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Content ArticleSince 2018, Nicola Burgess has led a team from Warwick Business School that evaluated the partnership between the English NHS and the Virginia Mason Institute in the USA. The partnership aimed to implement a systematic approach to quality improvement (QI) in five English NHS trusts and learn lessons about how to foster a culture of continuous improvement across the wider health and care system. In this blog, she summarises six key lessons from the evaluation report for health and care leaders looking to build a systematic approach to QI. Build cultural readiness as the foundation for better QI outcomes Embed QI routines and practices into everyday practice Leaders show the way and light the path for others Relationships aren’t a priority, they’re a prerequisite Holding each other to account for behaviours, not just outcomes The rule of the golden thread: not all improvement matters in the same way
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Content Article
SAPHNA - Eating disorder toolkit (October 2022)
Patient-Safety-Learning posted an article in Eating disorders
This toolkit has been co-produced by the School and Public Health Nurses Association (SAPHNA) with school nursing services, mental health campaigners, eating disorder experts, education colleagues and young people with lived-experience of eating disorders. It is aimed at qualified, trained and skilled nurses who have access to robust supervision. The toolkit is free of charge, but you will need to enter your details in order to receive a PDF copy by email. -
Content ArticleThis letter to the editor published in The Journal of Biomedical Research outlines the ways in which simulation will be used in medical education in the future. The author highlights that: simulation is likely to become much more closely linked to assessment in the future. our vision of what constitutes simulation will change radically in the future, with access to simulation becoming easier and wider. the future of simulation in medical education will follow the same path as the future of healthcare—more primary care, management of long term conditions and patient self-management.
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Content ArticleIn this blog, Ted Baker, Former Chief Inspector of Hospitals at the Care Quality Commission, suggests that a false view that health services are intrinsically safe leads to defensive responses to safety concerns and perpetuates a culture of blame. He argues that the mismatch between safety as described and the reality of safety in practice prevents healthcare professionals being able to speak up about safety concerns. By taking an alternative approach that accepts the risk inherent in healthcare and the fallibility of individuals, he believes we can build organisations and systems that really learn from safety events. In order to do this, we need staff to feel able and supported to speak up, something that can be achieved through widespread understanding of safety society and building a supportive culture. Ted argues that this open culture is still lacking within many services.
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Content ArticleHealthcare service innovations are considered to play a pivotal role in improving organisational efficiency and responding effectively to healthcare needs. However, healthcare organisations often encounter difficulties in sustaining and sharing innovations. This qualitative study aimed to explore how healthcare innovators of process-based initiatives see and understand factors that either facilitated or obstructed the implementation of innovation. The authors found that even though the innovations studied were very varied, innovators often highlighted the significant role of the evidential base of success, the inter-personal and inter-organisational networks, and the inner and outer context.
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Content ArticleThis 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.
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Content ArticleDuring the Covid-19 pandemic there was a large-scale shift to remote consulting in UK general practice. In 2021, we saw a partial return to in-person consultations, which occurred in the context of extreme workload pressures due to backlogs, staff shortages and task shifting. This study in the British Journal of General Practice looked at media depictions of remote consultations in UK general practice at a time when general practice was under stress. The authors did a thematic analysis of national newspaper articles about remote GP consultations during two time periods: 13–26 May 2021, following an NHS England letter, and 14–27 October 2021, following a government-backed directive, both stipulating a return to in-person consulting. They found that newspaper coverage of remote consulting was strikingly negative and conclude that remote consultations have become associated in the media with poor practice. They recommend proactive dialogue between practitioners and the media to help minimise polarisation and improve perceptions around general practice.
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Content ArticleThe Voluntary Organisations Disability Group (VODG) has launched a commission on Covid-19, Disablism and Systemic Racism to explore how the worst impacts of Covid have fallen on Disabled people, particularly those from Black, Asian and minoritised ethnic groups. The Commission is examining the extent to systemic neglect of social care over many years has caused negative outcomes that have been worsened by confused approaches by the Government during the pandemic. This includes poor implementation of policy and conflicting guidance. The work will gather evidence, scrutinise the Department of Health and Social Care’s policies and responses to the pandemic, including ways in which systemic racism may have further worsened outcomes for disabled people of colour, and build solutions and support for transformative and sustainable change in social care, based on justice and human rights. The Commission is calling on Disabled people and people with long-term health conditions from Black, Asian and minoritised ethnic groups to share their views and experiences of the Covid-19 pandemic as part of its 'Call for Views and Experiences'. They are also keen to hear from families, carers and people who work in social care.
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Content ArticleCrisis resolution teams (CRTs) provide treatment at home to people experiencing mental health crises, as an alternative to hospital admission. This study in the International Journal of Mental Health Nursing aimed to measure whether CRTs adhere to a model of good practice, using one-day fidelity reviews of UK crisis teams. The authors found that despite a national mandate to implement the CRT model, there are wide variations in implementation in the UK and no teams in the sample achieved overall high fidelity.
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Content ArticleThis article explores the question of why change management was an issue in the NHS in the 1980s. It reports the results of a study which explored reasons for variability in the observed rate and pace of strategic service change in the NHS. The article introduces the metaphor of 'receptive' and 'non-receptive' contexts for change, as well as outlining eight 'signs and symptoms' of receptivity. It provides a logic and language which may enable a better understanding of the processes of change in the NHS.
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Content ArticleTo be effective, clinical governance should reach every level of a healthcare organisation—it requires structures and processes that integrate financial control, service performance and clinical quality in ways that will engage clinicians and generate service improvements. In this article for the BMJ, the authors argue that because clinicians are at the core of clinical work, they must be at the heart of clinical governance. They look at problems with the prevailing model of clinical governance and describe an alternative approach.
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Content ArticleIn healthcare, there is a well-recognised gap between what we know should be done, and what is actually done. This article considers new models that look at the implementation of evidence-based practice in healthcare systems, particularly looking at the application of a conceptual model called 'sticky knowledge'.
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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. Dan talks to us about how his experiences as a paediatrician and military doctor have influenced his view of patient safety. He also describes the increasing complexity in healthcare systems and highlights the need for the Government to commit policy and resources to building and sustaining the NHS workforce. -
Content ArticleEach year, Carers UK carries out a survey of carers to understand the state of caring in the UK, and this is the largest State of Caring survey carried out by Carers UK to date. Over 8,500 carers and former carers shared their experiences.
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Content ArticleIn 2020, all NHS organisations were instructed to name a single executive board member as their senior responsible person for tackling health inequalities. Across the NHS, there should now be over 450 dedicated health equality named leads in healthcare organisations. This report published by the independent NHS Race & Health Observatory in collaboration with The King’s Fund sets out recommendations to help ensure senior NHS officials responsible for improving health inequalities are able to make a difference.
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Content ArticleThis article in The Lancet aimed to review published work about the efficacy and safety of electroconvulsive therapy (ECT) with simulated ECT, ECT versus pharmacotherapy and different forms of ECT for patients with depressive illness. The authors designed a systematic overview and meta-analysis of randomised controlled trials and observational studies. They concluded that: ECT is an effective short-term treatment for depression, and is probably more effective than drug therapy. bilateral ECT is moderately more effective than unilateral ECT. high dose ECT is more effective than low dose.
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Content ArticleIn this BMJ opinion piece, Iona Heath reviews a new book by Penelope Campling, who worked as an NHS psychiatrist and psychotherapist for 40 years. Don't Turn Away tells the story of "an increasingly brutal turning away from the most abused and damaged people who struggle to survive within our complacent society." The article argues that over the past few decades, our society has failed to listen to and support the most vulnerable people, with mental health systems focusing on exclusion criteria and keeping people out of the system.
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Content ArticleSelf-binding directives instruct clinicians to overrule treatment refusal during future severe episodes of illness. These directives are promoted as having the potential to increase autonomy for individuals with severe episodic mental illness. Although lived experience is central to their creation, the views of service users on self-binding directives have not been seriously investigated. This study in The Lancet Psychiatry aimed to explore whether reasons for endorsement, ambivalence or rejection given by service users with bipolar disorder can address concerns regarding self-binding directives, decision-making capacity and human rights.
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Content ArticleThe poor treatment of autistic people and people with learning disabilities has been a long-standing problem for the NHS and care system. Although successive governments have focused on supporting autistic people and people with learning disabilities to live independent and fulfilled lives in the community, over 2,055 people remain in secure institutions where they are unable to live fulfilled lives and are often subject to unacceptable and inhumane treatment. This report by the Health and Social Care Select Committee chaired by Jeremy Hunt MP outlines the finding of the committee's Inquiry into the treatment of autistic people by health and care services.
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Content ArticleThe Prescribing Safety Assessment (PSA) is a 60-question exam required as part of UK medical training to progress from FY1 to FY2. This independent review into the PSA was commissioned by the Medical Schools Council (MSC) together with the British Pharmacological Society (BPS) in the summer of 2022. It suggests a strategic future direction for the PSA and addresses how the PSA has impacted prescribing assessment and practice for medical students and Foundation Year 1 (FY1) doctors. It is intended to support national decision making about the future of UK prescribing assessment in the context of the imminent introduction of the Medical Licensing Assessment (MLA).
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Content ArticleHealth Education England, Loughborough University and a range of partners have developed the new Human Factors Healthcare Learning Pathway in response to the NHS Patient Safety Syllabus 2021. It is the first ever system-wide Patient Safety Syllabus and is available as e-learning short courses that can be completed as a Learning Pathway (Levels 1-3) or individually. Fully accredited by the Chartered Institute of Ergonomics and Human Factors (CIEHF) and the CPD Certification Service, the Pathway offers a complete programme for health and social care staff to: develop competence and capability in Human Factors (Ergonomics) focus their knowledge on patient safety and staff wellbeing. Level 1 is available for free on the NHS Education for Scotland TURAS system and Health Education England's e-Learning for Healthcare platform Selected Level 2 modules are available to book on the Loughborough University Healthcare Learning Pathway webpage
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Content ArticleThe Royal College of Anaesthetists set up PatientsVoices@RCoA to help the College improve the delivery of safe, more effective, patient-centred care to enhance patients’ experience of anaesthesia and perioperative care. This plan by PatientsVoices@RCoA aims to set out a clear direction for our future work which ensures patients’ voices are clearly heard across all relevant activities, as the College delivers its strategic aims over the next five years.
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Content ArticleThe Patients Association's Patient Partnership Week brought together patients, carers and healthcare professionals to talk about patient partnership.
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Content ArticleIn this editorial. Peter Walsh reflects on 20 years as Chief Executive of Action against Medical Accidents (AVMA) as he retires from the role. AvMA also marks its 40th anniversary this year, and Peter examines the organisation's unique role in focusing on patient safety and justice for patients. He highlights that healthcare systems and patient safety practice still have a long way to go in offering fairness and support to families affected by avoidable harm in healthcare, and argues that focusing on patients and their families must be a top priority when looking at system safety. He highlights the vital role that AvMA has played in bringing Duty of Candour into law in the countries of the UK, and argues that legal action is an important right that must be retained for patients and families who have come to harm as a result of medical error. He also talks about AvMA's recent development of a Harmed Care Pathway in collaboration with the Harmed Patients Alliance, which outlines the specific set of needs that should form part of a package of care for harmed patients and families.
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Content ArticleThe National Centre for Social Research’s (NatCen’s) British Social Attitudes (BSA) survey has been conducted annually since 1983. Each year the survey asks people what it's like to live in Britain and what they think about how Britain is run, including measuring levels of public satisfaction with the health and care services. The most recent survey was carried out between 7 September and 30 October 2022 and asked a nationally representative sample (across England, Scotland and Wales) of 3,362 people about their satisfaction with the National Health Service (NHS) and social care services overall, and 1,187 people about their satisfaction with specific NHS services, as well as their views on NHS funding. This report highlights the key findings of the survey, which was jointly sponsored this year by The King's Fund and the Nuffield Trust.
