Actions to improve Forth Valley Royal Hospital's emergency department following a damning independent review are now almost complete.
NHS Forth Valley's chief executive Cathie Cowan ordered the review when staff and trade unions raised concerns about the working environment and patient safety.
And after the report was published last summer, highlighting a culture of bullying and cover-ups, she pledged to implement several recommendations to put things right.
At a meeting of Forth Valley NHS Board on Tuesday, members heard that most of the recommendations - including recruiting several new members of staff - are either in place or close to being fully implemented.
Among the new jobs, a clinical nurse manager is now in post and a review of the nursing structure will be finished by July.
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The report was particularly critical of the fact that staff were unwilling to report incidents or near misses as they had felt it was futile to do so.
One recommendation was an immediate and entire review of clinical governance arrangement and Dr Andrew Murray, NHS Forth Valley medical director, said they had made "a huge amount of progress" and would report back to the Clinical Governance committee soon.
The independent review also said it was essential that the hospital's adverse events policy was "made easy for frontline staff to understand" and then implemented and monitored to demonstrate their commitment to promoting "an open and honest culture".
New staff who will oversee Significant Adverse Events Reviews (SAER) are now in post and Dr Murray said it was important to allow them to settle into their roles so they could contribute to any policy reviews.
The report also recommended a review of induction, skills assessment and learning and development plan within ED to ensure that staff are competent to carry out their role safely, something board members were assured was in progress.
Another recommendation is a redesign of urgent and emergency care which is ongoing although there are "significant challenges" here, Dr Murray said.
Work is also ongoing to review the Emergency Department's clinical nurse staffing levels round the clock and agree investment in the health and social care workers' role and development.
Other changes have the introduction of protected learning time of two hours a week or one day per month for emergency department nurses.
The next step, Ms Cowan told the board, is to make sure that all the recommendations are actually making a difference.
She said: "A key requirement that board members have challenged us on is about testing the impact of our actions and of our investments, but I really feel its a bit early yet to get a real handle on effectiveness.
"However, I think it's something that we shouldn't lose sight of and we should give thought to that for a future board meeting because we should be beginning to see those investments landing and the impact."
She said that the relatively quick progress was due to the fact that many of the changes had been planned before the review took place.
"People have said to me it's remarkable the progress, and I think it just demonstrates that a lot was actually in process and was paused because of Covid, but nonetheless we had some serious learning to do and we've accepted that."
