Learning from Excellence – A Royal Free NHS Foundation Trust Experience


Dr Patricia Lutalo – Paediatric trainee

Dr Dominic Fenn – Paediatric trainee

Dr Shanthi Shanmugalingam – Consultant Neonatologist



Taking the lead from Adrian Plunkett and his team at the Birmingham Children’s Hospital, the Learning from Excellence (LfE) Project was launched at Barnet Hospital’s Women’s Health and Children’s department in June 2016.  The project aims to capture and celebrate examples of high quality practice.  Traditionally the drive for optimising patient safety has focussed on adverse incident reporting.  The tendency to focus on the negative, while effective, can lead to second victim phenomenon adversely affecting those involved.  Humans innately obsess with the negative, yet there is a significant amount of positive practice which should be learned from and celebrated. 


Initially a simple paper based nomination system was adopted at Barnet Hospital to highlight everyday excellence with nominations placed in designated yellow boxes distributed throughout the piloting departments.  The nominees received email feedback from the lead consultant who was responsible for spearheading the initiative.  The nominees and nominations within the first few months of the project launch, as expected, came from within the piloting departments.  The good word, however, soon spread throughout the Royal Free Hospital NHS Foundation Trust with multiple disciplines either nominating or being nominated.  The progressive osmosis of other teams continued and by November 2016, with the tremendous support from the IT team, the LfE Project went viral with the introduction of electronic reporting.  This not only increased the number of nominations but also the diversity of nominees.


Nominations have been inclusive of clinical and non-clinical roles, inter and intra disciplinary and independent of hierarchy bias.  The recipients of nominations have expressed delight and commented about how this method of working together has contributed to enhancing morale and a positive working environment.  The common themes identified have included examples ranging from teaching, supportive non-clinical members of staff, appreciation of empathy, good team working and the management of resuscitation situations.


In a climate where there are multiple challenges facing the NHS and its staff, the LfE team at the Royal Free Hospital Foundation Trust hopes that by recognising individuals and the teams crucial to delivering and maintaining the high level of care seen at the Royal Free Trust, a positive learning environment can be promoted which can also serve to boost staff morale.     


Examples of a few responses received from nominees.


“Thank you. I was bowled over by that …It was a challenging situation and I really felt I was just doing my job…”


“Thank you so much. Has cheered me up!”


“Positive feedback gives us the impetus to work harder, feel valued and appreciated…”


“…importance of feedback…to hear it or have it written down motivates one to continue working harder and helps perpetuate a positive cycle of praise and appreciation in any team

SMART Objectives


The project aims to capture and celebrate examples of high quality practice and provide positive feedback to the nominees.


The number of nominees and information about their specific departments are collected. 

The themes of the nominations are recorded. 

Qualitative data on responses from the nominees is also captured.  



The project needs multi-disciplinary participation and champions in various departments in order to promote awareness and nominations.  This was achieved at the Royal Free Hospital NHS Foundation Trust and catapulted with the introduction of electronic nominating with significant input from the IT department.  



Traditionally the drive for optimising patient safety has focussed on adverse incident reporting.  There is a significant amount that can be learned from highlighting positive practice and this should be celebrated.  It has also been shown that a positive working environment improves staff morale.


Time bound:

No time limit as this is an on-going project which needs quarterly review of results.  

What has been learned from the project?

Multidisciplinary involvement from clinical, nursing and midwifery leads and the IT department is required to promote the initiative and garner enthusiasm from members of staff to provide nominations and encourage regular positive feedback.

Leadership from a consultant is required to influence uptake within a Trust.

Individuals who work in healthcare are dedicated and hardworking people who really value formal positive feedback and garner encouragement and resilience from it.


Take home message:

The Learning from Excellence Project is all about learning from and celebrating good practice within the health sector.  It is a positive, effective way of promoting education and staff morale.  


Plunkett., 2016 Learning from Excellence: Start up guide, Birmingham Children’s Hospital. Available: http://learningfromexcellence.com

Leonhardt, J., Licu, T., Shorrock, S. 2013. From Safety-I to Safety-II. A White Paper. EUROCONTROL (European Organisation for the Safety of Air Navigation).

 Kelly N, Blake S, Plunkett A. 2016. Learning from excellence in healthcare: a new approach to incident reporting. Arch Dis Child 101:788-9

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