M4. Taking risks and blind spots

M4-a. Do you sometimes have to take risks that make you feel uncomfortable about safety?

M4-b. Are some risky activities now normalised where you work? If so, what are they and what are the consequences?

M4-c. Are you aware of safety problems that are not being addressed sufficiently? If so, what barriers are in place?

M4-d. How can you help to make sure that care safety problems are acted upon and resolved rather than ignored?

Reflection form