Here Comes the Flood, but Not Failure? Lessons to Learn after the Heavy Rain and Pluvial Floods in Germany 2021

Floods are a known natural hazard in Germany, but the amount of precipitation and ensuing high death toll and damages after the events especially from 14 to 15 July 2021 came as a surprise. Almost immediately questions about failure in the early warning chains and the effectiveness of the German response emerged, also internationally. This article presents lessons to learn and argues against a blame culture. The findings are based on comparisons with findings from previous research projects carried out in the Rhein-Erft Kreis and the city of Cologne, as well as on discussions with operational relief forces after the 2021 events. The main disaster aspects of the 2021 flood are related to issuing and understanding warnings, a lack of information and data exchange, unfolding upon a situation of an ongoing pandemic and aggravated further by critical infrastructure failure. Increasing frequencies of flash floods and other extremes due to climate change are just one side of the transformation and challenge, Germany and neighbouring countries are facing. The vulnerability paradox also heavily contributes to it; German society became increasingly vulnerable to failure due to an increased dependency on its infrastructure and emergency system, and the ensuing expectations of the public for a perfect system.

Serious Injuries and Fatalities: A Study of Data and Prevention Strategies

Serious injuries and fatalities (SIFs) occurring in the workplace have become a significant focus in the field of safety. Over the past 20 years there has been a steady decline in the prevalence of all injuries, however the rates of SIFs have plateaued in recent years, contrary to Heinrich's Triangle. In one of the largest studies of its kind, we set out to identify trends and common factors of SIF incidents to identify strategies to reduce the risk of SIF incidents occurring. We have studied OSHA log records and OSHA recorded fatalities of over 50,000 companies over multiple years broken down by numerous different indicies including industry, age, day of the week, body part affected, type of incident and severity of incident to give a picture of SIF prevalence and trends. This data has also been cross referenced against qualititive information of these companies to identify trends, commonalities and disparities in order to identify causes and opportunities for improvement. The data reported on has shown different risk groups for SIF incidents occurring, that 60% of companies are at low risk of SIF incidents occurring and identifying the highest risk injuries for SIF events occurring (drilling and construction work). In addition, seemingly random factors such as day of the week and month of they year are found to statistically vary, presenting opportunities for targetted outreach based on this data in order to reduce risk. Furthermore, the study reveals companies who work with chemicals, performing welding work and work at heights should be the top targets for SIF prevention intervention, whilst the impact of heavily regulated industries (e.g., PSM facilities) and ensuring organisations have good safety procedures are linked to lower risks of SIF events occuring. This information is of valuable use for all organisations who are interested in truly understanding the root causes of incidents and learning techniques to achieve a Vision Zero of a reduction of incidents, particularly serious injuries and fatalities, to the lowest possible level. A no-blame culture to the accurate reporting of incidents is also vital to a deeper understanding of causation and prevention.

EXPRESS: Evidence-based Practice and the Ethics of Care: ‘What Works’ or ‘What Matters’?

This paper considers why and how evidence-based practice (EBP) has become distorted in practice, and what to do about it. We present qualitative data from an action research project in policing to highlight tensions between the rhetoric and reality of EBP, and the ways in which EBP’s seductive catchphrase ‘what works’ is being understood and applied. Through the lens of care ethics, we integrate ‘what matters’ with ‘what works’, and ‘what matters/works here’ with ‘what matters/works everywhere’. This approach recognises relational expertise, practical reasoning and critical inquiry as vital for EBP in practices of social intervention. Drawing on key care ethics motifs, we suggest that care is the ethical scaffolding upon which social justice relies, and hence crucial to organs of security, peacekeeping and law enforcement. From this position, we argue that policing might renegotiate its difficult relationship with the particular, recasting it from something uncomfortably discretionary (the maverick cop) and shameful (an individualised blame culture) into something which underpins and enhances police professionalism. Whilst developed in a policing context, these reflections have a broader relevance for questions of professional legitimacy and credibility, especially within the ‘new professions’, and the costs of privileging any one type of understanding over others.

Changing the narrative around obesity in the UK: a survey of people with obesity and healthcare professionals from the ACTION-IO study

ObjectivesTo investigate the perceptions, attitudes, behaviours and potential barriers to effective obesity care in the UK using data collected from people with obesity (PwO) and healthcare professionals (HCPs) in the Awareness, Care, and Treatment In Obesity maNagement–International Observation (ACTION-IO) study.DesignUK’s PwO (body mass index of ≥30 kg/m2 based on self-reported height and weight) and HCPs who manage patients with obesity completed an online survey.ResultsIn the UK, 1500 PwO and 306 HCPs completed the survey. Among the 47% of PwO who discussed weight with an HCP in the past 5 years, it took a mean of 9 years from the start of their struggles with weight until a discussion occurred. HCPs reported that PwO initiated 35% of weight-related discussions; PwO reported that they initiated 47% of discussions. Most PwO (85%) assumed full responsibility for their own weight loss. The presence of obesity-related comorbidities was cited by 76% of HCPs as a top criterion for initiating weight management conversations. The perception of lack of interest (72%) and motivation (61%) in losing weight was reported as top reasons by HCPs for not discussing weight with a patient. Sixty-five per cent of PwO liked their HCP bringing up weight during appointments. PwO reported complex and varied emotions following a weight loss conversation with an HCP, including supported (36%), hopeful (31%), motivated (23%) and embarrassed (17%). Follow-up appointments were scheduled for 19% of PwO after a weight discussion despite 62% wanting follow-up.ConclusionsThe current narrative around obesity requires a paradigm shift in the UK to address the delay between PwO struggling with their weight and discussing weight with their HCP. Perceptions of lack of patient interest and motivation in weight management must be challenged along with the blame culture of individual responsibility that is prevalent throughout society. While PwO may welcome weight-related conversations with an HCP, they evoke complex feelings, demonstrating the need for sensitivity and respect in these conversations.Trial registration numberNCT03584191.

Enigma of maternity service safety improvements and increasing expression of patient dissatisfaction

There have been gradual and continual improvements in maternity care in the UK. This has been paradoxically accompanied by increasing censure by authorities for adverse outcomes and public expression of dissatisfaction. Serious maternal and perinatal adverse outcomes have a devastating effect. Grieving families need an honest explanation, continued support and reassurance that lessons are being sought and learnt. Additionally, the public would welcome the acknowledgement of limitations of healthcare and the science itself; and that the adverse outcomes can be minimised but not eradicated. Blame culture is harmful to the clinicians, healthcare system and, ultimately, patients. The controversial issue of intrapartum fetal monitoring best illustrates the urgent need to reform mistaken science in addition to organisational and cultural improvements. Most enquiries do not critique bad science or guidelines but only birth attendants. The healthcare outcomes must continue to improve through investigations, reviews, openness, medical progress and by helping the clinicians to mitigate the limitations of scientific knowledge, resources and human factors.

Barriers to Incident Reporting among Nurses: A Qualitative Systematic Review

Incident reporting in health care prevents error recurrence, ultimately improving patient safety. A qualitative systematic review was conducted, aiming to identify barriers to incident reporting among nurses. Joanna Briggs Institute methodology for qualitative systematic reviews was followed, with data extracted using JBI QARI tools, and selected studies assessed for methodological quality using Critical Appraisal Skills Program (CASP). A meta-aggregation synthesis was carried out, and confidence in findings was assessed using GRADE ConQual. A total of 921 records were identified, but only five studies were included. The overall methodological quality of these studies was good and GRADE ConQual assessment score was “moderate.” Fear of negative consequences was the most cited barrier to nursing incident reporting. Barriers also included inadequate incident reporting systems and lack of interdisciplinary and interdepartmental cooperation. Lack of nurses’ necessary training made it more difficult to understand the importance of incident reporting and the definition of error. Lack of effective feedback and motivation and a pervasive blame culture were also identified.

Implementation status of morbidity and mortality conferences in Austrian hospitals-A cross-sectional national survey study

Introduction Morbidity and mortality conferences (M&MCs) are an instrument for learning from past complications, unexpected follow-ups and deaths in hospitals and are important for improving patient safety. However, there are currently no quantitative data on the implementation of M&MCs in Austria. The aim of the study was to determine the status quo of the M&MCs in Austria. Materials and methods A national cross-sectional study was conducted by means of a survey of 982 chief physicians of surgical disciplines, internal medicine, anesthesiology, intensive care, gynecology/obstetrics and pediatrics. The questionnaire focused on overall goals, structure and procedures of hospital M&MCs. Results Of the 982 contacted chief physicians, 314 (32.0%) completed the survey. Almost two thirds of the respondents, i.e. 203 (64.7%), had already implemented M&MCs. Of the 111 chief physicians who had not yet introduced M&MCs, 62 (55.9%) were interested in introducing such conferences in the future. Of the 203 respondents that had implemented M&MCs, 100 stated that their M&MC could be improved. They reported issues with "shame and blame" culture, hierarchical structures, too little knowledge about the capability of M&MC and, in particular, time constraints. Overall, the participating chief physicians showed that they are striving to improve their existing M&MCs. Discussion/Conclusion While we found a relatively high number of already implemented M&MCs we also identified a large heterogeneity in the format of the M&MCs. A highly structured M&MC including guidelines, checklists or templates does not only considerably improve its outcome but can also alleviate the main limiting factor which is the lack of time.