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.
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.
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
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.
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.
Open access. Improving healthcare services can all too easily become synonymous with the use of certain in vogue tools for improving quality. Trigger tools, run charts and driver diagrams are just three examples of techniques used by frontline staff who are undertaking improvement work. Educators seeking to teach improvement are similarly faced with long lists of possible approaches and techniques with which to fill their course descriptions. As a consequence the temptation for improvement leaders and teachers is to include yet another technique in an already crowded curriculum, to add in more ‘stuff’.
But what if focusing so much on the tools is actually unhelpful? What if our attempts to create better and safer organisations is muddled rather than enhanced by the growing interest in so many techniques? Could we be putting off the very people we need to engage by the use of what can be seen as jargon? Might it lead people to see improvement as an event or a ‘project’ rather than as a way of working?
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
QS117. This quality standard covers preventing excess winter deaths and health problems associated with cold homes. It includes people of all ages, and takes into account that some people are particularly vulnerable to the effects of the cold, such as people with cardiovascular or mental health conditions, young children and older people. For more information see the preventing excess winter deaths topic overview.
Open access. Since its publication in 2008, SQUIRE (Standards for Quality Improvement Reporting Excellence) has contributed to the completeness and transparency of reporting of quality improvement work, providing guidance to authors and reviewers of reports on healthcare improvement work. In the interim, enormous growth has occurred in understanding factors that influence the success, and failure, of healthcare improvement efforts. Progress has been particularly strong in three areas: the understanding of the theoretical basis for improvement work; the impact of contextual factors on outcomes; and the development of methodologies for studying improvement work. Consequently, there is now a need to revise the original publication guidelines. To reflect the breadth of knowledge and experience in the field, we solicited input from a wide variety of authors, editors and improvement professionals during the guideline revision process. This Explanation and Elaboration document (E&E) is a companion to the revised SQUIRE guidelines, SQUIRE 2.0.
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.
This was an opportunity to hear from a peer about Quality Improvement System and how it has helped staff to focus on the most important matters of improving the lives of the people who services and develop a culture of quality improvement.