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Patient Safety, Human Factors and PSIRF Insights for Healthcare Organisations
Featured Articles.
Start with our practical guides to PSIRF, human factors in healthcare, systems-based learning, patient safety investigations and healthcare governance.


Healthcare risk management and patient safety: why yesterday’s controls may not protect tomorrow
Yesterday’s successful control may not protect tomorrow’s patient. Steve Franklin explores ergodicity, complex systems and Taleb’s risk principles, with practical implications for PSIRF, healthcare risk management and board assurance.

Steve Franklin
17 hours ago


Unauthorised access to health records: why punishment alone is not a patient safety strategy
Recent NHS record-access cases demand accountability. This article asks what system owners, boards and digital leaders must do before a breach creates another victim.

Steve Franklin
5 days ago


Are Our Chimps Running the Organisation? Emotional Decision-Making, Human Factors and Learning Culture
When something goes wrong, does the organisation ask what it needs to learn, or how quickly it can show that it has acted? Steve Franklin explores whether our emotional “Chimps” are shaping leadership decisions.

Steve Franklin
Oct 19


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

Steve Franklin
Oct 99 min read


Safety cases in healthcare: can we make the case for safety before harm occurs?
What healthcare can learn from safety-critical industries about evidence, human factors, independent challenge and proactive assurance before major change.

Steve Franklin
Oct 712 min read


Safety management systems in healthcare: how to connect risk, PSIRF, CQC and governance
Healthcare has incident reporting, risk registers, audits and committees. This practical guide explains how to connect them into a safety management system aligned with PSIRF, CQC well-led expectations, quality improvement and board governance.

Steve Franklin
Oct 515 min read


When the HIPPO speaks
Healthcare board members reviewing evidence before making a governance decision

Steve Franklin
Sep 2213 min read


When Presence Changes the System
What can a disputed football goal teach us about patient safety and board governance? This article explores why measurable evidence is not always the complete picture, and why boards need to combine hard data with weak signals, staff experience and soft intelligence.

Steve Franklin
Sep 1717 min read


Beyond Blame: Can Healthcare Really Build a Just Culture When the Outside World Still Wants Someone to Blame?
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.

Steve Franklin
Sep 1013 min read


PSIRF, Human Factors and the Resource to Turn Patient Safety Learning into Action
The Patient Safety Incident Response Framework asks healthcare providers to learn proportionately and improve meaningfully. This article examines how NHS and independent healthcare leaders can use Human Factors, clinical governance and corporate governance to match expertise to the work, improve value and prevent AI from shifting the bottleneck from producing information to reviewing and acting on it.

Steve Franklin
Sep 915 min read
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