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Content ArticleThe successful implementation of clinical practice guidelines should improve quality of care by decreasing inappropriate variation and expediting the application of effective advances to practice. However, despite wide promulgation, practice guidelines have had limited effect on changing physician behavior. Cabana et al. conducted a systematic review of the barriers to physician adherence to clinical practice guidelines, practice parameters, clinical policies or national consensus statements. They found that physician adherence is dependent on physician awareness (31 examples), agreement (68 examples), self-efficacy (13 examples), outcome expectancy (12 examples), motivation (3 examples), and the absence of external barriers to perform guideline recommendations (62 examples). The findings suggest that studies describing interventions to improve physician adherence may not be generalisable, since barriers in one setting may not be present in another. Using this analysis, the authors propose a framework which describes the barriers that must be overcome to improve physician adherence. This framework can be used (1) as a method to profile barriers or sources of poor adherence and thus (2) as a diagnostic tool to standardise and select appropriate interventions to improve adherence. The selection of interventions to change physician behaviour has been haphazard in the past. This analysis offers a more rational approach towards improving physician adherence to practice guidelines as well as a framework for further research.
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Content Article
CQC case study: outstanding, safe care for all (May 2017)
Claire Cox posted an article in GP and primary care
Inclusion Healthcare, a social enterprise, provides primary medical services for homeless people in Leicester. It was rated outstanding following its CQC inspection in November 2014. CQC inspectors found strong leadership at its heart and a positive culture that ensures patient safety is paramount. In this short film, we hear from service users and staff and find out how they are promoting patient safety. -
Content ArticleDrug monitoring is a cumbersome, time consuming (expensive) and somewhat inaccurate process. The challenge set to ESC Software by a GP was to make an IT solution that was easy to use, comprehensive and reliable that would monitor patient testing to improve safety.
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Content ArticleThis short video from the Derbyshire Community Health Services NHS Foundation describes the importance of speaking up, what the process is and how speaking up will improve patient safety.
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Content Article
What is the British Medical Association (BMA)?
Claire Cox posted an article in Workforce and resources
The British Medical Association (BMA) is the trade union and professional body for doctors in the UK. -
Content Article
NHS Improvement: A Just Culture guide (updated 14 December 2018)
Claire Cox posted an article in Good practice
The fair treatment of staff supports a culture of fairness, openness and learning in the NHS by making staff feel confident to speak up when things go wrong, rather than fearing blame. Supporting staff to be open about mistakes allows valuable lessons to be learnt so the same errors can be prevented from being repeated. In any organisations or teams where a blame culture is still prevalent, this guide will be a powerful tool in promoting cultural change. -
Content ArticleDoctors feel that they are increasingly expected to treat patients in an unsafe, unsupportive environment, contributing to a vicious cycle of low morale and poor rates of recruitment and retention. This can and must change. This British Medical Association (BMA) report draws on the experience and expertise of BMA members across all branches of medical practice in the UK. It outlines where change is needed to ensure we safeguard patient care, make the NHS a great place to work and transform services for the better. This report sets out specific recommendations aimed at government and NHS bodies.
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Content ArticleThe distribution of malpractice claims among physicians is not well understood. If claim-prone physicians account for a substantial share of all claims, the ability to reliably identify them at an early stage could guide efforts to improve care. Using data from the National Practitioner Data Bank, Studdert et al. analysed 66,426 claims paid against 54,099 physicians from 2005 through 2014. The authors calculated concentrations of claims among physicians. They found over a 10-year period, a small number of physicians with distinctive characteristics accounted for a disproportionately large number of paid malpractice claims.
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Content ArticleBrighton and Sussex University Hospitals NHS Trust found a key challenge in tackling emergency department (ED) doctors' low levels of satisfaction, high rates of burnout and high turnover was because of the way shifts were organised. They found that while ED could be a highly pressurised environment that could contribute to these issues, another key challenge was the way shifts were organised and the lack of flexibility that had become a standard part of being an ED doctor.
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Content Article
NHS at 70: The Story Of Our Lives
Claire Cox posted an article in Stories from the front line
NHS at 70: The Story Of Our Lives is a national programme of work supported by The National Lottery Heritage Fund and led by The University of Manchester recording stories from people who worked and were cared for by the NHS since its creation in 1948. These stories will be available on the public Digital Archive and will provide a lasting resource for audiences to discover NHS history through the voices of the people who have worked and were cared for by the NHS since 1948. -
Content Article
Birmingham University Hospitals Trust: Poster for staff going home
Claire Cox posted an article in Good practice
This poster from Birmingham University Hospitals Trust is aimed at staff leaving to go home after their shift. -
Content ArticleEngaging with general practices during inspections gives valuable insight into their experiences. Feedback shows that although inspection reports highlight the areas of concern and risk that need to improve, practices want to know more about how to actually improve from a rating of 'requires improvement' or 'inadequate'. The Care Quality Commission (CQC) selected 10 practices throughout the country that had each made significant improvements from their initial inspection to their most recent, and whose overall rating had improved. These 10 case studies highlight some clear actions that other practices can use to help them learn and improve.
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Content Article"It’s time to halt, take a break, and redraw the relationship between patient care and self-care. Self-care isn’t an optional luxury. It must sit at the heart of what we do, to ensure our teams can continue to rise to the challenges of working in the 21st century NHS, to give our patients the best of both ourselves, and the organisation so many of us are proud to be a part of."
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Content ArticleJunior doctors can find the process of doing an audit helpful in gaining an understanding of the healthcare process—Andrea Benjamin, BMJ's clinical editor, explains how to do one.
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Content ArticleIn this video, clinicians from Great Ormond Street Children's Hospital who are involved in the SAFE project talk about how the ‘huddle’ technique – a ten minute free, frank exchange of information between clinical and non-clinical professionals involved in a patient’s care every few hours – is helping them to improve their situation awareness, resolve risks to patient safety more quickly and reduce harm.
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Content Article
JAMA: Time of day and the decision to prescribe antibiotics (December 2014)
Claire Cox posted an article in Culture
This research paper discusses the problem of decision fatigue and how it can impact patient safety. The authors hypothesised that decision fatigue, if present, would increase clinicians’ likelihood of prescribing antibiotics for patients presenting with acute respiratory infections as clinic sessions wore on. -
Content ArticleThis 15 minute video from the Brighton and Sussex University Hospitals NHS Trust gives an introduction to what human factors is within healthcare.
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Content ArticleThis report from the King's Fund explores in more detail the role of leaders in engaging a range of significant others in improving health and healthcare.
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Content Article
Healthier Lancashire & Cumbria - Digital Future
Gary Saunders posted an article in Implementation of improvements
A case study on how Healthier Lancashire and Cumbria have been driving forward their digital strategy. This strategy includes how they are standardising and redesigning digital systems to improve patient safety (see Theme 4 - Manage the system more effectively). -
Content ArticleSleep is fundamental to good health. Healthcare professionals receive little teaching on the importance of sleep, particularly with respect to their own health when working night shifts. Knowledge of basic sleep physiology, together with simple strategies to improve core sleep and the ability to cope with working nights, can result in significant improvements both for healthcare professionals and for the patients they care for. This article by Dr Mike Farquhar, published in the Archives of Disease in Childhood: Education & Practice, gives practical advice for night shift workers and, generally, how to improve your quality of sleep.
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Content ArticleStaff at C.S. Mott Children’s Hospital and Von Voigtlander Women’s Hospital, Michigan are adopting a new approach to safety. By picking up near misses, close calls, deviation off protocol and investigating each one via a daily huddle, they are able to enable change system wide.
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Content ArticleThis project is led by the Department of Anaesthesia at Newcastle upon Tyne NHS Foundation Trust, in partnership with Northumbria University Newcastle. The aim is to co-design a fatigue risk management strategy at the Trust to help teams effectively manage night shift fatigue.
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Content ArticleRhidian Bramley is a consultant radiologist and associate medical director at the Christie NHS FoundationTrust. In this blog he discusses how unintended consequences from implementation of digital solutions can have an impact on patient safety.
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Content ArticlePolicy to date has mostly focused on the role of 'whistleblowers' in raising concerns about quality and safety of patient care in healthcare settings. However, most opportunities for personnel to identify and act on these concerns are likely to occur much further upstream, in the day-to-day mundane interactions of everyday work. Using qualitative data from over 900 hours of ethnographic observation and 98 interviews across 19 English intensive care units (ICUs), Tarrant et al., in a paper published in Social Science & Medicine, studied how personnel gave voice to concerns about patient safety or poor practice.
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Content ArticlePatients with delirium have changes in their thinking and are often confused and cannot pay attention. About half of patients in an intensive care unit (ICU) have delirium during their stay. Research has shown that patients with delirium are more likely to die or to have long-term brain problems, including posttraumatic stress disorder, depression and other mental health issues, than those without delirium. Although nurses and doctors have tools to measure delirium in the ICU, it can be hard to identify and, in some cases, may be missed. Family members may be the first to notice that their loved ones have changes in their thinking or cannot pay attention. There are tools called the Family Confusion Assessment Method (FAM-CAM) and Sour Seven questionnaire that can be used by family members to detect delirium. However, neither of these tools has been used in an ICU. This study from Krewulak et al., published in CmajOPEN, shows that these tools can be used by family members to measure delirium in the ICU. The results from this study could lead to a change in policy that would involve partnering with family members to improve the diagnosis of delirium in the ICU. In turn, this would improve patient and family care and outcomes in the ICU.
