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Found 751 results
  1. Content Article
    There is a direct correlation between safety event management practices and care quality outcomes. The right safety management tools, supported by a shared perception and tolerance of risk, will help organisations go beyond reporting event data to improve safety culture.
  2. Event
    This conference will focus on measuring, understanding and acting on patient experience insight, and demonstrating responsiveness to that insight to ensure patient feedback is translated into quality improvement and assurance. Through national updates and case study presentations the conference will support you to measure, monitor and improve patient experience in your service, and ensure that insight leads to quality improvement. Sessions will include learning from patients, improving patient experience, practical sessions focusing on delivering a patient experience based culture, measuring patient experience, demonstrating insight and responsiveness in real time, monitoring and improving staff experience, the role of human factors in improving quality, using patient experience to drive improvement, changing the way we think about patient experience, and learning from excellence in patient experience practice. For further information and to book your place visit https://www.healthcareconferencesuk.co.uk/virtual-online-courses/patient-experience-insight or email frida@hc-uk.org.uk Follow on Twitter @HCUK_Clare #PatientExp hub members receive a 20% discount. Email info@pslhub.org for the discount code.
  3. Event
    Clinical Audit for Improvement 2024 is now in its 24th year and brings together clinicians, senior/middle managers and leading local and national clinical audit and improvement experts. Over the last two decades this event has become the ‘must-attend’ annual conference for clinical audit and QI professionals. Historically this one-day virtual conference has featured national updates with leaders providing information on relevant current and future policy. However, in 2024 the focus will change slightly with more emphasis on practical skills and techniques needed by those involved in delivering clinical audit projects at a local and/or national level. For further information and to book your place visit https://www.healthcareconferencesuk.co.uk/virtual-online-courses/clinical-audit-improvement-summit or email frida@hc-uk.org.uk hub members receive a 20% discount. Email info@pslhub.org for the discount code. Follow on Twitter @HCUK_Clare #ClinicalAudit2024
  4. Content Article
    Despite their widespread use, the evidence base for the effectiveness of quality improvement collaboratives remains mixed. Lack of clarity about ‘what good looks like’ in collaboratives remains a persistent problem. This qualitative study in BMJ Open aimed to identify the distinctive features of a state-wide collaboratives programme that has demonstrated sustained improvements in quality of care in a range of clinical specialties over a long period. The authors identified five features that characterised success in the collaboratives programme: learning from positive deviance high-quality coordination high-quality measurement and comparative performance feedback careful use of motivational levers mobilising professional leadership and building community.
  5. Content Article
    This is part of our series of Patient Safety Spotlight interviews, where we talk to people working for patient safety about their role and what motivates them. Sonia talks to us about how her role at NHS Confederation helps her understand the issues facing NHS staff and why she decided to start drawing graphics to communicate important information to patients and staff.
  6. Content Article
    The opioid epidemic has been declared a public health emergency in the US, with major news outlets calling operating rooms “unintended gateways.” In response to this emergency, a team from Thomas Jefferson University sought to decrease their organisation's contribution to the potential diversion pool—the opioids surgeons prescribe to patients which go unused. This article in the journal Patient Safety looks at the research and improvement work undertaken by the team, who concluded that surgical departments can develop opioid reduction toolkits aimed at reducing the potential diversion pool of opioids in communities.
  7. Content Article
    In 2022 the Center for Medicare & Medicaid Services (CMS) launched the CMS National Quality Strategy (NQS), an ambitious long-term initiative that aims to promote the highest quality outcomes and safest care for all. This document gives an overview of the strategy, using infographics to explain its four priority areas: Outcomes and alignment Equity and engagement Safety and resiliency Interoperability and scientific advancement
  8. Content Article
    The EvidenceNOW: Advancing Heart Health in Primary Care trial was designed to assist primary care practices in the US in implementing evidence-based practices in cardiovascular care and building capacity for quality improvement. This qualitative study in BMC Primary Care aimed to gain a comprehensive understanding of perspectives from research participants and team members on the value of implementation strategies and factors that influenced the EvidenceNOW initiative in Virginia. Read a simplified research summary: Strategies for implementing large-scale quality improvement in primary care
  9. Content Article
    Efforts to increase physician engagement in quality and safety are most often approached from an organisational or administrative perspective. Given hospital-based physicians’ strong professional identification, physician-led strategies may offer a novel strategic approach to enhancing physician engagement. It remains unclear what role medical leadership can play in leading programmes to enhance physician engagement. In this study, Rotteau et al. explore physicians’ experience of participating in a Medical Safety Huddle initiative and how participation influences engagement with organisational quality and safety efforts. They found that The Medical Safety Huddle initiative supports physician engagement in quality and safety through intrinsic motivation. However, the huddles’ implementation must align with the organisation’s multipronged patient safety agenda to support multidisciplinary collaborative quality and safety efforts and leaders must ensure mechanisms to consistently address reported safety concerns for sustained physician engagement.
  10. Content Article
    The Situation Awareness for Everyone (S.A.F.E.) programme has been used at 50 sites over four years to help reduce 50 sites over four years. This toolkit has been produced by the Royal College of Paediatrics and Child Health (RCPCH) to support child health professionals to use S.A.F.E. principles at their sites. The toolkit contains four modules: Translating quality improvement into action Theories of patient safety and application to the S.A.F.E programme The S.A.F.E programme: from reaction to anticipation Team perspectives
  11. Content Article
    This article by NHS England looks at a national project on aligning quality improvement (QI), experience of care and co-production. It explains the principles of co-production and the approach taken to implement the project, as well as highlighting identified themes and key findings. It makes some practical recommendations based on these findings.
  12. Content Article
    This study compared two quality improvement (QI) interventions to improve antenatal magnesium sulphate (MgSO4) uptake in preterm births for the prevention of cerebral palsy. It found that PReCePT improved MgSO4 uptake in all maternity units. Enhanced support did not further improve uptake but may improve teamwork, and more accurately represented the time needed for implementation. Targeted enhanced support, sustainability of improvements and the possible indirect benefits of stronger teamwork associated with enhanced support should be explored further.
  13. Content Article
    This book sets out what the terms governance and leadership mean, and how thinking about them has developed over time. Using real-world examples, the authors analyse research evidence on the influence of governance and leadership on quality and safety in healthcare at different levels in the health system: macro level (what national health systems do), meso level (what organisations do) and micro level (what teams and individuals do). The authors describe behaviours that may help boards focus on improving quality and show how different leadership approaches may contribute to delivering major system change.
  14. Event
    This free webinar will be discussing what it means to ‘Do Quality Differently’, including proven practices that will help you drive improved performance and manage risk. Hear multiple case studies that illustrate examples of results that are possible from implementation of these practices. Learn about practical ‘how to’ guidance to help you either get started in integrating these practices or improve the likelihood they will be sustained if you have already started on a Human Performance journey. Who will this be of interest to? Anyone in any industry who has a need to manage operational risk and improve operational performance. Register
  15. Content Article
    Large-scale improvement programmes are a frequent response to quality and safety problems in health systems globally, but have mixed impact. The extent to which they meet criteria for programme quality, particularly in relation to transparency of reporting and evaluation, is unclear. The aim of this study from Mary Dixon-Woods and colleagues was to identify large-scale improvement programmes focused on intrapartum care implemented in English National Health Service maternity services in the period 2010–2023, and to conduct a structured quality assessment. They found poor transparency of reporting and weak or absent evaluation undermine large-scale improvement programmes by limiting learning and accountability. This review indicates important targets for improving quality in large-scale programmes.
  16. Content Article
    This report published by the National Vascular Registry (NVR) contains information on emergency (non-elective) and elective procedures for the following patient groups: patients with peripheral arterial disease (PAD) who undergo either (a) lower limb angioplasty/stent, (b) lower limb bypass surgery, or (c) lower limb amputation patients who have a repair procedure for abdominal aortic aneurysm (AAA) patients who undergo carotid endarterectomy or carotid stenting.
  17. Content Article
    NHS England has outlined plans to develop an improvement approach - NHS IMPACT - to support continuous improvement. There are also ambitions for integrated care systems (ICSs) to become ‘self-improving systems’. This report, written and researched by Sir Chris Ham and jointly commissioned by the NHS Confederation, the Health Foundation and the Q community, reviews the experience of a number of ICSs identified as being at the forefront of this work, focusing on the approaches they have taken and the results achieved.
  18. Event

    IHI Forum

    Sam
    until
    The IHI Forum is a four-day conference that has been the home of quality improvement in health care for more than 30 years. Dedicated improvement professionals from across the globe will be convening to tackle health care's most pressing challenges: improvement capability, patient and workforce safety, equity, climate change, artificial intelligence, and more. Register
  19. Content Article
    The latest Care Quality Commission (CQC) report on the state of care in England is far from an encouraging read.1 Although the healthcare system is under serious strain, maternity services are among the areas identified as especially challenged. The problems identified in maternity care, while shocking, come as no surprise. The sector is seeing repeated high profile organisational failures and soaring clinical negligence claims, together with grim evidence of ongoing variation in outcomes, culture, and workforce challenges and inequities linked to socioeconomic status and ethnicity. In this BMJ Editorial, Mary Dixon-Woods and colleagues discuss why it's time for a fresh approach to regulation and improvement.
  20. Content Article
    The Care Quality Commission (CQC) have published the findings of their five local authority pilot assessments. Assessing how local authorities meet their duties under Part 1 of the Care Act (2014) is a new responsibility for CQC. During the pilots, the CQC looked at nine of their quality statements to assess how well each local authority is meeting its responsibilities. This enabled them to give an indicative rating. Birmingham City Council – indicative rating of good Lincolnshire County Council – indicative rating of good North Lincolnshire Council – indicative rating of good Nottingham City Council – indicative rating of requires improvement Suffolk County Council – indicative rating of good.
  21. Content Article
    The government recently published terms of reference for the Thirlwall Inquiry following the crimes committed by former neonatal nurse Lucy Letby while working for the Countess of Chester Hospital NHS Foundation Trust. As well as examining the detail of the offences, the inquiry will also probe whether the trust’s culture, management, governance structures and processes contributed to the failure to protect babies. In the wake of this tragedy, it became apparent that staff had sounded the alarm about Lucy Letby, but that their concerns were not acted on. The case has propelled the issue of NHS management structures and the regulation of managers back into the headlines and made it the subject of political debate. 
  22. Content Article
    The story behind Martha’s rule is depressingly familiar. A parent raising significant concerns about their daughter’s ongoing care only to be ignored with tragic consequences. Unfortunately, this feels like the latest in a long line of incidents where the NHS has failed to heed warnings from patients and their families about the quality of their care.  This article by Dan Wellings looks at recent collaborative work by The King's Fund and the Heads of Patient Experience (HOPE) network to understand why the NHS is still too often not listening to people who use its services. He highlights that progress made since the early 2000s in improving how the health service listens to patients has stalled, with the proportion of patients feeling involved in decisions about their care or treatment falling in recent years. He also outlines how organisational cultures that focus disproportionately on the positive miss opportunities to hear and respond to stories that demonstrate serious patient safety and experience issues.
  23. Content Article
    Through a data sharing agreement, the Faculty of Intensive Care Medicine can access a record of incidents reported to the National Reporting and Learning System (NRLS). Available information is limited and from a single source; all that is know about these incidents is presented in this report. The safety bulletin aims to highlight incidents that are rare or important, and those where the risk is perhaps something we just accept in our usual practice. It is hoped that the reader will approach these incidents by asking whether they could occur in their own practice or on their unit. If so, is there anything that can be done to reduce the risk?
  24. Content Article
    High reliability organisations are organisations that work in situations that have the potential for large-scale risk and harm, but which manage to balance effectiveness, efficiency and safety. They also minimise errors through teamwork, awareness of potential risk and constant improvement. This evidence scan collates empirical evidence about the characteristics of high reliability organisations and how these organisations develop within and outside healthcare.
  25. Content Article
    This report published by the National Confidential Enquiry into Patient Outcome and Death, is a review of the care provided to patients aged 16 and over with a diagnosis of, and who underwent surgery for, Crohn’s disease. In summary, the report says that surgery for patients with drug resistant Crohn’s disease surgery should be considered earlier in the treatment pathway for patients, instead of surgery being perceived as a failure of medical care. Once a decision to perform surgery has been made it should be undertaken within a month to prevent patients on elective waiting lists deteriorating and requiring emergency surgery. Furthermore, closer working between all members of the multidisciplinary team would benefit patients, to reduce delays as well as providing all the holistic care that patients with Crohn’s disease need. Read the full list of recommendations and the report via the link below.
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