Patient Safety, Human Factors and PSIRF Insights for Healthcare Organisations

Using George Eliot’s candle metaphor and Daniel Kahneman’s WYSIATI principle, Katie Franklin explores how partial perspectives shape judgement, why blame culture restricts learning, and how psychological safety, diversity and just culture help organisations see more clearly

A listening organisation does more than invite people to speak. It hears weak signals, responds with curiosity and acts before warning becomes harm.

Tess is not undone by one isolated mistake. Across the novel, she is repeatedly denied meaningful choice, judged by unequal standards and made to carry failures created by people and systems with far more power.

The Thirlwall Inquiry makes powerful recommendations on safeguarding, governance and NHS management. This article asks how the NHS can strengthen accountability without weakening systems learning, psychological safety or PSIRF.

When something goes wrong in healthcare, how can organisations recognise system pressures while responding fairly to scrutiny? This article explores how human factors, PSIRF, restorative accountability and effective governance can help healthcare organisations move beyond blame without removing accountability.