Doctors in training leading quality improvement: families reporting critical incidents and near misses

Great Ormond Street Hospital for Children

  • Project led by Great Ormond Street Hospital for Children.
  • Based on a paediatric nephrology ward.
  • Aimed to improve the identification of adverse events and near misses, and to reduce the possibility of adverse events.
  • Developed a web-based questionnaire to engage families and patients in the reporting of safety concerns.

The Great Ormond Street Hospital for Children project team developed a web-based questionnaire to engage families and patients in the reporting of safety concerns.

The aim of the project was to:

  • approach patient safety with a focus on service users as well as service providers
  • enable real-time analysis of safety concerns
  • support families to become active partners in all aspects of care
  • use insights from families and patients to deliver safe, efficient and high quality services.

The team asked families whose child’s anticipated discharge was within 48 hours to give their views on patient safety through an anonymous 10 minute questionnaire. All incidents reported were measured, classified according to type of harm and graded according to severity. The Patient Advice and Liaison Service provided support to families if needed.

Who was involved

The project was led by a paediatric cardiology specialist training registrar, with support from members of the clinical and nursing teams, a divisional clinical improvement lead, a medical director and a project management assistant.


  • 85% of families and patients who were approached completed the questionnaire.
  • 33 new safety concerns were raised during the observation period, with only 3% of these matched by staff reports.
  • 59% increase in staff reporting of incidents.
  • Families and patients were most concerned about communication problems (31%) and medication errors (21%).


The team decided to explore the use of a volunteer with dedicated time to talk to families about their concerns and to act as an independent point of contact. They felt that this could be of particular benefit to family members who do not speak English or who have learning disabilities.

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