Situation Awareness for Everyone (S.A.F.E) Programme

Situation Awareness for Everyone logo - a heart in a green circle

The RCPCH led this two year programme in partnership with 28 hospitals to develop and trial a suite of quality improvement techniques. Our Resource Pack helps sites implement the programme's core principles to improve communication, build a safety-based culture and deliver better outcomes for children and young people.

Resource pack

This free online resource includes presentations, tools and worked examples so you can introduce and improve situation awareness locally. Posters and presentations from participating programme sites can help inspire you to implement this at your hospital.

Access the resource

About the programme

Currently there are an estimated 2,000 preventable deaths each year compared to the best performing countries in Western Europe. The programme aimed to reduce preventable deaths and error occurring in the UK’s paediatric departments. 

The programme's aims were to:

  • reduce avoidable error and harm to acutely sick children by 2016
  • improve communication between all healthcare professionals involved in a child’s care as well as families to ensure treatment is consistent and of the same high standard regardless of postcode or class
  • close the disparity in health outcomes for children in UK vs other countries as well as between children’s care and adult care
  • involve parents, children and young people to be better involved in their children’s / own care.

The RCPCH led the S.A.F.E Programme on behalf of the S.A.F.E Partnership, which comprises the RCPCH, Great Ormond Street HospitalUCLPartners, and the Anna Freud Centre. It was funded by the Health Foundation’s Closing the Gap in Patient Safety programme.


We trialled models of care including the ‘huddle’ technique - a ten minute, free, frank exchange of information between clinical and non-clinical professionals involved in a patient’s care. The huddle encourages information sharing and equips professionals with skills to spot when a child’s condition is deteriorating and to prevent missed diagnosis.

Dr Peter Lachman, S.A.F.E National Clinical Lead, describes the huddle in this video.

How the programme worked

The programme brought together paediatric units from 28 hospitals across England into three collaboratives. Each ran a local quality improvement (QI) project aimed at improving outcomes for paediatric patients. While a set of central measures was collected, each participating unit had the freedom to focus their project on a particular measure they want to improve.

The collaborative model allowed participating units to share their knowledge and experience with other partners, demonstrating both their successes and failures. This provided the opportunity for good practice to be spread and adapted within the collaborative, and for this to contribute to the single common aim of the programme: to reduce preventable deaths and error from occurring.

Programme evaluation

The Anna Freud Centre is evaluating the impact of improved situation awareness, and will submit the results to the Health Foundation at end September 2016.

The question is:

Under what circumstances, by what means and in what ways does increasing situation awareness lead to improved safety, experience and other elements of quality for children under inpatient care?

The evaluation comprises a quantitative element involving all twelve sites, and a qualitative element, which will involve two specialist children’s hospitals and two district and general hospitals.

Further information

You can keep up to date with the S.A.F.E Programme by following us on @SAFE_QI, or contacting

You can also download and view a short presentation which introduces the programme (PPT, 1.7MB).