Patient Safety Incident Investigation (PSII) - patient and family support

The aim of this leaflet is to help explain the patient safety incident investigation process. It also details what help and resources are available to support you through this process.

If you have been directed here (or have been given a hard copy of this information), it may be because Cambridge University Hospitals NHS Foundation Trust (CUH) has identified a need to undertake a patient safety incident investigation following an incident experienced by you or someone close to you.

The purpose of the patient safety incident investigation is to learn about:

• what happened
• why it happened
• how things can be changed or improved to try and make sure it doesn’t happen again.

We value your involvement in the investigation as it is an opportunity for you to shape what the investigation looks into. If you do not wish to have this level of involvement, we will respect this.

We know that the investigation can’t change what has happened, but we hope it will help you to understand what happened and the ways in which our Trust is committed to change and to improve from this incident.

The five stages of the PSII

Stage 1: Understanding you and your needs

A conversation will be initiated and guided by your incident investigator. The lead investigator is employed by our Trust and trained to undertake this role. We will listen to you to understand what you are needing from the investigation.

Stage 2: Agreeing how you work together

At this stage it is important that we agree how you would like us to work together, specifically in relation to things like how we get in contact with you, and how often you would like us to get in touch.

Stage 3: Giving and getting information

The investigator will gather information about the incident from lots of different sources, including from you and your family or carers. You will be given the opportunity to share your experience and ask any questions you have about the incident.

Stage 4: Checking and finalising the report

Towards the end of the investigation, a report will be produced based on all of the gathered evidence. This will explain what happened and identify areas for learning and improvement. You will be invited to provide feedback on the report before we produce the final version.

Stage 5: Next steps

Sometimes there will be other processes that happen alongside a patient safety incident investigation. For example, the Coroner may be reviewing the case as part of an inquest, or an independent organisation may be carrying out their own investigation of the case. If you find you need more information about these processes, your main point of contact will be able to help.

Where to go for further information

Your main point of contact during the investigation will be the patient safety lead investigator. They will contact you directly and share their contact details with you. Further information about the NHS investigation process can be found on the national Learn Together website (opens in a new tab) (accessible via the QR code below).

Where to go for further support

Residents of Cambridgeshire who require support or advocacy from a source outside the hospital can contact POhWER (opens in a new tab) on 0300 456 2370.

What if you are unhappy with the investigation?

If you are unhappy with the investigation at any stage, please speak to the patient safety lead investigator. If this does not resolve the problem or if you would prefer to speak to someone else, you can get support and help by emailing our Patient Advice and Liaison Service (PALS), or calling them on 01223 216 756 - 09:00 (9am) to 16:00 (4pm) Monday to Friday.

If you need information in a different format or help communicating, please inform the patient safety investigator leading your case.