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Showing results for tags 'Quality improvement'.
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Content ArticleFamily-activated medical emergency teams (MET) have the potential to improve the timely recognition of clinical deterioration and reduce preventable adverse events. Adoption of family-activated METs is hindered by concerns that the calls may substantially increase MET workload. Brady et al. aimed to develop a reliable process for family activated METs and to evaluate its effect on MET call rate and subsequent transfer to the intensive care unit (ICU).
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Content ArticleThis state-of-the-nation report from the National Hip Fracture Database (NHFD) focuses on the period from 1 January to 31 December 2022. It shows that the number of people who died in the month following a hip fracture now stands at 6.2%; down from 10.9% in 2007, when the NHFD was set up. However, the report also finds that it took longer for patients to reach a ward where a hip fracture team can work together (where there is the best chance of recovery) in 2022. It also states that fewer patients received prompt surgery to repair their broken hip by the day after they presented to hospital. There was an improvement in how many people with hip fracture received bone strengthening medicines to avoid future fractures in 2022, but some hospitals continue to report that none of their patients receive such treatment.
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Content ArticleThe Acute Frailty Network (AFN) was a scheme run in England by NHS Elect, using an approach called Quality Improvement Collaboratives (QICs), to help trusts implement principles of Comprehensive Geriatric Assessment (CGA) as part of their acute pathway. In July 2023, Street et al published a paper in BMJ Quality and Safety analysing the impact of the AFN which concluded that there was no difference in length of hospital stay, in-hospital mortality, institutionalisation and hospital readmission between organisations that took part in AFN and those that did not. This article outlines the position of the British Geriatrics Society (BGS) on the paper, addressing why it thinks that focusing on older people’s healthcare is more important than ever. It highlights the importance of ensuring that the paper's findings are not used as a reason to abandon efforts to improve acute frailty care. Rather, they should be seen as a call to redouble efforts to identify and overcome the barriers to delivering CGA in acute settings.
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Content ArticleIn 2008, five ‘serious untoward incidents’ occurred on a small maternity unit in a hospital in the UK. The prevailing view, held by clinical staff, hospital managers, and executives, was that these events were unconnected and did not signal systemic failures in care. This view was maintained by the testimony of staff and governance procedures which prevented the incidents from being considered together. Drawing on the inquiry report of the Morecambe Bay Investigation (2015), Dawn Goodwin examines how the prevailing view was built and dismantled, eventually being replaced with a very different description of events. Overturning this view required affected parents to engage with governing bodies and legal processes, challenge clinical staff, lobby for inquests, and mobilise social media and the national press. Tracing how different descriptions of events weaken or gather force as they travel through different forums, processes, and are presented to different audiences, she explores the sociology of knowledge around establishing failures of care.
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Content ArticlePatients are increasingly describing their healthcare experiences publicly online. This has been facilitated by digital technology, a growing focus on transparency in healthcare and the emergence of a feedback culture in many sectors. The aim of this study was to identify a typology of responses that healthcare staff provide on Care Opinion, a not-for-profit online platform on which patients are able to provide narrative feedback about health and social care in the UK. The authors used framework analysis to qualitatively analyse a sample of 486 stories regarding hospital care and their 475 responses. Five response types were identified: non-responses, generic responses, appreciative responses, offline responses and transparent, conversational responses. The key factors that varied between these response types included the extent to which responses were specific and personal to the patient story, how much responders' embraced the transparent nature of public online discussion and whether or not responders suggested that the feedback had led to learning or impacted subsequent care delivery. Staff provide varying responses to feedback from patients online, with the response types provided being likely to have strong organisational influences. The findings offer valuable insight and have both practical and theoretical implications for those looking to enable meaningful conversations between patients and staff to help inform improvement. The authors suggest that future research should focus on the relationship between response type, organisational culture and the ways in which feedback is used in practice.
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Content ArticleIn 2011, the government acknowledged a large treatment gap for people with mental health conditions and sought to establish ‘parity of esteem’ between mental and physical health services. From 2016, the Department of Health & Social Care (DHSC) and NHS England made specific commitments to improve and expand NHS-funded mental health services. NHSE, working with the Department and other national health bodies, set up and led a national improvement programme to deliver these commitments. This report by the House of Commons Public Accounts Committee assesses progress made in delivering these commitments. The report acknowledges that NHS England has made progress in improving and expanding mental health services, but says this was "from a low base."
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News Article
Is the CQC giving the NHS an easy ride?
Patient Safety Learning posted a news article in News
The purpose of Care Quality Commission (CQC) ratings has been a hotly contested question since the creation of the four category classifications in the last decade. The original idea was to give the public a sense of how good their local hospital was, as well as providing commissioners, system managers and government with an idea of whether the local, regional or national health services they had responsibility for were getting better or worse. The practicality of the first aim was always questionable given the public’s inability and unwillingness, in most cases, to take their custom elsewhere. The second ran into the lack of desire and/or courage on behalf of most commissioners to challenge their local provider, but it did seem to have traction at the top of the shop. Jeremy Hunt, told HSJ, once they had been dished out across the sector, that their CQC classification now mattered much more then whether or not it had achieved foundation status or not. Another function, whether intended or not, was that by splashing “inadequate” and unsafe care on the front pages, in the wake of the Francis report, CQC ratings fuelled a drive to put more staff on the wards (forcing the Treasury to pay for the consequent agency bills and deficits, and curtailing Simon Stevens’ transformation funds). Whatever your take on their purpose, however, they only make sense if they accurately reflect the state of the service. And the latest data suggests that may not be the case. Read full story (paywalled) Source: HSJ, 17 March 2022- Posted
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News Article
Modernisation Agency chief returns to lead improvement drive
Patient Safety Learning posted a news article in News
The director of the Modernisation Agency in the early 2000s is returning to lead a new national service improvement drive, NHS England has announced, while asking systems and providers to “baseline” their improvement needs and capability. NHSE is establishing a “national improvement board” to oversee a new improvement programme called NHS Impact, as recommended by a review last year of the current infrastructure. NHSE announced the board will be chaired by David Fillingham, who was director of the NHS Modernisation Agency from 2001-2004 where, NHSE said, “he focused on developing new practices and fostering leadership development”. The national improvement board will choose a small number of improvement priorities to be followed across national bodies and the wider health service. It will “set the direction of system wide improvement” through “collaboration and co-design,” NHSE said. Read full story (paywalled) Source: HSJ, 19 July 2023 -
News Article
‘Culture battle’ over NHS England’s emergency recovery plans
Patient Safety Learning posted a news article in News
Senior sources have described a ‘culture battle’ in NHS England’s approach to urgent care recovery after systems were told to carry out “maturity” self-assessments, and appoint “champions” to drive improvements. Systems were last week told by NHSE to ”self assess” their compliance against key asks in the UEC recovery plan, and asked to nominate urgent care “recovery champions” to “create a community, close to the front line, who can help drive improvement” in emergency care. The “champions” and self-assessments are part of a new “universal offer” of support being drawn up by NHSE under its scheme for urgent care recovery, in which Integrated Care Boards are also being placed in “tiers” of intervention. It is the first project carried out under NHSE’s new service improvement banner, called “NHS Impact” or “improving patient care together”, which was established after an internal review recommended it should focus on a “small number of shared national priorities”. Read full story (paywalled) Source: HSJ, 18 July 2023 -
News Article
‘Overwhelmingly negative narrative must stop’
Patient Safety Learning posted a news article in News
NHS England’s chief strategy officer has called for a “reset” of the current “overwhelmingly negative narrative” about the health service. Chris Hopson said there was a collective responsibility to present a more balanced picture, while still being honest about problems. The service should do more to emphasise successes, improvements and where there is good performance, he said. He acknowledged there were too many instances where good quality care could not be delivered due to current pressures on the service. But they were being addressed and improvements being made. “We need to make sure that our staff, our patients but also the taxpayers hear that more balanced narrative,” he said at the Ambulance Leadership Forum event on Wednesday. Ambulance services – whose response times have sky-rocketed, well beyond their targets, over the past 18 months – have been at the centre of much recent negative coverage. Mr Hopson argued that the constantly negative narrative was having an impact on staff – whose work was not being recognised – and creating a sense that the NHS was broken. “That narrative is partly being driven by opponents of the NHS and also [those] who want to attack the government,” Mr Hopson said, although he acknowledged that it also reflected genuine instances of staff and patient experience. Read full story (paywalled) Source: HSJ, 8 September 2022 -
News Article
Grim figures reveal the scale of healthcare decline worldwide
Patient Safety Learning posted a news article in News
Startling numbers from around the world give grim statistical support for the argument that healthcare quality has not only stalled, but is in worrying retreat. Nearly 15 million deaths have been attributed to Covid-19 worldwide. All countries have seen waiting times increase and deaths from cardiac conditions and cancer rise. Mental health problems have been exacerbated, while the frailty of some elderly care services has left families unsupported. The global workforce crisis has been exposed, health inequalities amplified, and life expectancy arrested. Government debt has soared, and livelihoods have been lost. In a new report, health systems leaders from across the world – including the UK, Australia, India, Singapore, Canada, the USA and Europe – raise the alarm. There has been a decline in the focus on quality by the leadership of health systems all over the world with an opportunity cost in terms of patient outcomes, safety issues and people’s experience of healthcare. How do we shift from firefighting to a focus on quality of care? Dr Mark Britnell, chair of the Beamtree Global Impact Committee report, makes a simple argument: the only way to reverse the retreat from quality is to march steadfastly towards it. Read full story (paywalled) Source: The Telegraph, 26 July 2022 -
News Article
Manager ‘bootcamps’ helped eliminate two-year waiters
Patient Safety Learning posted a news article in News
The chief executive of one of the first teaching trusts in the country to have eliminated two-year waiters for elective care has said there is ‘no magic to it’ and it can be replicated elsewhere. Since the beginning of April, University Hospitals of Coventry and Warwickshire Trust has reported zero patients waiting over two years for their elective treatment – ahead of NHS England’s target of July 2022. According to the latest data, there are now 42 trusts that have eliminated 104-week waits and UHCW is the largest trust to have done this. UHCW chief executive Andy Hardy said that in order to achieve this the trust had been “relentless” in its focus on waiting times and had set up “bootcamps” to help managers understand how referral to treatment works. Mr Hardy said in an interview with HSJ: “It really does come down to a laser-like focus on waiting times, both at an executive level, down to a group level, and down to speciality level. It can be replicated. There’s no magic to it.” He said: “We use data to drive our organisations away from bad decisions and I have a weekly access meeting with the chief operating officer to look at where we are against all access targets, but obviously we focus on waiting times." Read full story (paywalled) Source: HSJ, 15 June 2022 -
News Article
Urgent action ordered at maternity scandal trust
Patient Safety Learning posted a news article in News
The trust at the centre of a maternity scandal has been ordered to report on urgent improvements in services for women and babies, amid ‘significant concerns’ about the risk of harm. The Care Quality Commission (CQC) used its enforcement powers to issue the conditions on East Kent Hospitals University Foundation Trust, after it carried out an unannounced inspection last month. However, the “section 31” warning letter has just been made public, and the first deadline for the trust to report back to the CQC is Monday (20 February). The CQC said some of the problems it found were due to the labour ward environment – but others involved monitoring of women and babies whose conditions deteriorate and the risk of cross-infection due to poor cleanliness standards. “We have significant concerns about the ongoing wider risk of harm to patients and a need for greater recognition by the trust of the steps that can be taken in the interim to ensure safety and an improved quality of care,” Carolyn Jenkinson, CQC’s deputy director of secondary and specialist healthcare, said in a statement today. Read full story (paywalled) Source: HSJ, 17 February 2023 -
News Article
USA: Amid hospital 'chaos,' stick to standards to improve quality
Patient Safety Learning posted a news article in News
Every time a mistake is made in a healthcare setting, there can be serious repercussions. Patients may suffer lifetime injuries or even pay the ultimate price for someone else's mistake. Hospitals may wind up paying the price literally — financially and legally — and suffer costly public reputation troubles in the aftermath. Increased patient loads combined with the workforce shortage and often decreasing financial resources have created "chaos" in hospitals, said Doug Salvador MD, chief quality officer at Baystate Health in Springfield, Mass. Safety watchdog organizations, including The Joint Commission and The Leapfrog Group, have reported the result of that chaos: soaring cases of preventable medical errors. The solution, he and several other sources who spoke with Becker's said, is to create standard operating procedures in every department, at every step of the patient journey. These SOPs are more than lists of guidelines; they require strict adherence and limited room for error thanks to built-in cross-check points. And, when instituted properly, they highlight system flaws in real time by creating what Dr. Salvador called "situational awareness." Situational awareness, he added, keeps front-line healthcare professionals on top of their safety game. Read full story Source: Becker's Healthcare, 9 May 2023 -
News Article
Regulator clears trust to bring back junior doctors
Patient Safety Learning posted a news article in News
Up to 10 junior doctor posts will be reinstated at a small district general hospital after regulators agreed it had improved its learning environment. In 2021, Health Education England removed 10 doctors from Weston Hospital over concerns they were being left without adequate supervision on understaffed wards. The unusual move prompted University Hospitals Bristol and Weston Foundation Trust to launch a “quality improvement approach” to improve its learner and clinical supervision environment. The regulator said the trust had made significant improvements that included: Better staff engagement with the trust leadership at all levels. Better clinical supervision, particularly around shift handovers and senior oversight of clinical decisions. Better learner experience in new training settings in rheumatology and intensive care medicine. Read full story (paywalled) Source: HSJ, 10 May 2023 -
News Article
‘National improvement board’ to be set up by NHS England
Patient Safety Learning posted a news article in News
NHS England has launched a new framework for quality improvement and delivery, including a national board that will pick a “small number of shared national priorities”. The new document says NHSE will “establish a national improvement board, to agree the small number of shared national priorities on which NHS England, with providers and systems, will focus our improvement-led delivery work”. The review says NHSE will, among other actions: Create a “national improvement board” to “agree a small number of shared national priorities and oversee the development and quality assure the impact of the NHS improvement approach”. Set an expectation that all NHS providers, working in partnership with integrated care boards, will embed a quality improvement method aligned with the NHS improvement approach”. Incentivise a universal focus on embedding and sustaining improvement practice”, including with “regulatory incentives alongside clearer and more timely offers of support. Work with the [Care Quality Commission] to align the revised CQC well-led [inspection method] with the improvement approach. Read full story (paywalled) Source: HSJ, 21 April 2023 -
Content ArticleCommunity hospitals are an important part of local health and care systems, yet there has been very little shared on their role and contribution during the pandemic. This project from the Community Hospitals Association sought to redress this and highlight the role of these local hospitals. This two-year project enabled staff to reflect on their experiences and innovations in their community hospitals during the pandemic in a systematic way that facilitated wider sharing and learning. It captures the experiences of staff working in UK community hospitals during the COVID-19 pandemic, with a focus on positive impact changes.
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Content ArticleLearn how one trust has applied staff engagement techniques as part of its continuous improvement programme.
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Content ArticleQuality improvement is a methodology used routinely in emergency departments (EDs) to bring about change to improve outcomes such as waiting times, time to treatment and patient safety. However, introducing the changes needed to transform the system in this way is seldom straightforward with the risk of “not seeing the forest for the trees” when attempting to make changes. This article in Annals of Emergency Medicine aims to demonstrate how the functional resonance analysis method can be used to capture the experiences and perceptions of frontline staff to identify the key functions in the system (the trees), to understand the interactions and dependencies between them to make up the ED ecosystem (“the forest”) and to support quality improvement planning, identifying priorities and patient safety risks.
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Content ArticleDr Gordon Caldwell shares how he changed his whole approach to ward rounds after seeing spaghetti maps of where a nurse walked during a shift. He cut down walking distance on rounds by creating a mobile office on wheels out of an old electricians trolley. See also: Making the ward a more efficient place: a qualitative evaluation of the impact of the Vista 90 trolley
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Content Article
Behaviour change techniques cards
Patient Safety Learning posted an article in Culture
Behaviour Change Techniques are the ‘active ingredients’ of activities that lead to behaviour change. These cards were developed by Lucie Byrne-Davis, Eleanor Bull and Jo Hart to help those who work with people to try to change their behaviour, and particularly for educators, trainers, leaders and those involved in organisational development, quality improvement or implementation. This was was funded by Health Education England -
Content ArticleThis article explains the emerging role of simulation in improving quality and safety. It is part of the Cambridge University Press 'Elements of Improving Quality and Safety in Healthcare' series. The article covers: Healthcare Simulation as an Improvement Technique Definition and Description of Healthcare Simulation How Simulation Became Integrated into Approaches to Improve Quality and Safety Simulation in Action Exploring Working Environments and the Practices and Behaviours of Those in Them Improving Clinical Performance and Outcomes Testing Planned Interventions and Infrastructural Changes Helping Healthcare Professionals to Learn about and Embed a Culture of Improvement Critiques of Simulation Is Simulation an Effective Technique for Improvement? How Should We Integrate Simulation into Healthcare Improvement? Can We Build a Business Case for Simulation?
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Content ArticleBased on data from 22,132 patients who had emergency bowel surgery in England and Wales between December 2020 and November 2021, this report from the National Emergency Laparotomy Audit (NELA) found that improvements in in-hospital mortality have levelled off. As such, it calls for hospitals to continue to engage with NELA data collection and, in particular, to make use of real-time data and resources available to drive clinical and service quality improvement.
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Content ArticleDelivering the future hospital is an account of the successes, challenges and learning from the Future Hospital Programme. The Future Hospital Programme (FHP) was established to implement the recommendations of the Future Hospital Commission. These recommendations were based on the very best of our hospital services, taking examples of existing innovative and patient-centred services to develop a comprehensive model of care. The FHP worked with eight Future Hospital development sites, comprising multidisciplinary teams of physicians, nurses, managers, allied health professionals, social workers and patients on discrete projects aligned to the vision of the FHC. Delivering the future hospital contains an overview of the improvement journey, outcomes and learning from each development site. In addition, to mark the end of their collaboration with the FHP, development site teams prepared a more detailed account of their experiences and learning. Both the summary and long-form reports are available from the link below.
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Content ArticleHighlights from the South West Integrated Personalised Care Awards celebrating some of the great work in the NHS.
