Episode #


Episode #7 - Nichola Crust from Healthcare Safety Investigation Branch (HSIB)

Nichola Crust is a National Investigator at the Healthcare Safety Investigation Branch, Registered General Nurse in the NHS 28 years and also a GenerationQ fellow.


Nichola's Background

Nichola has worked at a strategic level in a variety of healthcare settings spanning primary and secondary care. Her roles have included professional nurse leadership and mentoring of nursing teams, mobilisation of new services including service and workforce redesign, and training and education in incident investigation.

Nichola has developed clinical governance systems in both primary and secondary care, established systems for identifying risks and has worked collaboratively with national bodies relating to healthcare.

Nichola has extensive teaching experience and specialist understanding of supporting patients and families through the investigation process. Her key qualities are empathy, ability to build rapport and ability to influence.

Professional background

Before joining HSIB, Nichola was a Head of Nursing, Quality and Safety for the NHS Leicester, Leicestershire and Rutland Alliance. Nichola joined the Healthcare Safety Investigation Branch (HSIB) in March 2017 as a National Investigator. She works closely with patients and their families and carers, healthcare staff, trusts, hospitals and other healthcare providers. Nichola was the HSIB representative on the CQC Never Events Thematic Review expert advisory group.

The National Safety Investigator role interested her because it has a focus on leadership and quality improvement and Nichola has a real desire and enthusiasm for leading and influencing improvement work which will directly impact on patient safety.

Further qualifications

Nichola has completed the Health Foundation’s GenerationQ leadership and quality improvement programme and holds an MSc in Leadership (Quality Improvement). Nichola continues to meet with her Action Learning Set following completion of the GenerationQ programme. Nichola reflects on the benefits of Action Learning Sets as a way of reflecting and learning from real life problems and our actions from what happens to us, and around us. They are an opportunity to ask difficult questions, discuss sensitive issues and allow time to question, understand and reflect, to gain insights and consider how to act in the future, sharing learning in a supportive environment.

Time Stamps

  • 01:46​ What is the remit of the Healthcare Safety Investigation Branch (HSIB)?
  • 03:39​ What are the big differences between an RCA thats done at a local NHS organisation and one that the HSIB does?
  • 06:45​ How do you decide what you are going to investigate?
  • 08:33​ How was the NG tube related investigation triggered?
  • 10:03​ Does every HSIB investigation have a reference case?
  • 11:53​ When you had completed and started reviewing your findings, were there any findings that surprised you?
  • 16:33​ Whats your impression of the confidence clinical staff have when they are using those existing methods?
  • 23:03​ The report talks about NG tube misplacement being a never event, whats the view from yourself and the team with regards to misplaced NG tubes being a never event?
  • 27:08​ Some clinicians suggest despite being a statutory requirement there still may be under reporting of never events involving NG tube’s. Did anything in your enquiry or even your experience suggest that might be the case?
  • 31:24​ There are numerous observations, recommendations and actions in the nasogastric tube report, which one do you think will have the biggest impact on patient safety with regards to nasogastric tubes if they were implemented in full.


Link to HSIB report on the Placement of nasogastric tubes: https://www.hsib.org.uk/documents/268…

Link to HSIB website: https://www.hsib.org.uk/investigation…

HSIB Social Links

HSIB on Linkedin: https://www.linkedin.com/company/heal…

Nichola Crust: https://www.linkedin.com/in/nichola-c…



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