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This joint project with East Berkshire CCG was highlighted within the AKI Programme within Oxford Patient Safety Collaborative. Fewer residents are suffering urinary tract infections (UTIs) following the introduction of a hydration programme in care homes. UTIs are closely associated with dehydration. This project was designed to encourage residents to drink more fluids with the aim that this would lead to fewer UTIs requiring medication or hospital admission. This approach involved introducing structured drinks rounds seven times a day, designed and delivered by care home staff. The initial focus was in four care homes which had higher than average UTI admission to hospital rates.

The East Midlands Patient Safety Collaborative (EMPSC) piloted an audit tool to measure the prevalence of common care problems found in nursing and residential homes. The audit tool was first rolled out to 26 care homes across Nottinghamshire and Derbyshire in 2015, extending to 30 care homes across the East Midlands in 2016, 31 in 2017 and 39 in 2018. The tool is called the International Prevalence Measurement of Care Problems in Care Homes (Landelijke Prevalentiemeting Zorgkwaliteit, or LPZ for short, in Dutch). LPZ was developed in the Netherlands to provide a reliable mechanism for measuring the prevalence of common care problems within care homes and provide consistent recording of data to drive, or measure, the impact of quality improvement initiatives in the sector.

In 2008, Sir Liam Donaldson wrote an article looking at the history of the national health service in the UK and the development of clinical governance and a quality framework. He concluded the article by looking at the challenges ahead for the next decade. First, to make quality and safety the common currency of the NHS so that it is on an equal footing to money and productivity; second, to put clinicians in leadership roles with full responsibility for assuring and improving the quality and safety of their services; and third, to build the understanding, expertise and track record on safety in healthcare to the level of other high-risk industries. Now in 2020, how far forward are we in meeting these challenges?

Traditionally, clinicians present complications at surgical morbidity and mortality (M&M) conferences, and the AHRQ Patient Safety Indicators (PSIs) use inpatient administrative data to identify certain adverse outcomes. Although both methods are used to identify adverse events and inform quality improvement efforts, these two methods might not overlap. This is a retrospective observational study from Anderson et al. of all hospitalisations at a single academic department of surgery (including subspecialties) in 2016 involving a PSI-defined event identified by surgery faculty and residents for review by departmental M&M conference or administrative data. The authors analysed the degree to which these two processes captured PSI-defined events and reasons for exclusion by each process. The study found that surgical M&M and the PSIs are complementary approaches to identifying complications. Both case-finding processes should be used to inform quality improvement efforts.

Although debate continues over estimates of the amount of preventable medical harm that occurs in healthcare, there seems to be a consensus that healthcare is not as safe and reliable as it might be. It is often assumed that copying and adapting the success stories of nonmedical industries, such as civil aviation and nuclear power, will make medicine as safe as these industries. However, the solution is not that simple. This article explains why a benchmarking approach to safety in high-risk industries is needed to help translate lessons so that they are usable and long lasting in healthcare.  Five successive systemic barriers currently prevent health care from becoming an ultrasafe industrial system: the need to limit the discretion of workers, the need to reduce worker autonomy, the need to make the transition from a craftsmanship mindset to that of equivalent actors, the need for system-level (senior leadership) arbitration to optimise safety strategies, and the need for simplification. Finally, healthcare must overcome 3 unique problems: a wide range of risk among medical specialties, difficulty in defining medical error, and various structural constraints (such as public demand, teaching role, and chronic shortage of staff). Without such a framework to guide development, ongoing efforts to improve safety by adopting the safety strategies of other industries may yield reduced dividends. Rapid progress is possible only if the health care industry is willing to address these structural constraints needed to overcome the 5 barriers to ultrasafe performance.

The “WHO handbook for national quality policy and strategy” outlines an approach for the development of national policies and strategies to improve the quality of care. Such policy and strategy can help clarify the structures, roles and responsibilities within national quality efforts, support the institutionalisation of a culture of quality, and secure buy-in from health system leaders and stakeholders. The handbook is not a prescriptive process guide but is designed to support teams developing policies and strategies in this area, and very much recognizes the varied expertise, experience and resources available to countries. It outlines eight essential elements to be considered by teams developing national quality policy and strategy: national health goals and priorities; local definition of quality; stakeholder mapping and engagement; situational analysis; governance and organizational structure; improvement methods and interventions; health management information systems and data systems; quality indicators and core measures. The NQPS handbook was co-developed with countries each finding themselves at different stages of the development and execution of national quality policies and strategies and was informed by the review of a sample of more than 20 existing quality strategies across low-, middle- and high-income countries globally.

This quality standard from the National Institute of Health and Care Excellence (NICE), covers preventing and controlling infection in adults, young people and children receiving healthcare in primary, community and secondary care settings. It includes preventing healthcare-associated infections that develop because of treatment or from being in a healthcare setting. It describes high-quality care in priority areas for improvement.