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Enhanced Significant Event Analysis

Published: 15th June 2014

Enhanced Significant Event Analysis is an NHS Education for Scotland innovation which aims to guide health care teams to apply human factors thinking when performing a significant event analysis, particularly where the event has had an emotional impact on staff involved.

At the individual level, the tool encourages reflection on your own emotional response to a significant event and possible support needs prior to focussing on what happened and what should be done. The individual can then choose to complete a written report or bring the highlighted event to the care team meeting for a group analysis.

At the care team level, the guide tool will assist the group to focus on determining the interactions between the individual, the complexity of the task that was undertaken and wider systems issues in order to develop a more meaningful action plan for improvement.

The Enhanced Significant Event Analysis tools are divided into three parts

  1. A small booklet to help individuals reflect on the potential emotional impacts of a significant event – and their own role in the event – by using human factors principles to gain a clearer understanding of all of the contributory factors involved. It also comes with a small set of cards which outline the most common factors known to contribute to significant events that can be used as prompts to help with the analysis. Download Booklet and Cards – Card 1, Card 2, Card 3, Card 4
  2. An A3 size Desk Pad for the care team (his can also be printed as a simple A4 prompt sheet), the sheets from which can be distributed to all those who attend a team meeting to analyse significant events. Each sheet contains instructions and prompts to guide the care team to take a systems-based approach to analysing the event in question and take notes on what was agreed – the above cards may also be used at this stage. Download Deskpad
  3. SEA Report form which is now updated to accommodate a systems-based approach. It is strongly recommended that this format is used for GP speciality training and medical appraisal, as well as for practice manager and nurse vocational training and appraisal. Download Report

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