Background The positive deviance approach focuses on those who demonstrate exceptional performance, despite facing the same constraints as others. ‘Positive deviants’ are identified and hypotheses about how they succeed are generated. These hypotheses are tested and then disseminated within the wider community. The positive deviance approach is being increasingly applied within healthcare organisations, although limited guidance exists and different methods, of varying quality, are used. This paper systematically reviews healthcare applications of the positive deviance approach to explore how positive deviance is defined, the quality of existing applications and the methods used within them, including the extent to which staff and patients are involved. To read the full article, log in using your NHS Athens
Objectives One important component of patient-centred care is provider incorporation of patient contextual factors—life circumstances relevant to their care—in managing the patient's health. The current study uses data sets collected from direct observation of care to examine if how a provider learns contextual information influences whether the provider incorporates the information into a care plan.
Quality improvement (QI) methods have been introduced to healthcare to support the delivery of care that is safe, timely, effective, efficient, equitable and cost effective. Of the many QI tools and methods, the Plan-Do-Study-Act (PDSA) cycle is one of the few that focuses on the crux of change, the translation of ideas and intentions into action. As such, the PDSA cycle and the concept of iterative tests of change are central to many QI approaches, including the model for improvement,1 lean,2 six sigma3 and total quality management.4
Patient-centred care, defined as respecting and responding to the needs and preferences of patients, empowering them to make decisions that best fit their individual needs, has been identified by the Institute of Medicine as an essential element of high-quality care.1 It can be thought of as respectfully involving the patient2 in a way that helps practitioners provide care that is concordant with their patients’ values, needs and preferences while better enabling patients to actively provide input and participate in their healthcare.3 Patients are more satisfied with their care when they feel that healthcare providers are understanding their needs, carefully listening and clearly providing information4; in addition, patient-centred care has been found to be associated with improved patient outcomes.5 In order to provide exemplary patient-centred care, one needs well developed communication skills, especially in the realm of active listening and responding to patient cues. The importance of physicians mastering the art of patient-centred communication skills can be seen as a theme in the educational objectives of medical school curricula as well as in the competencies of the Accreditation Council for Graduate Medical Education. To read the full article, log in using your NHS Athens
Quality improvement (QI) efforts affect a broader range of people than we often assume. These are the potential stakeholders for QI and its evaluation, and they have valuable perspectives to offer when they are consulted in planning, conducting and interpreting evaluations. QI practitioners are accustomed to consulting stakeholders to assess unintended consequences or assess patient experiences of care, but in many cases there are additional benefits to a broad inclusion of stakeholders.
In hospitals, breakdowns in communication has been found to be a major source of errors.1 Communication between clinicians can occur at scheduled times or rounds, through face-to-face meetings or may be facilitated through the use of communication tools such as pagers. For the latter, often urgent communication between clinicians about a patient is required. Problems in communication can result in a failure to rescue or result in poor coordination of care. To read the full article, log in using your NHS Athens
Objective Improving quality of life (QOL) is the central focus of palliative care support for children with life-limiting illness (LLI), but achieving this can be challenging.
Intervention MyQuality is an online tool that enables families to choose and monitor parameters they identify as having an impact on their QOL, which aims to improve patient–professional communications and also to enhance patient empowerment within healthcare dialogues.
Picker Institute Europe has published a new briefing; “Person-centred care in Europe: a cross-country comparison of health system performance, strategies and structures.” The document provides an overview of the different approaches taken to providing quality healthcare across Europe. Looking specifically at the person-centred care interpretations and strategies taken in England, Italy, Spain, Germany and the Netherlands.
Managing demand for planned health care is described in this report as a “wicked problem” – demand for healthcare is outpacing capacity to meet it.
Health economies have tried various approaches to managing demand; referral management centres, expanded roles, direct access amongst others. But the evidence base has been mixed, of variable quality and sometimes conflicting findings.
This synthesis of evidence sets out to understand what works but with a particular focus on context, to understand what works, in what settings and why.
The NHS in England faces the immense challenge of bringing about improvements in patient care at a time of growing financial and workload pressures.
In a report published today, we argue that the NHS urgently needs to adopt a quality improvement strategy if it is to rise to this challenge. All NHS organisations need to build in-house capacity for quality improvement and to commit time and resources to acquiring the necessary capabilities. They should do so by learning from the experience in trusts such as Salford, Sheffield and Wigan where quality improvement is well established.
Lean healthcare is claimed to contribute to improved patient satisfaction, but there is limited evidence to support this notion. This study investigates how primary-care centres working with Lean define and improve value from the patient's perspective, and how the application of Lean healthcare influences patient satisfaction. To read the full article, log in using your NHS OpenAthens details
In February 2016, we updated this guideline to link to the Medicines and Healthcare Products Regulatory Agency’s (MHRA) toolkit to ensure female patients are better informed about the risks of taking valproate during pregnancy.
Dr Paul Lelliott, Deputy Chief Inspector of Hospitals (lead for mental health) has welcomed the publication of the independent Mental Health Taskforce's Mental Health Taskforce's Five Year Forward View for Mental Health.
Two £25 vouchers are up for grabs in the library’s ‘Making the Most of Information’ survey.
To take part, just visit http://goo.gl/AdN4ok by Friday 19th February.
We have published the first of three prototype reports looking at how we might assess the quality of care in a local area to encourage improvement. [First report covers North Lincolnshire]
Presentation from NHS Transformathon. Social media tools are developing at pace and offer many ways to bring about change in health and care. This session provides a snapshot of the global work of innovators, clinicians, patients and digital collaborators who have shared their learning online and explored the possibilities to improve patient care.
Innovation happens through connecting ideas and people. Social media enables connection at scale, pace and by flattening hierarchies. The presenters offer their different narratives of change, how this resonates with their communities and highlight analytics that can be used. This is a whistle stop tour of social media innovation which starts with a simple idea and develops to healthcare change with impact.
Presentation from NHS Transformathon. There many ways to understand how we make change happen. The Art of Change Making draws on the experience of a team of ‘enablers’ who have worked on complex system issues all across England and in some cases the world. The Art captures this wisdom in a simple to access guide to how to make change happen.
In this interactive session, we will explore with you several techniques and models that have proved helpful in running major national projects as well as organisational and community interventions. Be prepared to think about issues in your own place and come ready to explore them further with colleagues as part of our work together.
Presentation from NHS Transformathon. This session will show how, as a nation, Scotland is seeking to achieve large scale improvement in health and care through a combination of programme-specific activities and supporting development of sustainable QI cultures within health and care organisations. They’ll do this by sharing their experience of using a range of activities to support cultural change including the Building a QI Infrastructure Programme and Board development activities. They will also share their learning and outcomes from a specific example in the care of people living with frailty and delirium.
A new waiting time target for admission to acute psychiatric care of four hours should be introduced, a commission convened by the Royal College of Psychiatrists has said.1
The commission warned that access to acute care for severely ill adult mental health patients was “inadequate nationally and, in some cases, potentially dangerous.” There were major problems both in admissions to psychiatric wards and in providing alternative care and treatment in the community, it added.
The commission asked for a new waiting time pledge to be included in the NHS Constitution from October 2017. It wants a maximum four hour wait for admission to an acute psychiatric ward or for home based treatment.
Over the past few weeks, concerns have been raised with CQC by some Experts by Experience in relation to moving between their current employers and Remploy Ltd, one of the two organisations awarded new contracts to deliver Experts by Experience services from 1 February.
We will publish two documents covering foundation trusts’ requirements for 2015/16. This consultation includes:
our proposals for indicators to be subject to assurance in our detailed guidance for external assurance on quality reports 2015/16
our proposal to clarify guidance on how auditors should report a modified conclusion on their limited assurance work
an invitation for you to comment on who should provide the external assurance on quality reports from 2016/17
We will consider all responses in finalising these documents for 2015/16.
Four evidence reviews written to support work NICE carried out on staffing levels in the NHS have been released. Under the Freedom of Information (FOI) Act, the documents had been withheld to give NHS Improvement time to study them in their new remit to consider service improvement. The release of the documents follows an internal review of the FOI decision.
In 2013 the Francis and Berwick reports, published in the wake of care failings at the Mid Staffordshire NHS Trust, identified NICE as a key player to help advise the NHS on staffing levels. The Department of Health and NHS England asked NICE to begin work developing evidence based guidelines focusing on nursing care, one of the main drivers of patient safety.
Tara Lamont and colleagues discuss how researchers can help service leaders to evaluate rapidly changing models of care, with a range of approaches depending on needs and resources. To read the full article, log in using your NHS Athens
The aim of the project is to listen to children and young people’s views on how health and care services could be improved. To do this, we worked with Youth Action Wiltshire to train 12 people, aged 16-18 years, in skills such as safeguarding, listening and communication. They can now go out into the community and speak to children and young people about their experiences.
Day-to-day responsibility for smooth operational running of trusts lies with their boards, and when things go wrong, formal oversight of trust boards is provided by regulators. But between those two stools is performance management; in the current system, that sits with commissioners.
This Future Hospital Programme case study comes from Withybush Hospital. It lays out the process for initiating an organised quality improvement project run by trainees, with the coordination of a lead doctor.
Open access. Letters of complaint written by patients and their advocates reporting poor healthcare experiences represent an under-used data source. The lack of a method for extracting reliable data from these heterogeneous letters hinders their use for monitoring and learning. To address this gap, we report on the development and reliability testing of the Healthcare Complaints Analysis Tool (HCAT).
Patient participation in healthcare is recognised internationally as essential for consumer-centric, high-quality healthcare delivery. Its measurement as part of continuous quality improvement requires development of agreed standards and measurable indicators. To read the full article, log in using your NHS OpenAthens details
CQC’s Chief Inspector of Hospitals, Professor Sir Mike Richards and the Chief Executive of NHS Improvement, Jim Mackey have written to all 255 NHS hospital trusts in England to ask them to consider quality and finances on equal footing in their planning decisions.
Ahead of publishing the consultation response into the functions of the office of the National Guardian, Dame Eileen Sills has set out the principles and priorities that will guide her first months in post.
‘Responding to Concerns’, is a new educational film developed by Health Education England that aims to improve patient safety. Developed with input from patient safety experts, including our raising concerns network, the film aims to equip staff with the knowledge, skills and confidence to adequately and safely respond to patient safety concerns.
Four evidence reviews written to support work NICE carried out on staffing levels in the NHS have been released. Under the Freedom of Information (FOI) Act, the documents had been withheld to give NHS Improvement time to study them in their new remit to consider service improvement. The release of the documents follows an internal review of the FOI decision.
Background: evidence from inspection programmes suggest that the quality of care provided by individual care homes for older people is very variable. Aside from periodic inspection, there is limited information that is routinely collected and can be used to monitor quality.
Objectives: to describe a method for using routine hospital data on admissions of older people as means for monitoring quality of care within a care home. To explore how this might be applied and used. Login using your SSSFT NHS OpenAthens for full text. SSOTP - request a copy of the article from the library - www.sssft.nhs.uk/library
Dr Paul Lelliott, Deputy Chief Inspector of Hospitals (and lead for mental health) said:
"We welcome this report, which highlights the failure of Southern Health NHS Foundation Trust to investigate and learn from the deaths of people who received care from their Learning Disability and Mental Health services. We will be working closely with NHS England, Monitor and the Health and Safety Executive to understanding the implications of its findings.
"We will also be undertaking a wider review into the investigation of deaths of people with Learning Disabilities in Mental Health and Acute trusts in different parts of the country. As part of this review, we will assess whether opportunities for prevention of death have been missed, for example by late diagnosis of physical health problems."
Our Experts by Experience programme, which involves the public in its inspections, is expanding and looking for new recruits.
Experts by Experience are people who have personal experience of using or caring for someone who uses health, mental health and/or social care services that are regulated by CQC.
The successful winners of new contracts to provide CQC with Experts by Experience are the organisations Remploy in the North, South and London regions and Choice Support in the Central region. They are now looking for new Experts by Experience to join CQC inspection teams and help deliver other aspects of CQC’s work.
We have announced today the appointment of Dame Eileen Sills, the Chief Nurse at Guy's and St Thomas' NHS Foundation Trust, as the first National Guardian for speaking up safely in the NHS.
Open access. Quality improvement (QI) methods have been introduced to healthcare to support the delivery of care that is safe, timely, effective, efficient, equitable and cost effective. Of the many QI tools and methods, the Plan-Do-Study-Act (PDSA) cycle is one of the few that focuses on the crux of change, the translation of ideas and intentions into action
Mental Elf Blog post. The quality and outcomes framework (QOF) was introduced in the NHS in 2004 as part of the new General Medical Services contract (Health and Social Care Information Centre, 2016). Its purpose was to improve the quality of NHS primary care clinical services and also to retain general practitioners (GPs).
..... If one looks at the high level of attainment of these QOF indicators among GP practices you could say that the quality of clinical care is better insofar as the indicators themselves measure it. The real question for someone like me is whether it makes any difference at all to the medium or long term outcomes of people with mental health problems.
To study the effects of scale type (visual analogue scale vs. Likert), item order (systematic vs. random), item non-response and patient-related characteristics (age, gender, subjective health, need for assistance with filling out the questionnaire and length of stay) on the results of patient satisfaction surveys. Login using your SSSFT NHS OpenAthens for full text. SSOTP - request a copy of the article from the library - www.sssft.nhs.uk/library
An analysis has identified “significant patient safety risks” at private hospitals treating NHS patients in England. To read the full article, log in using your NHS Athens
NHS England has today published an independent report into the deaths of people with a learning disability or mental health problem at Southern Health NHS Foundation Trust, and highlighted a system-wide response.
Secretary of State for Health, Jeremy Hunt, responded to an Urgent Question asked by Shadow Secretary of State for Health, Heidi Alexander, in the House of Commons on the report of the investigation into the deaths at Southern Health NHS Foundation Trust.
The Committee of Public Accounts today raises new concerns about the performance of the Care Quality Commission, the independent regulator of health and adult social care in England.
Open access. Despite taking advantage of established learning from other industries, quality improvement initiatives in healthcare may struggle to outperform secular trends. The reasons for this are rarely explored in detail, and are often attributed merely to difficulties in engaging clinicians in quality improvement work. In a narrative review of the literature, we argue that this focus on clinicians, at the relative expense of managerial staff, has proven counterproductive. Clinical engagement is not a universal challenge; moreover, there is evidence that managers—particularly middle managers—also have a role to play in quality improvement.
A patient safety alert has been issued by NHS England to raise awareness of the importance of taking, recording and responding to vital signs where restraint has been used to manage a person’s behaviour if they are at risk to themselves or others.
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