Open access. The positive deviance approach seeks to identify and learn from those who demonstrate exceptional performance. This study sought to explore how multidisciplinary teams deliver exceptionally safe care on medical wards for older people.
This guideline covers diagnosing and managing chronic obstructive pulmonary disease (COPD) in people aged 16 and older, which includes emphysema and chronic bronchitis. It aims to help people with COPD to receive a diagnosis earlier so that they can benefit from treatments to reduce symptoms, improve quality of life and keep them healthy for longer.
Health inspectors say there has been a “significant improvement” in how public sector organisations work together to provide services for older people who need care in Stoke-on-Trent.
The Care Quality Commission (CQC) has revisited the city to look at how well older people – and specifically those over 65 – can move through the health and social care system following an initial inspection in September 2017.
Open access. The growing interest in hospital users’ complaints appears to be consistent with recent changes in health care, which considers the patient’s voice a valuable information source to improve health care. Based on the assumption that the clinicians’ lived experience is an essential element of health care and to neglect it may have serious consequences, this study aimed to explore how physicians experience hospital users’ complaints and the associated mediation process.
As part of its work to improve staff engagement scores on the NHS Staff Survey, Lincolnshire Community Health NHS Trust has taken inspiration from the London Underground to develop a staff engagement tube map.
The case study looks at how the trust aimed to improve its Care Quality Commission rating and NHS Staff Survey score by focused on getting three areas right.
Middle-aged and older adults requiring skilled home healthcare (‘home health’) services following hospital discharge are at high risk of experiencing suboptimal outcomes. Information management (IM) needed to organise and communicate care plans is critical to ensure safety. Little is known about IM during this transition. A U.S. study.. To read the full article, log in using your NHS OpenAthens details.
Despite widespread use of quality indicators, it remains unclear to what extent they can reliably distinguish hospitals on true differences in performance. Rankability measures what part of variation in performance reflects ‘true’ hospital differences in outcomes versus random noise.. To read the full article, log in using your NHS OpenAthens details.
Free access. All healthcare systems show variation in the quality of care provided, whether that means access to primary care services,1 ambulance response times,2 Accident & Emergency waiting times3 or treatment processes and outcomes.4–6 Monitoring this variation in quality can serve multiple purposes: informing patients about where best to seek care;7 allowing clinicians to compare their performance with that of their peers and thus identify targets for local-level quality improvement efforts, and supporting the development of national policy. Though, what all these have in common is a trust in the reliability of the data to adequately reflect healthcare quality—sometimes a questionable assumption.
In BMJ Quality and Safety, Hofstede et al 8 have addressed a common situation where providers (such as hospitals, general practices or community teams) are ranked according to their performance on a quality indicator.
NHS Digital has produced and published the Innovation Scorecard quarterly as an official statistic since January 2013 on behalf of the Office of Life Sciences. It can be used by local NHS organisations to monitor progress in implementing NICE Technology Appraisal recommendations.
We produce the scorecard using a range of data sources. No central data collection is involved.
Junior doctors have the highest rates of prescribing errors, yet no study has set out to understand the differences between completely novice prescribers (Foundation year one (FY1) doctors) and those who have gained some experience (Foundation year two (FY2) doctors). The objective of this study was to uncover the causes of prescribing errors made by FY2 doctors and compare them with previously collected data of the causes of errors made by FY1 doctors.. To read the full article, log in using your NHS OpenAthens details.
Open access. Evidence is mounting that patient-reported experience can provide a valuable indicator of the quality of healthcare services. However, little is known about the relationship between the experiences of people with severe mental illness and the quality of care they receive. We conducted a study to examine the relationship between patient-reported experience and the quality of care provided to people with schizophrenia.
We've added 10 new Be Aware updates following your suggestions:
Musculoskeletal ; Osteoporosis ; Nutrition and obesity ; Falls ; HR ; Research Methods ; Information Governance ; Bladder, bowel and pelvic healthcare ; Rheumatology ; Medicines and healthcare products regulatory agency (circulated email)
Professor Steve Field, Chief Inspector of Primary Medical Services and Integrated Care, said: “Our review of health and social care services in the county found that older people had varied experiences of health and social care services. There were variations in what was available to them depending on where they lived, which meant that people’s experiences of care and the support they received were inconsistent.
West London NHS Trust has been rated Good overall by the Care Quality Commission.
The trust, which was formerly known as West London Mental Health Trust, was rated Outstanding for being caring, Good for being effective, responsive and well-led, and Requires Improvement for being safe, during the inspection which took place on dates between August and October 2018.
West London NHS Trust provides mental health and an increasing range of community healthcare services in west London and Berkshire.
The Chief Inspector of Hospitals has told Avon and Wiltshire Mental Health Partnership NHS Trust that it must make further improvements following its latest inspection by the Care Quality Commission.
The Secretary of State for Health and Social Care asked us to work with NHS Improvement to look at issues in NHS trusts that contribute to Never Events taking place.
Open access. Identifying characteristics associated with struggling healthcare organisations may help inform improvement. Thus, we systematically reviewed the literature to: (1) Identify organisational factors associated with struggling healthcare organisations and (2) Summarise these factors into actionable domains.
Open access. Using outcome measures to advance healthcare continues to be of widespread interest. The goal is to summarize the results of studies which use outcome measures from clinical registries to implement and monitor QI initiatives. The second objective is to identify a) facilitators and/or barriers that contribute to the realization of QI efforts, and b) how outcomes are being used as a catalyst to change outcomes over time.
We'd like to hear your suggestions for new book alert topics. Simply reply to this email with 'Book Alert Topic' and your suggestions. You can also view and sign-up to our current new book alerts here: http://library.sssft.nhs.uk/librarykeepuptodate
In a national report published today, the Care Quality Commission (CQC) found that too many people are being injured or suffering unnecessary harm because NHS staff are not supported by sufficient training, and because the complexity of the current patient safety system makes it difficult for staff to ensure that safety is an integral part of everything they do.
The commitment includes a proposal for some of the most important types of avoidable harm to patients to be halved over the next five years in areas such as medication errors and Never Events, alongside developing a ‘just culture’ for the NHS where frontline staff are supported to speak up when errors occur.
A new resource on CQC’s website, which will see pages added as new topics are addressed, explores the use of technology in care, looking at the benefits of innovation and updating previously published information on surveillance.
Open access. Embracing practice-based quality improvement (QI) represents one way for clinicians to improve the care they provide to patients while also improving their own professional satisfaction. But engaging in care redesign is challenging for clinicians. In this article, we describe our experience over the last 7 years transforming the care delivered in our large primary care practice. We reflect on our journey and offer 10 tips to healthcare leaders seeking to advance a culture of improvement.
Open access. Several countries have national policies and programmes requiring hospitals to use quality and safety (QS) indicators. To present an overview of these indicators, hospital-wide QS (HWQS) dashboards are designed. There is little evidence how these dashboards are developed. The challenges faced to develop these dashboards in Dutch hospitals were retrospectively studied.
Open access. To quantify the association between patient self-management capability measured using the Patient Activation Measure (PAM) and healthcare utilisation across a whole health economy.
Open access. To provide a description of the Imperial College Mortality Surveillance System and subsequent investigations by the Care Quality Commission (CQC) in National Health Service (NHS) hospitals receiving mortality alerts.
To investigate the association between alerts from a national hospital mortality surveillance system and subsequent trends in relative risk of mortality.. To read the full article, log in using your NHS OpenAthens details.
Editorial. Alerts have become a routine part of our daily lives—from the apps on our phones to an increasing number of ‘wearables’ (eg, fitness trackers) and household devices. Within healthcare, frontline clinicians have become all too familiar with a barrage of alerts and alarms from electronic medical records and medical devices.
Somewhat less familiar to most clinicians, however, are the alerts received by institutions from regulators and other regional or national bodies monitoring healthcare performance. After the Bristol inquiry in 2001 in the UK,1 research showed that given the available data Bristol could have been detected as an outlier and that it was not simply a matter of the low volume of cases.2 3 Had the cumulative excess mortality been monitored using these routinely collected data, then an alarm could have given for Bristol after the publication of the 1991 Cardiac Surgical Register and could have saved children’s lives.4 Similar assertions have been made about detecting problems at Mid Staffordshire National Health Service Foundation Trust—that excessively high hospital standardised mortality ratios (SMRs) pre-dated the eventual recognition of exceptionally substandard care subsequently confirmed by other means.5 6. To read the full article, log in using your NHS OpenAthens details.
To obtain an overview of existing evidence regarding quality criteria, instruments and requirements for nursing documentation.. To read the full article, log in using your NHS Athens details. To access full-text: click “Log in/Register” (top right hand side). Click ‘Institutional Login’ then select 'OpenAthens Federation', then ‘NHS England’. Enter your Athens details to view the article.
Letter. We were delighted to read the recent Postgraduate Medical Journal article by Gillen et al 1 describing their explorative findings in relation to Kate Granger’s #hellomynameis campaign.2 Introducing oneself by name, along with an explanation of one’s role, is key to a positive introduction by healthcare professionals to patients, but this is often omitted.2 The ‘#hellomynameis…’ campaign was founded by Dr Kate Granger, following her experiences as a patient. She found that healthcare professionals rarely introduced themselves to her, leading Kate to feel that this missing ‘basic step in communication’ was ‘incredibly wrong’.2 Gillen and his colleagues in Ireland1 point out that there has been little research to examine how doctors (or other healthcare professionals) introduce themselves to patients. Our approach was slightly different: volunteer medical students ….... To read the full article, log in using your NHS OpenAthens details.
Open access. To explore how the South-West Foundation Doctor Quality Improvement programme affected foundation year 1 (F1) doctors’ attitudes and ability to implement change in healthcare.
THE first-ever national guidance for NHS mental health trusts to ensure ways of improving services are learned from patients’ deaths is unveiled today.
The guidance, drawn up by the Royal College of Psychiatrists (RCPsych), focuses on patients with severe mental illness and on four ‘red-flag’ scenarios, including where concerns have been raised by families and carers or where patients have experienced psychosis or had an eating disorder.
Integration of evidence into practice is suboptimal. Clinical pathways, defined as multidisciplinary care plans, are a method for translating evidence into local settings and have been shown to improve the value of patient care.. To read the full article, log in using your NHS OpenAthens details.
Open access. International guidance on models of care stress the importance of good quality, continuous patient-provider relationships to support high quality and efficient care and hospital avoidance. However, assessing the quality of patient-provider relationships is challenging due to its experiential nature. The aim of this study was to undertake a systematic review to identify questionnaires previously developed or used to assess the quality of continuous relationships between patients and their provider in primary care.
Mandie Esp, Ward Manager, said: “By removing non-productive time we now have so much more time in the day to do what is important. The ward is now a calmer environment, so that our patients have commented on the positive changes.
“The atmosphere in the department is also much better as everyone feels more empowered. We spend more time delivering direct patient care, while staff are now able to finish their shifts on time.”
Open access. To explore how the South-West Foundation Doctor Quality Improvement programme affected foundation year 1 (F1) doctors’ attitudes and ability to implement change in healthcare.
Yet there is growing evidence that equality and human rights for people using services and staff needs to play a central role in improving the quality of care. We are finding that some of the best providers are doing this successfully – even in times of constraint.
We have updated the good practice resource and also published:
more case studies
an online e-learning module
Open access. We evaluated the introduction of a predictive risk stratification model (PRISM) into primary care. Contemporaneously National Health Service (NHS) Wales introduced Quality and Outcomes Framework payments to general practices to focus care on those at highest risk of emergency admission to hospital. The aim of this study was to evaluate the costs and effects of introducing PRISM into primary care.
Open access. Lack of resources is often cited as a reason for long waiting times and queues in health services. However, recent research indicates these problems are related to factors such as uncoordinated variation of demand and capacity, planning horizons, and lower capacity than the potential of actual resources.
This study aimed to demonstrate that long waiting times and wait lists are not necessarily associated with increasing demand or changes in resources. We report how substantial reductions in waiting times/wait lists across a range of specialties was obtained by improvements of basic problems identified through value-stream mapping and unsophisticated analyses.
Embracing practice-based quality improvement (QI) represents one way for clinicians to improve the care they provide to patients while also improving their own professional satisfaction. But engaging in care redesign is challenging for clinicians. In this article, we describe our experience over the last 7 years transforming the care delivered in our large primary care practice. We reflect on our journey and offer 10 tips to healthcare leaders seeking to advance a culture of improvement. Our organisation has developed a cadre of QI leaders, tracks a range of performance measures and has demonstrated sustained improvements in important areas of patient care. Success has required deep engagement with both patients and clinicians, a long-term vision, and requisite patience.. To read the full article, log in using your NHS OpenAthens details.
Open access. Healthcare systems worldwide are concerned with strengthening board-level governance of quality. We applied Lozeau, Langley and Denis’ typology (transformation, customisation, loose coupling and corruption) to describe and explain the organisational response to an improvement intervention in six hospital boards in England.
Following improved access and optimisation of the website, the NICE guidance app will no longer be available for download with plans to phase it out by January 2019.
Over the last 2 years, the programme has seen 177 people complete their facilitator training, 20 people signing up as mentors and 250 QI projects completed or in progress, with members of our executive management team undertaking their own QI projects.
The Health and Social Care Committee hears from the Chair, Chief Executive and Chief Inspectors of the Care Quality Commission on the State of Care Report.
The Care Quality Commission’s (CQC) annual assessment of the quality of health and social care in England shows that overall, quality has been largely maintained, and in some cases improved, from last year. This is despite continuing challenges around demand and funding, coupled with significant workforce pressures as all sectors struggle to recruit and retain staff. The efforts of staff, leaders and carers to ensure that people continue to receive good, safe care despite these challenges must be recognised and applauded.
The South London and Maudsley (SLaM) NHS Foundation Trust has been rated Good overall by the Care Quality Commission.
SLaM was rated Good for being effective, caring, responsive and well-led. It was rated Requires Improvement for being safe, following the inspection in July and August 2018.
England’s Chief Inspector of Hospitals has rated the services provided by Tees, Esk and Wear Valleys NHS Foundation Trust as Good following an inspection by the Care Quality Commission.
This year's report finds that most people in England receive a good quality of care. Our ratings show that quality overall has been largely maintained from last year, and in some cases improved, despite the continuing challenges that providers face.
Free access. Incident reporting has been a mainstay of patient safety initiatives throughout the world, but its purpose and potential for stimulating safety improvements are still much debated. Record review studies of adverse events revealed the nature and scale of harm to patients, and it was initially hoped that incident reporting systems would capture these adverse events on an ongoing basis.1 2 This epidemiological dream was never realised; studies showed that incident reporting was actually very poor at identifying adverse events.3 Furthermore, incident reporting, record review and other systems such as pharmacy reports capture very different types of problems, which means that combining information sources can provide a more complete picture of safety issues.4 5
Open access. The Primary Care Patient Measure of Safety (PC PMOS) is designed to capture patient feedback about the contributing factors to patient safety incidents in primary care. It required further reliability and validity testing to produce a robust tool intended to improve safety in practice.
This study identified service characteristics associated with quality of care in specialist mental health supported accommodation services that can be used in the design and specification of services.
This guideline covers decision-making in people 16 years and over who may lack capacity now or in the future. It aims to help health and social care practitioners support people to make their own decisions where they have the capacity to do so. It also helps practitioners to keep people who lack capacity at the centre of the decision-making process.
England's Chief Inspector of Hospitals has found a number of improvements at Derbyshire Healthcare NHS Foundation Trust but says more work is needed following an inspection by the Care Quality Commission.
A team of CQC inspectors visited Southern Health in June and July 2018 to check 10 mental health services and five of its community services. Inspectors also looked specifically at management and leadership to answer the key question: Is the trust well led?
As a result of this inspection the trust remains rated as Requires Improvement overall. However, Inspectors rated the trust as Good for the key questions: Are services caring and responsive and Requires Improvement for safety and effectiveness. Inspectors also rated the trust Requires Improvement for the key question: Is the trust well-led.
The Care Quality Commission has found further improvements Berkshire Healthcare NHS Foundation Trust
A team of CQC inspectors visited the trust during June and July 2018 to check four of the trusts ten mental health services and three of its community services. CQC also looked specifically at management and leadership to answer the key question: Is the trust well led?
Through its Regulators’ Pioneer Fund, the Department for Business, Energy and Industrial Strategy (BEIS) has awarded CQC £500,000 to explore how we can work with providers to encourage good models of innovation.
Independent research carried out by AvMA shows that the Care Quality Commission (CQC) “requires improvement” in how it regulates the statutory duty of candour. This is despite significant improvements since AvMA’s previous report in 2016.
The independent homicide review report identifies a number of areas for improvement in the care we provided and these largely mirror the findings of the Trust’s own investigation in 2015. Since that time we have implemented a number of significant changes and improvements to our mental health services in Southampton and are in the process of putting in place the additional recommendations highlighted in this report.
A team of allied health professionals in Barnsley have been motivating each other and helping to make improvements using simple flipcharts known as the ‘wonderwall’ and the ‘why wall’.
Introduced to the group by specialist dietitian Sarah Armer, the ‘wonderwall’ is a board for staff to note down compliments and praise for each other, while the ‘why wall’ is a safe space to ask questions and create debate.
The artists and Hospital Rooms have worked in partnership with the patients and staff on ES1 PICU to improve the quality of care for patients, change the physical environment and produce innovative permanent artworks. The award highlights how a physical environment on a ward can have a big impact on the quality of care which patients receive.
Open access. The research aimed to explore the value of the Net Promoter Score as a service improvement tool and an outcome measure. The study objectives were to (1) explore associations between the Net Promoter Score with patient and service‐receipt characteristics; (2) evaluate the strength of association between the Net Promoter Score and a satisfaction score; and (3) evaluate its test‐retest reliability.
This guideline covers diagnosing and managing chronic heart failure in people aged 18 and over. It aims to improve diagnosis and treatment to increase the length and quality of life for people with heart failure.
This guideline covers ways to reduce suicide and help people bereaved or affected by suicides. It aims to:
help local services work more effectively together to prevent suicide
identify and help people at risk
prevent suicide in places where it is currently more likely.
The three new areas we have now been asked to review and will report on individually by December are:
Staffordshire
Leeds
Reading
We have also been asked to choose three local system areas, from those that we carried out in our programme of work in 2017/18, to follow up on progress made.
The three follow-up areas are:
Stoke-on-Trent
York
Oxfordshire
‘Quality improvement in hospital trusts’ shares learning from acute, community and mental health trusts.
All had adopted and embedded Quality Improvement (QI) across their organisation. This is a systematic approach to improving service quality, efficiency and morale.
This report highlights what these trusts told us about their experiences of using QI.
The Prevention of Hospital Infections by Intervention and Training (PROHIBIT) project included a cluster-randomised, stepped wedge, controlled study to evaluate multiple strategies to prevent catheter-related bloodstream infection. We report an in-depth investigation of the main barriers, facilitators and contextual factors relevant to successfully implementing these strategies in European acute care hospitals.
. To read the full article, log in using your NHS OpenAthens details.
Open access. Editorial. An enduring challenge for the improvement of healthcare quality is variation in the success of quality improvement (QI) interventions when implemented across settings.1 This is particularly true in the field of healthcare-associated infection (HAI) prevention. Some of the brightest success stories in QI have emerged from large-scale efforts to reduce HAIs such as central venous catheter-related bloodstream infections (CRBSIs)2 or catheter-associated urinary tract infections.3 The light dims, however, when efforts to export these interventions to other settings fail to meaningfully improve outcomes.4 5
Free. Editorial. All healthcare systems show variation in the quality of care provided, whether that means access to primary care services,1 ambulance response times,2 Accident & Emergency waiting times3 or treatment processes and outcomes.4–6 Monitoring this variation in quality can serve multiple purposes: informing patients about where best to seek care;7 allowing clinicians to compare their performance with that of their peers and thus identify targets for local-level quality improvement efforts, and supporting the development of national policy. Though, what all these have in common is a trust in the reliability of the data to adequately reflect healthcare quality—sometimes a questionable assumption.
In BMJ Quality and Safety, Hofstede et al 8 have addressed a common situation where providers (such as hospitals, general practices or community teams) are ranked according to their performance on a quality indicator.
- Quick access to the Royal Marsden online via the library website homepage: library.sssft.nhs.uk
- Sign-in using your Open Athens username and password (if you don't yet have an Open Athens account, register at: openathens.nice.org.uk)
- Do a quick keyword search of all procedures
- Browse all chapters, clinical procedures and illustrations
- View custom MPFT procedures including: infection control skin preparation, medicines management.
The Care Quality Commission (CQC) has rated Oxford Health NHS Foundation Trust ‘good’ in four out of five quality measurements – caring, responsive, well-led, effective and ‘requiring improvement’ for safe.
This guideline covers how to increase uptake of the free flu vaccination among people who are eligible. It describes ways to increase awareness and how to use all opportunities in primary and secondary care to identify people who should be encouraged to have the vaccination.
It outlines the steps needed to address the variation in the provision of specific services for adults with cerebral palsy and aims to help local and regional services to provide consistent clear pathways of clinical and social care.
NICE draft guidance published today (31 August) says a potentially life changing treatment for some adults with severe asthma is safe and effective enough for use on the NHS, depending on commissioning arrangements.
The trust was rated as Good following an inspection in January 2017 but on CQC’s return inspectors found a number of improvements had been made resulting in it receiving an Outstanding rating.
CQC refused CMG’s application on the basis it did not demonstrate it would comply with CQC’s policy ‘Registering the Right Support’ – as well as the underpinning national guidance – that states new services and variations to registrations within a campus and congregate setting should not be developed due to this model of care not being in the best interests of people with a learning disability.
The guidelines provide recommendations on how to increase uptake of the free flu vaccination among those who are eligible.
The recommendations encourage employers of health and social care staff to use a multicomponent approach, including providing information about the effectiveness and safety of the flu vaccine, training peers to vaccinate their co-workers and assigning dedicated staff to increase awareness and uptake.
Now three years into the partnership with the Virginia Mason Institute (VMI) in Seattle, The Shrewsbury and Telford Hospital NHS Trust (SaTH) is reaping the rewards of its own Transforming Care Production System (TCPS) with the procurement team making savings of £1.8 million in the last financial year.
‘The Problem with…’ series covers controversial topics related to efforts to improve healthcare quality, including widely recommended, but deceptively difficult strategies for improvement and pervasive problems that seem to resist solution.. To read the full article, log in using your NHS OpenAthens details.
Open access. Healthcare organisations often fail to harvest and make use of the ‘soft intelligence’ about safety and quality concerns held by their own personnel. We aimed to examine the role of formal channels in encouraging or inhibiting employee voice about concerns.
Patient safety measurement remains a global challenge. Patients are an important but neglected source of learning; however, little is known about what patients can add to our understanding of safety. We sought to understand the incidence and nature of patient-reported safety concerns in hospital.. To read the full article, log in using your NHS OpenAthens details.
The guidance has been developed by NHS England as part of the NQB led programme of work to implement the recommendations we made in our report ‘Learning, Candour and Accountability’. Our report identified specific concerns about the way NHS trusts were investigating and learning when patients within their care die and the extent to which families and carers were involved in the investigations process.
Wast Hills House is an independent hospital providing assessment, treatment and care to people with a complex learning disability and autism. Wast Hills House is owned by Oakview Estates Limited, trading as The Danshell Group.
Inspectors found staff were caring and compassionate and people were being provided with safe, responsive, caring, effective and well-led care. A full inspection report has been published on our website: read the report.
Between 30 April and 16 May 2018, a team of CQC inspectors visited the trust’s core services. Inspectors rated the care provided by staff to be Good regarding whether services were effective, caring, responsive and well-led and rated as Requires Improvement regarding whether services were safe.
A team of inspectors visited Northumberland Tyne and Wear NHS Foundation Trust in April and May. It was rated Good for safety, and Outstanding for caring, effectiveness, responsiveness and well-led. Overall, the trust rating has remained Outstanding - the same rating that it achieved when it was last inspected, in June 2016.
Picker has published a report which outlines the key learnings from NHS trusts involved in the scale-up and spread of Always Events.
Always Events are aspects of the patient experience that are so important to patients and family members that health care providers must aim to perform them consistently for every individual, every time.