How our Approach to Patient Safety links to Accountability

Patient Safety Incident Response Framework (PSIRF)

To support our commitment to patient safety, NUH has adopted the national Patient Safety Incident Response Framework (PSIRF). The PSIRF provides a structured, systematic process for responding to patient safety incidents, focusing on learning and improvement rather than assigning blame. This method of working guarantees that incidents are comprehensively examined, and appropriate modifications are implemented to prevent future occurrences.

The PSIRF also supports openness and honesty when mistakes occur, reinforcing the link between patient safety and accountability.

PSIRF places a strong emphasis on fostering an open, transparent, and just culture, where staff are encouraged to report incidents without fear of blame or retribution. The focus is on learning and improving care, rather than assigning fault.

By promoting this type of organisational culture, we can engage staff at all levels, learn from incidents more effectively, and continually enhance the safety of our services.

PSIRF integrates four key aims:

1. Compassionate engagement and involvement of those affected by patient safety incidents

2. Application of a range of system-based approaches to learning from patient safety incidents

3. Considered and proportionate responses to patient safety Incidents

4. Supportive oversight focused on strengthening response system functioning and improvement.

New NHSE Guide - ‘Being Fair' Tool

NUH fully embraces the Being Fair tool, introduced by NHSE in May 2025, as a cornerstone of our just and learning culture. Replacing the 2018 Just Culture Guide and aligned with PSIRF, the tool guides a fair, proportionate response when safety incidents raise concerns about individual conduct while ensuring that wider system factors are examined with equal rigour.

Our commitment is to create conditions where:

  • Safety takes precedence over blame, incidents are explored to learn, not to punish.
  • Psychological safety is protected; colleagues can speak up; confident they will be treated with dignity and respect.
  • System contributions are addressed, investigations consider human, organisational and environmental factors, reducing unconscious bias and driving meaningful change.

These principles echo the NHS Just and Learning Culture Charter, reinforcing kindness, inclusion and fairness as levers for sustained improvement. The Being Fair framework also helps leaders decide when targeted support or remediation is necessary and ensures decisions are consistent, transparent and free from bias. By embedding this approach, NUH nurtures trust across teams and the community, turning every incident into an opportunity for collective learning and safer patient care.

Benefits of implementing the ‘Being Fair' Tool

Implementing the ‘’Being Fair’ Tool provides numerous benefits for both staff and patients:

  • Better patient outcomes: By addressing systemic issues and learning from incidents, patient safety improves, leading to better care quality.
  • Enhanced reporting and learning: Staff are more likely to report incidents, leading to a greater understanding of safety concerns and the implementation of preventive measures.
  • Improved staff well-being: A supportive environment reduces stress and burnout, leading to higher job satisfaction and retention rates.

Alignment with NUH's Commitment

At NUH, we are committed to embedding the ‘Being Fair’ tool across all levels of our organisation. This commitment aligns with our dedication to patient safety, staff well-being, and continuous improvement. By fostering an environment where learning is prioritised over blame, we aim to enhance the quality of care we provide to our patients and build a supportive workplace for our staff.

The ‘Being Fair’ tool aligns with the values of the Trust:

  • We are kind 
  • We are inclusive 
  • We are ambitious 
  • One Team

Detailed description of the 'Being Fair' tool is provided in Appendix 1 of this document.

Duty of Candour

NUH fulfils its Duty of Candour by being open and transparent with patients, families, and carers when things go wrong. This legal and ethical responsibility requires us to acknowledge mistakes, provide honest explanations, and offer a sincere apology where appropriate. We must ensure that affected patients and their families are kept informed, supported and involved in the process of understanding the incident and the actions being taken to prevent a recurrence.

This commitment to candour is integral to our approach to patient safety, as it builds trust with patients and the public, demonstrating that we are willing to take responsibility for our actions and continuously work to improve care (The Duty of Candour is enshrined in law under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (UK).

Accountability in Practice

Accountability in patient safety is about more than responding to incidents, it is about creating an organisational culture that prioritises the safety and well-being of every patient. By integrating the PSIRF framework with our Duty of Candour, we hold ourselves accountable not only to our patients but also to the wider community. It allows us to show that we are taking proactive steps to learn from incidents, improve care delivery and ensure that safety is always our top priority.