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.
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.
Book review. Writing to Improve Healthcare, edited and authored by David P. Stevens, is a timely and important book that is designed to help quality improvers publish their quality improvement (QI) work. (Dr Stevens was the previous Editor-in-Chief of this journal, when it was called Quality & Safety in Healthcare.) The book is unique in that it applies a healthcare improvement perspective to the traditional manuscript preparation and publication process. This is useful for the novice writer and for authors accustomed to writing more traditional clinical research studies or writing for other biomedical fields. Indeed, while some prospective authors of QI work may not be first-time writers, this may be the …...To read the full article, log in using your MPFT NHS OpenAthens details. To read a copy of the book in this review, please contact the library
Open access. The Care Quality Commission (CQC) is responsible for ensuring the quality of healthcare in England. To that end, CQC has developed statistical surveillance tools that periodically aggregate large numbers of quantitative performance measures to identify risks to the quality of care and prioritise its limited inspection resource. These tools have, however, failed to successfully identify poor-quality providers. Facing continued budget cuts, CQC is now further reliant on an ‘intelligence-driven’, risk-based approach to prioritising inspections and a new effective tool is required.
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.
The Care Quality Commission’s Chief Executive, Ian Trenholm and Dr Paul Lelliott, Deputy Chief Inspector (Mental Health) will give evidence to the UK Parliament Human Rights Committee in early June.
High quality care is patient-centred.1 Efforts to promote patient-centred care in clinical practice should improve quality. Both shared decision-making (SDM) and the process of obtaining informed consent could be expressions of patient-centred care—to the extent that they respond to the advocates' call for ‘nothing about me without me’. In this issue of BMJ Quality and Safety, Shahu et al2 discuss variations in the quality of informed consent procedures, which could, in their view, fail to support patient-centred care in general, and SDM specifically. To read the full article, log in using your NHS OpenAthens details.
Editorial. High quality care is patient-centred.1 Efforts to promote patient-centred care in clinical practice should improve quality. Both shared decision-making (SDM) and the process of obtaining informed consent could be expressions of patient-centred care—to the extent that they respond to the advocates' call for ‘nothing about me without me’. In this issue of BMJ Quality and Safety, Shahu et al2 discuss variations in the quality of informed consent procedures, which could, in their view, fail to support patient-centred care in general, and SDM specifically. To read the full article, log in using your NHS OpenAthens details.
Health systems invest in diabetes quality improvement (QI) programmes to reduce the gap between research evidence of optimal care and current care.1 Examples of commonly used QI strategies in diabetes include programmes to measure and report quality of care (ie, audit and feedback initiatives), implementation of clinician and patient education, and reminder systems. A recent systematic review of randomised trials of QI programmes indicates that they can successfully improve quality of diabetes care and patient outcomes.2 Changes in surrogate markers such as blood glucose control, blood pressure or cholesterol levels are used to measure QI intervention effectiveness.2
However, investments in QI strategies are only worthwhile if the programmes that effectively improve care are sustained after trial completion.3. To read the full article, log in using your NHS OpenAthens details.
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.
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
Open access. It is now 15 years since Bell and Redelemeier published their landmark study demonstrating higher mortality for people admitted to hospital during weekdays compared with the weekend.1 Examining the records of 3.8 million patients admitted over a 10-year period to emergency departments in Ontario, Canada, this ‘weekend effect’ existed over a range of acute conditions, including 23 out of the 100 leading causes of death.
Since that paper in 2001, over 100 studies have explored the weekend effect, across a range of patient populations and health systems.2 Surprisingly, despite this large number of studies, there remains ongoing debate about whether the weekend effect exists, and if so, what causes it......
It is now 15 years since Bell and Redelmeier published their landmark study demonstrating higher mortality for people admitted to hospital during weekends compared with during the week.1 Examining the records of 3.8 million patients admitted over a 10-year period to emergency departments in Ontario, Canada, this ‘weekend effect’ existed over a range of acute conditions, including 23 out of the 100 leading causes of death.
Since that paper in 2001, over 100 studies have explored the weekend effect, across a range of patient populations and health systems.2 Surprisingly, despite this large number of studies, there remains ongoing debate about whether the weekend effect exists, and if so, what causes it. For example, one recent and highly influential study found higher rates of in-hospital death following admission on Saturday or Sunday compared with Wednesday admissions (HR 1.10 for Saturday and 1.15 for Sunday).3 To read the full article, log in using your NHS OpenAthens details.
Open access. In 2001, the Institute of Medicine defined high-quality healthcare as care that is safe, effective, patient-centred, timely, efficient and equitable.1 Subsequently, efforts to improve quality have tended to treat the six dimensions as separate rather than interrelated, with improvement in the various dimensions being pursued independently, led by different professions and occupational groups. Investment in research and improvement knowledge across the dimensions has been comparatively uneven, with little shared learning between researchers and professionals working to improve quality in one dimension about the value and efficacy of improvement approaches and methods used in others. Despite policy efforts to define quality in the round as safe, effective and patient-centred,2 3 and despite intermittent calls for patients to be involved in patient safety,4 the dimensions of quality do not have equal status within the improvement community, and patients and families do not play much part in patient safety: their input in this area is seen as subjective and less relevant to outcomes.
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.
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.
Open access. South West London and St George's Mental Health NHS Trust developed a system of weekend new patient reviews by higher trainees to provide senior medical input 7 days a week. To evaluate the effectiveness of these reviews, the notes for all patients admitted over 3 months were examined. The mean length of stay for patients before and after the introduction of the weekend new patient reviews were compared via unpaired t-test.
Providers should continue to ensure that they provide communication to families of people who have died using their services and those affected by serious incidents. By Laura Paton. Please contact the library to receive a copy of this article - http://bit.ly/1Xyazai
The Care Quality Commission has rated wards for people with learning disabilities or autism provided by Central and North West London NHS Foundation Trusts as Outstanding following its latest inspection.
Determination of phosphate solubilization and plant growth promotion of bacterial isolates from paddy rhizosphere Vinithra Muthaiyan, Saravanan...
IJAAR Published such kinds of Articles in every issue. Here is March 3 issue
This quality standard covers short-term prevention and management of violent and physically threatening behaviour among adults, children and young people with a mental health problem. It applies to settings where mental health, health and social care services are provided. This includes community settings and care received at home. It describes high-quality care in priority areas for improvement.
The Shrewsbury and Telford Hospital NHS Trust (SaTH) has been working to improve care for patients who suffer Sepsis and has been using techniques learnt from the Virginia Mason Institute (VMI) in Seattle, as part of a five-year partnership.
This guideline covers assessing and reducing the risk of venous thromboembolism (VTE or blood clots) and deep vein thrombosis (DVT) in people aged 16 and over in hospital. It aims to help healthcare professionals identify people most at risk and describes interventions that can be used to reduce the risk of VTE.
April 2016: Statement 4 describing the use of compression stockings was removed. This is because the guidance from NICE has been updated and the advice on using compression stockings has changed. All other information remains the same.
In the last 10 years or more there has been a proliferation of ‘innovations’ under the guise of improving patient safety and quality improvement. Service and quality improvements have a dominant focus on small-scale projects, incorporating locally collected ‘evidence’ and engaging in small ‘tests of change’ usually using PDSA (Plan, Do, Study, Act) cycles that get scaled up across organisations if considered to be successful....Login using your SSSFT NHS OpenAthens for full text. SSOTP - You can request a copy of this article by replying to this email. Please ensure you are clear which article you are requesting.
Quality improvement initiatives can become bogged down by excessive data collection. Sometimes the question arises—are we doing an adequate job with respect to a recommended practice? Are we complying with some guideline in at least X% of our patients? The perception that one must audit large numbers of charts may present a barrier to initiating local improvement activities. The model for improvement and its Plan–Do–Study–Act (PDSA) cycles typically require frequent data collection to test ideas and refine the planned change strategy. The perception that data collection must involve many patients can lead to insufficiently frequent PDSA cycles.1 In this review, we demonstrate the important contributions that small samples can make to improvement projects, including local audits, PDSA cycles and during broader implementation and evaluation. To read the full article, log in using your NHS Athens
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 guide aims to improve patient care and clinical audit delivery by providing practical advice on how established RCA techniques can 'add value' to clinical audit. The guide is primarily aimed at clinical audit professionals and healthcare staff that participate in clinical audit initiatives at both local and national level.
In addition there are useful templates which can also be downloaded as separate documents below and adapted for your personal use.
Editorial. More than 50 years of health services research has driven home a core lesson: unintended and inappropriate variations in care are common.1 2 Identification of such variation in obstetrics was the impetus for Archie Cochrane to start his work.3 In this issue of BMJ Quality & Safety, Weiss and colleagues report an intervention developed to address inappropriate variation in aspects of maternal newborn care across Ontario, Canada’s most populous province.4 The intervention involved systematic collection and analysis of administrative data to assess key quality indicators for all hospital births in the province and provision of this data in a ‘dashboard’ back to hospitals.. To read the full article, log in using your NHS OpenAthens details.
Open access. Measuring quality of care and comparing this against agreed-upon standards of practice or peer performance (ie, audit) and delivery of the results to healthcare professionals and/or administrators (ie, feedback) is a common quality improvement strategy.5 Whether referred to as ‘audit and feedback’, ‘report cards’, ‘benchmarking’, ‘practice profiles’ or other synonyms, the underlying rationale for audit and feedback is sound. The large literature evaluating this approach indicates that (1) clinicians are relatively poor at self-assessment,6 meaning that they tend to pursue continuing professional development or quality improvement in areas of interest (where performance is often already high) rather than areas of greatest need; (2) comparing current performance to a target can drive increased performance in motivated individuals,7–9 meaning that when desired behaviours can be measured and presented in a formative fashion,10 health professionals may respond positively to them; and (3) high-performing health systems tend to feature audit and feedback as an evidence-based, scalable and relatively inexpensive strategy to encourage uptake of best practices.11
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.
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.
Minister of State for Community and Social Care, Alistair Burt, responded to an Urgent Question asked by Shadow Minister for Mental Health, Luciana Berger, in the House of Commons on the safety of care and services provided by Southern Health NHS Foundation Trust on Tuesday 3 May 2016.
Care Quality Commission (CQC) inspectors have updated ratings for the Tavistock and Portman NHS Foundation Trust following an inspection in November 2016, rating us as Good across all categories.
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.
Open access. Just over 50 years ago, Avedis Donabedian published his seminal paper, which sought to define and specify the ‘quality of health care’, articulating the now paradigmatic triad of structure, process and outcome for measuring healthcare quality.1 In recent years, we have seen the rapid expansion of increasingly inexpensive information technology capability and capacity, facilitating the collection and analysis of large healthcare data sets. These technological advances fuel the current proliferation of performance measurement in healthcare
PERFORMANCE: A review into the unexpected deaths of 18 mental health patients at an East Midlands trust has found “consistent failings” in the way staff carried out risk assessments when investigating the deaths. Contact the library for a copy of this article.
UHDB is celebrating a year of embarking on an improvement practice this month. On 12 April 2018, we were chosen as one of seven trusts nationally to take part in a programme which draws on learning from an American hospital to enable staff in a new improvement method which delivers results that patients will see and feel.
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
Mental health wards for older people at Central and North West London NHS Trust have been rated as Good overall by the Care Quality Commission.
The wards at five different trust sites were rated as Good for being effective, caring, responsive and well-led. They were rated as Requires Improvement for being safe, after the inspection carried out at the end of January and beginning of February 2017.
The trust had made many improvements since the last CQC inspection in 2015 when caring, responsiveness and effectiveness were all rated as Requires Improvement.
Last week Trusts from Cornwall and Somerset met to look at how their services meet the needs of those living with a learning disability and epilepsy.
Cornwall Partnership NHS Foundation Trusts (CFT) Learning Disability Epilepsy Team met with staff from Somerset Partnership NHS Foundation Trust Community Learning Disability Team to look at how their services work to meet the needs of their patients and the different models of service design from a patient perspective.
PERFORMANCE: Older people’s mental health wards across Sussex require improvement, according to the Care Quality Commission. Please contact the library to receive a copy of this article - http://bit.ly/1Xyazai
A Pre-admission Suite (PAS) at a south London mental and community health trust has now closed, following a Care Quality Commission focused inspection in August 2019.
CQC undertook the inspection following concerns received about the length of
time patients stayed in Oxleas NHS Foundation Trust’s PAS and complaints from patients and relatives.
This is an important judgement as it further clarifies what is an acceptable care setting. The appearance of the proposed service did not match with the residential area it was located within and was too big - there was a supported living service on the same site. This did not promote integration with the local community.
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 present study investigates the suitability of various treatment outcome indicators to evaluate performance of mental health institutions that provide care to patients with severe mental illness. Several categorical approaches are compared to a reference indicator (continuous outcome) using pretest-posttest data of the Health of Nation Outcome Scales (HoNOS).
This quality standard covers all young people (aged up to 25) using children’s health and social care services who are due to make the transition to adults’ services. It includes young people:
with mental health problems
with disabilities
with long-term, life-limiting or complex needs
in secure settings
under the care of local authorities.
This guideline covers the period before, during and after a young person moves from children's to adults' services. It aims to help young people and their carers have a better experience of transition by improving the way it’s planned and carried out. It covers both health and social care.
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.
Open access. Quality improvement (QI) projects have been shown to positively influence patient care. They provide opportunities for trainees to present and publish their work locally and nationally, and to gain valuable leadership and management experience. We describe a pilot project to engage in QI trainees across a National Health Service trust and a school of psychiatry. After the first year of this programme over half of psychiatry trainees in the school (58% of core trainees and 47% of advanced trainees) are participating in 28 individual QI projects and QI project methodology is to become embedded in the core psychiatry training course. Specialty doctors, consultants, foundation doctors, general practitioner trainees, medical students and the wider multidisciplinary team have all become engaged alongside trainees, working with patients and their families to identify problems to tackle and ideas to test.
The Care Quality Commission has rated the care being provided by MOSAIC to be Outstanding after an inspection in January 2019.
MOSAIC is a substance misuse service operated by Stockport Metropolitan Borough Council and provides support and treatment for people with drug and alcohol issues, as well as support for young people whose parents misuse substances.
Safe staffing levels across the NHS have worsened significantly in the last year, according to UNISON’s UK-wide annual survey of nursing professionals published today (Monday), at the start of its annual health conference in Brighton.
There is much debate within the improvement field about the value of RCTs in determining the effectiveness of improvement interventions. In 2007, Donald Berwick's monologue ‘eating soup with a fork’ provided a convincing argument for why the RCT was necessary for evidence-based medicine, but inadequate for evaluating complex social interventions such as collaboratives and campaigns. Since then, there has been an apparent ‘cooling’ in the appetite of improvement practitioners to adopt RCT methods in attempts to understand the overall impact of improvement initiatives. Against this backdrop, we applaud the authors in their attempt, which goes against the trend, but disappointingly, once again, offers conflicting and weak evidence of beneficial effect despite adherence to rigorous method. So what does this study teach us about whether or not to embrace RCTs in improvement? To read the full article, log in using your NHS OpenAthens details
For better or worse, the EHR has become an integral part of medical care. For every hour we spend on direct patient care, we spend another two with the EHR.5 Even when interacting with patients, our focus is on computer screens up to 80% of the time.6
Given this degree of attention, it is not surprising that the EHR influences physician behaviour, especially the overuse of low-value medical care. For example, an unchecked box on an order set provides a powerful stimulus to order a test, regardless of clinical utility.7 Displaying brand name instead of generic options leads to more expensive prescribing.8 Allowing labs to be ordered recurrently increases unnecessary phlebotomy.9 Even individually listing inappropriate antibiotics (rather than grouping them) can make them more noticeable, resulting in more broad-spectrum use.10. To read the full article, log in using your NHS OpenAthens details.
Guidelines are ubiquitous but inconsistently used in UK mental health services. Clinical psychologists are often influential in guideline development and implementation, but opinion within the profession is divided. This study utilized grounded theory methodology to examine clinical psychologists' beliefs about and use of NICE guidelines. Login using your SSSFT NHS OpenAthens for full text. SSOTP - You can request a copy of this article by replying to this email. Please ensure you are clear which article you are requesting.
The updated guidance gives recommendations on preventing and managing PTSD. Adults who are at risk of PTSD should be offered individualised cognitive-behavioural therapy within a month of experiencing a stressful event. Children can be considered for group therapy after shared trauma to reduce the risk of developing PTSD, the guidance says.
Audit and feedback (A&F) is a common intervention used to change healthcare provider behaviour and, thus, improve healthcare quality. Although A&F can be effective its effectiveness varies, often due to the details of how A&F interventions are implemented. Some have suggested that a suitable conceptual framework is needed to organise the elements of A&F and also explain any observed differences in effectiveness. Through two examples from applied research studies, this article demonstrates how a suitable explanatory theory (in this case Kluger & DeNisi's Feedback Intervention Theory (FIT)) can be systematically applied to design better feedback interventions in healthcare settings. To read the full article, log in using your NHS OpenAthens details
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.
Open access. Although previous research suggests that different kinds of patient feedback are used in different ways to help improve the quality of hospital care, there have been no studies of the ways in which hospital boards of directors use feedback for this purpose.
A. Garc\'ıa Frey, G. Calvary, и S. Dupuy-Chessa. Proceedings of the 2Nd ACM SIGCHI Symposium on Engineering Interactive Computing Systems, стр. 41--46. New York, NY, USA, ACM, (2010)
F. Aschoff, V. Schaer, и G. Schwabe. Proceedings of the 5th International Conference on Communities and Technologies, стр. 69--78. New York, NY, USA, ACM, (2011)
P. Adamopoulos. ICIS, Association for Information Systems, (2013)The findings of our analysis illustrate that Professor(s) is the most important factor in online course retention and has the largest positive effect on the probability of a student to successfully complete a course. The sentiment of students for Assignments and Course Material also has positive effects on the successful completeness of a course whereas the Discussion Forum has a positive effect on the probability to partially complete a course. Furthermore, self-paced courses have a negative effect, compared to courses that follow a specific timetable. In addition, the difficulty, the workload, and the duration of a course have a negative effect. On the other hand, for the more difficult courses, self-paced timetable, longer duration in weeks, and more workload have a positive effect on the probability to successfully complete a course. Besides, final exams and projects, open textbooks, and peer assessment have also positive effects. Moreover, whether a certificate is awarded upon the successful completion of a course also affects retention. Additionally, the better a university is considered (i.e. higher ranking), the more likely that a student will successfully complete a course. Further, our results illustrate that the courses which belong to the academic disciplines of Business and Management, Computer Science, and Science have a positive significant effect in contrast to courses in other disciplines (i.e. Engineering, Humanities, and Mathematics). Finally, attrition was not found to be related with student characteristics (i.e. gender, formal education)..