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Found 35 results
  1. Content Article
    Carl Heneghan discusses the role of modelling in the Covid-19 pandemic.
  2. Content Article
    A recent paper (from clinicians and Human Factors specialists at the Royal Surrey NHS Foundation Trust) jointly supported by Elsevier and BJA Education clarifies what Human Factors (HF) is by highlighting and redressing key myths.  The learning objectives from the paper are as follows: Identify common myths around HF Describe what HF is Discuss the importance of HF specialists in healthcare Distinguish the importance of a systems-based approach and user-centred design for HF practice.  It explains that HF is a scientific discipline in its own right, a complex adaptive system very much like healthcare. Its principle have been used within healthcare for decades but often in an informal way.  A link to the summary of the article on Science Direct and further links to purchase the paper can be found here: https://www.sciencedirect.com/science/article/abs/pii/S2058534923000963?dgcid=author 
  3. Content Article
    The NHS is the closest thing we have to a national religion – or so it's often said. But many critics have claimed that the high value we place on our health system leads to widespread resistance to its reform. In the second of a series of mythbusting commentaries, Nigel Edwards shows this isn't the case – arguing that, in fact, the NHS has perhaps had too much reform, of the badly planned kind.
  4. News Article
    The ‘optimal layout’ for an isolation room to contain the spread of Covid has been created following tests at a London hospital. The room was designed by researchers at Imperial College London to reduce the risk of infection for health care staff as far as possible. Researchers used a state-of-the-art fluid model to simulate the transmission of the virus within an isolation room at the Royal Brompton Hospital in Chelsea, west London. They found that the area of highest risk of infection is above a patient’s bed at a height of 0.7 to two metres, where the highest concentration of Covid is found. After the virus is expelled from a patient’s mouth, the research team explained that it gets driven vertically by wind forces within the room. The research, published in the journal Physics of Fluids, is based on data collected from the room during a Covid patient’s stay. The work centred on the location of the room’s air extractor and filtration rates, the location of the bed, and the health and safety of the hospital staff working within the area. Read full story Source: The Independent, 8 February 2023
  5. Content Article
    One solution often proposed for the NHS’s problems is to change how it is funded, and move instead to a social insurance model. In the latest in his series of myth-busting commentaries published by Nuffield Trust, Nigel Edwards describes why such a move in the UK would be unlikely to provide most of the benefits that its advocates hope for.
  6. Content Article
    Cynefin, pronounced kuh-nev-in, is a Welsh word that signifies the multiple, intertwined factors in our environment and our experience that influence us (how we think, interpret and act) in ways we can never fully understand.  The Cynefin Framework was developed to help leaders understand their challenges and to make decisions in context. It has been applied to many different environments including healthcare and safety. To read more about the framework and to watch a 12-minute introductory film, follow the link below to the Cynefin Co website.
  7. Content Article
    The Covid-19 pandemic has led to the reorganisation of healthcare services to limit the transmission of the virus and deal with the sequelae of infection. This reorganisation had a detrimental effect on cardiovascular services, with reductions in hospitalisations for acute cardiovascular events and the deferral of all but the most urgent interventional procedures and operations. Aortic stenosis (AS) is the most common form of valvular heart disease. Once stenosis is severe, symptoms follow and the prognosis is poor, with 50% mortality within 2 years of symptom onset. Thus, timely treatment is of paramount importance. There was a large decline procedural activity to treat severe AS during the COVID-19 pandemic.  As we move into an era of ‘living with’ COVID-19, plans must urgently be put in place to best manage the additional waiting list burden for treatment of severe AS. In this study, Stickels et al. used mathematical methods to examine the extent to which additional capacity to provide treatment of severe AS should be created to clear the backlog and minimise deaths of people on the waiting list.
  8. Content Article
    This qualitative study in BMC Medicine aimed to improve understanding of the reality of making and sustaining improvements in complex healthcare systems. It focused on understanding the implications of complexity theory, introducing a framework known as Successful Healthcare Improvement From Translating Evidence in complex systems (SHIFT-Evidence). This approach is accompanied by a series of ‘simple rules’ that aim to make complexity navigable (whilst recognising that it will never be simple), providing actionable guidance to both practice and research. The authors concluded that the SHIFT-Evidence framework provides a tool to guide practice and research. The ‘simple rules’ have potential to provide a common platform for academics, practitioners, patients and policymakers to collaborate when intervening to achieve improvements in healthcare.
  9. Event
    until
    Harnessing the contribution of support staff, and the wider population, is crucial in both determining the success of service transformations and shaping health outcomes. The fourth seminar in the Health Education England series will discuss the importance of whole system design and transformation and maximising everyone’s contribution to promoting and protecting the public’s health, as well as the significance of encouraging new and emergent roles and routes into health and care systems. Register
  10. Content Article
    The Covid-19 pandemic presented the need for fast decision-making in a rapidly shifting global context. This article in BMJ Evidence Based Medicine looks at the limitations of traditional evidence-based medicine (EBM) approaches when investigating questions in the context of complex, shifting environments. The authors argue that it is time to take a more varied approach to defining what counts as ‘high-quality’ evidence. They introduce some conceptual tools and quality frameworks from various fields involving what is known as mechanistic research, including complexity science, engineering and the social sciences. The article proposes that the tools and frameworks of mechanistic evidence, sometimes known as ‘EBM+’ when combined with traditional EBM, may help develop the interdisciplinary evidence base needed to take us out of this protracted pandemic.
  11. Content Article
    Covid-19 may be receding, but it’s leaving a quiet menace lurking in hospitals in its wake. In a Perspective essay in The New England Journal of Medicine, four senior physicians with the Centers for Medicare & Medicaid Services and the Centers for Disease Control and Prevention warned of a “severe” post-Covid decline in patient safety. The Association for Professionals in Infection Control and Epidemiology reached a similar conclusion, warning of a rise in “common, often-deadly” infections. To help reverse this troubling trend, the federal physician leaders called for “promoting radical transparency.”  In this article, Michael L. Millenson and J. Matthew Austin discuss how adapting the psychological principles of 'Maslow’s Hierarchy of Needs' as an organising framework, paired with the principles of information design, can significantly boost both the use and impact of safety and quality information.
  12. Content Article
    The iterative processes that engineers and technicians use to address problems could have been applied by decision-makers throughout the COVID-19 pandemic writes Rick Schrenker.
  13. Content Article
    This study aims to present two system models widely used in Human Factors and Ergonomics (HF/E) and evaluate whether the models are adoptable to England’s national patient safety team in improving the exploration and understanding of multiple incident reports of an active patient safety issue and the development of the remedial actions for a potential National Patient Safety Alert. The existing process of examining multiple incidents is based on inductive thematic analysis and forming the remedial actions is based on barrier analysis of intelligence on potential solutions. However, no formal systems models evaluated in this study have been used. AcciMap and Systems Engineering Initiative for Patient Safety (SEIPS) were selected, applied and evaluated to the analysis of two different sets of patient safety incidents: (i) incidents concerning ingestion of superabsorbent polymer granules and (ii) incidents concerning the interruption in use of High Nasal Flow Oxygen.
  14. Content Article
    This Rapid Evidence Scan from Moore et al. examined the effectiveness of virtual hospital models of care. While no reviews evaluated a complete model, tele-healthcare only and tele-healthcare with remote telemonitoring interventions demonstrated similar or significantly better clinical or health system outcomes including reduced hospitalisations, readmissions, emergency department visits and length of stay, compared to usual care, including those delivered without home visits or face-to-face care. The use of the Internet showed mixed but promising results. The strongest evidence was for cardiac failure, coronary heart disease, diabetes and stroke rehabilitation. Nurses played a central role in home visiting, providing telephone support and education. However, the studies were heterogenous and the results should be interpreted with caution.
  15. Content Article
    Although most current medication error prevention systems are rule-based, these systems may result in alert fatigue because of poor accuracy. Previously, we had developed a machine learning (ML) model based on Taiwan’s local databases (TLD) to address this issue. However, the international transferability of this model is unclear. This study examines the international transferability of a machine learning model for detecting medication errors and whether the federated learning approach could further improve the accuracy of the model. It found that the ML model has good international transferability among US hospital data. Using the federated learning approach with local hospital data could further improve the accuracy of the model.
  16. Content Article
    This research, published by PLoS ONE, highlights how community-based antenatal care, with a focus on continuity of carer reduced health inequalities and improved maternal and neonatal clinical outcomes for women with social risk factors. The findings support the current policy drive to increase continuity of midwife-led care, whilst adding that community-based care may further improve outcomes for women at increased risk of health inequalities. 
  17. Content Article
    This paper from Samson et al. discusses the properties of complex systems and a systems approach to incident investigation, describes the differences between reactive and proactive safety approaches and describes some of the system-focused models applied to patient safety incident investigations.
  18. Content Article
    Failure to attend scheduled hospital appointments disrupts clinical management and consumes resource estimated at £1 billion annually in the UK NHS alone. Accurate stratification of absence risk can maximise the yield of preventative interventions. The wide multiplicity of potential causes, and the poor performance of systems based on simple, linear, low-dimensional models, suggests complex predictive models of attendance are needed. In this paper, Nelson et al. quantify the effect of using complex, non-linear, high-dimensional models enabled by machine learning.
  19. Content Article
    In July 2015 five NHS Trusts were selected to work with Virginia Mason Institute (VMI) to develop localised versions of the Virginia Mason Production System (an adaption of the Toyota Production System, a continuous improvement approach commonly known as Lean). The goal was to develop a sustainable culture of continuous improvement capability in each of the five partner NHS hospital Trusts, and to share lessons from the partnership with NHS system leaders. Here are a series of video interviews with the CEOs of these NHS Trusts and the Virginia Mason Institute.
  20. Content Article
    Larouzee and Le Coze describe the development of the “Swiss cheese model” and the main criticisms of this model and the motivation for these criticisms.  The article concludes that the Swiss cheese model remains a relevant model because of its systemic foundations and its sustained use in high-risk industries and encourages safety science researchers and practitioners to continue imagining alternatives combining empirical, practical and graphical approaches.
  21. Content Article
    Plan Do Study Act (PDSA) cycles are an ideal quality improvement tool that can be used to test an idea by temporarily trialling a change and assessing its impact.
  22. Content Article
    ‘Systems thinking’ is often recommended in healthcare to support quality and safety activities but a shared understanding of this concept and purposeful guidance on its application are limited. Healthcare systems have been described as complex where human adaptation to localised circumstances is often necessary to achieve success. Principles for managing and improving system safety developed by the European Organisation for the Safety of Air Navigation (EUROCONTROL; a European intergovernmental air navigation organisation) incorporate a ‘Safety-II systems approach’ to promote understanding of how safety may be achieved in complex work systems. Authors of this paper, published by BMJ Open Quality, aimed to adapt and contextualise the core principles of this systems approach and demonstrate the application in a healthcare setting.
  23. Content Article
    Complex systems consist of many dynamic interactions between people, tasks, technology, environments (physical and social), organisational structures and arrangement and external factors, such as the influence of national policy or regulation. The nature of these interactions often results in unpredictable changes in system conditions (such as patient demand, staff capacity, available resources and organisational constraints) and goal conflicts (such as the frequent pressure to be efficient and thorough). To achieve success, people frequently adapt to these system conditions and goal conflicts. But rather than being planned in advance, these adaptations are often approximate responses to the situations faced at the time.  Therefore, to understand patient safety or staff wellbeing (and other emergent outcomes) we need to look beyond the individual components of care systems to consider how outcomes (wanted and unwanted) emerge from interactions in, and adaptations to, everyday working conditions. Follow the link below to the NHS Education Scotland (NES) website to find out more about systems thinking and access systems approach resources.
  24. Content Article
    System thinking encourages the consideration of the interacting forces contributing to problems to enable the design and implementation of strategies to address the underlying conditions that perpetuate those problems. This article from Bradley et al. in eClinical Medicine provides an illustration of the various forces to be resolved to effectively respond to COVID-19. Bradley DT, Mansouri MA, Kee F, Garcia LMT. A systems approach to preventing and responding to COVID-19. 
  25. Content Article
    Simon Whitely in this video responds to some of the comments received on his last video, where he talk about a high-level HCS Model of the Healthcare System and how interactions with the general public are key for patient safety. He also talks about the challenges between managing safety and the potential impacts upon the overall economy.
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