The Oakden Report documented failures in governance, clinical practice and organisational culture occurring at the Oakden Older Persons’ Mental Health Service and drew national attention to the care of older people with complex clinical needs. Responding to the recommendations of the Report, a working group brought together stakeholders to engage in a codesign process involving literature review, gallery walks and focus groups, under the governance of the Oakden Response Oversight Committee. The working group developed a framework as a blueprint for organisational culture reform built around a central philosophy of compassionate relationship-centred care, supported by four priorities: developing a values-based workforce, cultivating psychological safety, facilitating excellence in care and providing transparent accountability. The purpose of the framework was to provide a way forward for South Australian older persons’ mental health services after The Oakden Report, and it may provide insight into similar processes of codesign and culture change in other service contexts. What is known about the topic? Changes to healthcare systems, requiring improved efficiencies and lower costs, are contributing to increasing challenges with staff satisfaction and wellbeing, and consistent delivery of dignified, meaningful care to people and their families. The need to nurture and lead healthcare organisations characterised by compassionate cultures is an increasingly prominent theme in global healthcare literature. The engagement of people with lived experience at all levels of system design supports effective and ethical service development. What does this paper add? This paper illustrates an approach to positive, compassion-focused organisational culture change, developed through codesign, occurring as a reform process following a crisis in service delivery. The paper applies key concepts in a framework that may be applied in a range of services to achieve positive organisational transformation. What are the implications for practitioners? Committed action to develop positive organisational culture characterised by compassionate relationship-centred care will have benefit for healthcare providers and the people who receive care. Keeping people with lived experience at the centre of design and development will support optimal outcomes for all stakeholders.

Background Following a number of incidents within the trust setting in which difficult patient management dilemmas have occurred, the human patient simulation (HPS) team have formulated a "proactive" response rather than being "reactive". A number of simulated incidents that encourage the teams to take a "what if" approach to situations allowing workers to anticipate possible adverse outcomes and act in advance to avert them.1 Method The HPS team replicate the incidents that have occurred and staff are invited to attend in an endeavour to highlight any clinical and non technical influences on a safe patient outcome. Further more, during the debrief, the staff are encouraged to think around the dilemmas they are faced with, both clinical and non clinical to encourage them to "future" plan for any incidents they may encounter.2 Innovation The HPS team have developed a number of "what if" scenarios that they intend to run in clinical areas. These scenarios will be anaylsed in an attempt to highlight potential problems that could be encountered. This anticipatory method of training will be used to feedback to clinical and patient safety leads to hopefully reduce/minimise risk of incidents actually occurring. Results Training delivered around tracheostomy emergencies is one that has been particularly well received. A further training session around cardiac arrest management in non-clinical areas e.g. stairwells has also received very encouraging feedback. Conclusions Development of scenarios to address "what if" dilemmas, should be used to help improve patient and staff safety, and build an anticipatory response to clinical and non clinical problems. Take home message Simulation should not only be viewed as training tool to increase skills, but it should be used as a proactive rather than reactive tool to improve patient and staff safety, and confidence. References Minding the Gaps: Creating Resilience in Health Care.Nemeth C, Wears R, Woods D, Hollnagel E. (Online) accessed 12/6/14 National Health Service (2010) Human factor Training in the National Health Service: A Scoping Study [On Line] available from: [Accessed 4th March 2014]