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Medication nonadherence - when patients don’t take their medications as prescribed - is unfortunately fairly common, with research showing that patients don’t take their medications as prescribed about half the time. The phenomenon has added consequences for patients with chronic disease. When this is the case, it is important for physicians and other health professionals to understand why patients don’t take their medications. This will help teams identify and improve patients’ adherence to their medications. This article by AMA, highlights eight reasons why patients don't take their medications.

The Forgiveness Project shares stories of forgiveness in order to build hope, empathy and understanding. Founded in 2004 by journalist, Marina Cantacuzino, The Forgiveness Project provides resources and experiences to help people examine and overcome their own unresolved grievances. The testimonies we collect bear witness to the resilience of the human spirit and act as a powerful antidote to narratives of hate and dehumanisation, presenting alternatives to cycles of conflict, violence, crime and injustice. At the heart of The Forgiveness Project is an understanding that restorative narratives have the power to transform lives; not only supporting people to deal with issues in their own lives, but also building a climate of resilience, hope and empathy.

The Serenity Integrated Mentoring (SIM) model is described as "an innovative mental health workforce transformation model that brings together the police and community mental health services, in order to better support 'high intensity users' of Section 136 of the Mental Health Act (MHA) and public services." The SIM model is part of a 'High Intensity Network' (HIN) approach, which is now live in all south London boroughs. In this hub post, Steve Turner highlights the benefits and risks of this approach and seek your views on it. Background In 2018, SIM was selected for national scaling and spread across the Academic Health Science Networks (AHSNs). The High Intensity Network (HIN) has been working with the three south London Secondary Mental Health Trusts: The South London and Maudsley NHS Foundation Trust, Oxleas NHS Foundation Trust and South West London and St George’s Mental Health NHS Trust, and the Metropolitan Police, London Ambulance Service, A&E, CCG commissioners, and the innovator and Network Director of the High Intensity Network. The model can be summarised as: A more integrated, informed, calm approach in the way we respond to individuals that have unique needs during a crisis and A better form of multi-skilled, personalised support after the crisis event is over. So in July 2013 the Serenity Integrated Mentoring (SIM) model of care was proposed. This is how it works: SIM brings together all the key urgent care agencies involved in responding to high-intensity crisis service users around the table, once a month. This multi-agency panel selects each individual based on demand/risk data and professional referrals. They use a national 5-point assessment process to ensure that the right clients are chosen and in a way where we can ensure a delicate balance between their rights as an individual but our need to safeguard. Selected individuals are then allocated to a SIM intervention team. The SIM team is led principally by a mental health professional (who leads clinically) and a police officer (who leads on behaviour, community safety, risk and impact). The team supports each patient, to better understand their crises and to identify healthier and safer ways to cope. In the most intensive, harmful or impactive cases, the team also does everything it can to prevent the need for criminal justice intervention. Together, the mental health clinician, the police officer and the service user together create a safer crisis plan that 999 responders can find and use 24 hours day. The crisis plan is then disseminated across the emergency services. The SIM team reinforces these plans by training, briefing and advising front line responders in how to use the plans and how to make confident, consistent, higher quality decisions. What are the benefits and risks of this approach? Benefits: It is claimed that this is a more integrated, calm and informed approach to responding to individuals in crisis and the HIN provides "better multi-skilled, personalised support after a crisis event was over". The HIN website states: "Across the UK, emergency and healthcare services respond every minute to people in mental health crisis and calls of this nature are increasing each year. But did you know that as much as 70% of this demand is caused by a small number of ‘high-intensity users’ who struggle with complex trauma and behavioural disorders? These disorders often expose the patient to higher levels of risk and harm and can simultaneously cause intensive demand on police, ambulance, A&E departments, and mental health crisis teams." Risks: This approach has been subject to strong criticism from some users of mental health services, mental health clinicians and mental health support organisations. Concerns have been raised about whether the HIN/SIM approach is safe, effective or appropriate. I believe we need an open and inclusive discussion about High Intensity Networks, with users of mental services leading the debate. As a former mental health nurse in an Assertive Outreach team I'm keen to learn: How users of services were involved in the initial development of the model? What are the similarities and differences between High Intensity Networks and an Assertive Outreach model? How this approach compares with approaches in other countries? How users of services are involved in evaluating and adapting the model? What the specific benefits are for users of services and are there any risks to this approach? Does this lead to a long term improvements for users of services? I hope people will feel able to contribute openly to this discussion, so we can learn together. #HighIntensityNetwork #mentalhealth

In this article, Robert Greene, Founder and President of HungerNdThirst Foundation, explains why patient advocacy is a vital aspect during the entire clinical trial process. He discusses how a patient advocates help patients communicate with their healthcare providers in order to make an informed decision about their health care, the positives and negatives of participating in clinical trials and how building trust and collaboration between patients, patient advocates, other stakeholders, and clinical trial professionals is important.

This film, produced by Hearts in Healthcare, shows Kathy talking about her experience of being in an Intensive Care Unit following a serious accident. Kathy talks about the importance of communicating to patients, even when they are unable to respond, and recalls one particular nurse who made a huge difference to her recovery. An incredibly powerful account that beautifully illustrates human-centred healthcare.

Patient experience measures are widely used as a means of assessing the quality of care from the perspective of users. Despite the recent proliferation of these measures, they are all too often poorly understood and fail to lead to service improvements. This session, from the European patient experience and innovation congress (EPIC), will look at the role that measuring and understanding experiences can play in ensuring that care services are person-centred, including the barriers to effective use of experience information and how these can be overcome.  

When patients give feedback to healthcare providers, the topic of "communication" often features prominently. That is because when people are feeling vulnerable, the way they are spoken to, and the words that are used, matter a great deal. There can be few experiences that are more distressing than the death of a baby. So we need to think very carefully about how bereaved parents are spoken to. This paper looks at clinical terms such as "miscarriage", "stillbirth" and "neo-natal death" and finds that "These categorisations based on gestational age and signs of life may not align with the realities of parental experience". This study, published by the International Journal of Obstetrics and Gynaecology, explored the healthcare experiences of parents whose babies had died just before 24 weeks of gestation. Those interviewed "felt strongly that describing their loss as a "miscarriage" was inappropriate and did not adequately describe their lived experience".

This study from Landefeld et al., published in the Indian Journal of Community Medicine, looks at the perceptions of healthcare providers about barriers to improved patient safety in the Indian state of Kerala. Five focus group discussions were held with 16 doctors and 20 nurses across three institutions (primary, secondary and tertiary care centers) in Kerala, India and transcripts were analysed by thematic analysis. The results found there were 129 unique mentions of barriers to patient safety; these barriers were categorised into five major themes. ‘Limited resources’ was the most prominent theme, followed by barriers related to health systems issues, the medical culture, provider training and patient education/awareness. Although inadequate resources are likely a substantial challenge to the improvement of patient safety in India, other patient safety barriers such as health systems changes, training, and education, could be addressed with fewer resources. While initial approaches to improving patient safety in India and other low- and middle-income countries have focused on implementing processes that represent best practices, this study suggests that multifaceted interventions to also address more structural problems (such as resource constraints, systems issues, and medical culture) may be important.

This interview is part of the hub's 'Frontline insights during the pandemic' series where Martin Hogan interviews healthcare professionals from various specialties to capture their experience and insights during the coronavirus pandemic. Here Martin interviews an advanced specialist paramedic working in central London with four years' experience of working on the frontline. 

This study, published in Health Services and Delivery Research, found the patient experience feedback cycle was rarely completed, and despite diverse approaches to gathering feedback in inpatient settings, approaches to analysing and using this information remain underdeveloped.

In this International Society for Quality in Healthcare (ISQua) webinar, Eugene Litvak discussed streamlining patient flow to improve access to care and its quality, and reduce cost. Other benefits include lower staff turnover rates, improved organisation culture and improved patient outcomes. Eugene gives a number of examples of hospitals where this 're-engineering' of pathways has resulted in increased performance and reduced risk.

As the colourful rainbows in people's windows are beginning to fade, is the public support for our frontline workers also fading? Has gratitude and thank you's been replaced with frustration and anger from the public? In her latest blog, critical care outreach nurse Claire reflects on the impact this is having on the wellbeing of already exhausted frontline staff. When driving to work at the beginning of the pandemic, I felt a sense of worry and apprehension of what I would be faced with. As a critical care outreach nurse I never know what I may be faced with, but this has never bothered me. However, during the pandemic it did bother me. I worried how I could do my job; would I get sick and how would I navigate my way through the new ways of working? Seeing the brightly coloured rainbows in people’s windows gave me some hope. I knew that the public were thinking of us; they knew the risks we were putting ourselves at and our families. For a time, I felt special. It sounds pathetic, I know. For a time, I felt valued. Valued by the public, valued by the trust I work for and valued by politicians. As NHS staff we had priority shopping, we had discounts from big stores, we had free parking, we had donations of food every day while we were at work, we were donated hand creams and toiletries. School children drew us pictures to put on the walls of our staff room saying ”thank you”. What made me feel valued more than anything was staff wellbeing being at the forefront. Extra staff were redeployed to work on the ITU, we were made sure we had all our breaks and we were made to feel that each and every one of us counted. Relatives of patients wrote and expressed their gratitude, even if they were unable to visit their dying family – they were truly grateful to us. The ITU where I work received so many beautifully written letters and cards. We pinned every one onto the wall so we were reminded that we were shining bright despite the darkness. Then there was the Thursday clap. Personally, I thought this was an odd thing to do, but it seemed to bring people together and have a shared purpose – even if it was for a fleeting 5 minutes a week. When I think back at those months, it seems like a lifetime ago. Eve Mitchell’s recent blog on the hub highlighted that care homes are receiving complaint letters and some are even receiving threats of litigation. “Not enough PPE”, “lack of care given to my family member”, “my family member was neglected during the pandemic” – frustration and anger are palpable. Frustration and anger because families were unable to visit their relatives in their last days, frustration and anger that these precious moments have been denied from them. If it were my mum or dad would I feel the same? Of course I would. I would be the loudest voice there. Is it the fault of the care home? Should they be vilified for the protection of their residents? And now it’s the turn of the hospitals. We now have over a million people waiting on lists for operations, procedures, appointments. Some have already waited months before the pandemic started. Some have already died as a result of not having surgery at the right time. Patients have received surgery and treatment late and this has led to complications and a longer hospital stay – which then increases their mortality. At some point the gratitude from the public will turn to anger and frustration, as it has with the care homes. Would I be angry if my mum was waiting for an operation and died as a result of a prolonged wait? Yes I would. It is a natural response to blame the very people who should have helped – the NHS staff. I now drive to work and see faded rainbows in windows, I will be paying for parking again in the next few weeks, the donations of food have dried up, staff are back at ‘normal’ levels and I am back to having no breaks some days, not to mention that nurses were not included in the recent pay rise. I feel that we have served our purpose. ‘Thanks very much – now get back to normal, sort the waiting lists out and work harder to make sure it happens’. I don’t envy our senior leaders in acute Trusts. They are stuck in the middle of the Department of Health and Social Care and NHS England who are trying to fathom out a strategy to get the waiting lists down, and support frontline staff who are exhausted and a frustrated public that may erupt at any moment. Frontline workers have been through it the last few months. Navigating our way through complaints and litigation and an angry public who feel that they are not receiving the care that they expect in the coming months fills me with dread. We are not equipped. Faded rainbows – is this a representation of the fading support we are receiving in the NHS?

This paper from Helen Hughes presents a proposal to improve the safety of patients and the effectiveness of healthcare using Human Factors methods.

In her latest blog for the hub, topic lead Eve Mitchell discusses the impact COVID-19 is having on the mental health and wellbeing of healthcare staff who are now having to absorb the anger of the public, patients, and their carers.  Over the last couple of weeks I have been engaging in one of my favourite pastimes – chatting. I realise this seems a little frivolous, but after the more formal ‘meetings’ of previous weeks, chatting seemed appropriate. There is a serious reason behind this, the impact of ‘emotional labour’. Emotional labour is defined as “having to induce or suppress feeling in order to sustain the outward countenance that produces the proper state of mind in others”.[1] Or, in layman’s terms, pretending you are OK. For my colleagues and clients across health and social care, and particularly for frontline nursing and care staff, there has been an even greater need to deliver compassionate patient care whilst managing their own emotions during the pandemic, and somehow with the easing of lockdown some of the façade has started to fail. Through conversation, it has become clear that there is a new impact of COVID-19 on the mental health and wellbeing of healthcare staff: absorbing the anger of the public, patients, and their carers. In a previous post I mentioned that there was fear from some colleagues about potential litigation once the pandemic was over. Looking for someone to blame for what was and was not done. This is not an unusual reaction, but showering staff with vitriol does seem a little unprecedented. For example, in the care homes I work with every home has received letters or complaints about the care of their residents from family members: "you did not care for my mother"; "you let my father die alone"; "my mother died of loneliness as you wouldn’t let me see her"; "it is down to your lack of care that my brother died"; whether the home had COVID infections or not. The upset this has caused is palpable, with exhausted staff bearing the brunt for doing their job in the most difficult of circumstances. A similar story is heard from GP practice nurses and reception staff – patients refusing to wear masks, accusing the nurses and doctors of wilfully letting them suffer and refusing to see them when they were in need, demanding to see a professional immediately, refusing to leave the premises. A massive change for the surgeries who earlier were being given gifts of cake and chocolate and sent messages of gratitude. Hospital staff seem to have faired better, although as outpatient appointments come back online there is an expectation that the pent-up fear and frustration will be released in this setting too. Maybe it is not only health and care staff who suffer from compassion fatigue – it has happened to the general public at the same time as the clapping stopped and the next normal dawned. However, it is not clear how we should deal with this. Ensuring the welfare of staff across all settings of care should remain at the forefront of workforce planning and is enshrined in the new NHS People Plan; but it doesn’t tell us how to navigate and dissipate the anger of the public, and whilst this remains unaddressed it is our frontline staff that will bear the brunt, sending them ever closer to burnout, and puts the future of our health and care workforce at risk. And anything that impacts on staff safety, impacts on patient safety. References: Hochschild AR. The Managed Heart: Commercialisation of Human Feeling. Oakland: University of California Press: 2012. World Health Organization. Mental Health and Psychosocial Considerations During the COVID-19 Outbreak. Geneva: WHO; 2020.. Patient Safety Learning have set up a community page on the hub to capture insights from staff on their safety. World Patient Safety Day on Thursday 17 September this year focuses on staff safety. If you have been affected by the issues raised in this blog and want your voice to be heard (whether attributable or anonymously), please share here. Patient Safety Learning will use such insights to highlight the staff safety issues and call for action.

This paper, published by the Canadian Journal of Surgery, suggests that the failure to systematically measure patient safety is the reason for limited progress. In addition to defining patient safety outcomes and describing their financial and clinical impact, the authors argue why the failure to implement patient safety measurement systems has compromised the ability to move the agenda forward. They also present an overview of how patient safety can be assessed and the strengths and weaknesses of each method and comment on some of the consequences created by the absence of a systematic measurement system.

PHSO – Labyrinth of Bureaucracy is the follow-up report to the November 2014 Patients Association report on the Parliamentary and Health Service Ombudsman, The ‘Peoples’ Ombudsman – How it Failed us.

In the worst moment of your life, what would you need? In 2017, Jen Gilroy-Cheetham’s life changed forever. Just six months after having her second child, she was diagnosed with a rare neuroendocrine tumour and was advised that she would need to undergo open surgery to have half of her stomach removed. Complications led to one of the darkest and scariest times of Jen’s life, as she was put into a hospital ward feeling unwell, vulnerable and unsafe. Now recovered, Jen shares her experiences as a patient from a hospital bed - or audience member - watching all of the healthcare staff around her - actors on a stage - doing everything they could to make her feel safe. In reliving her journey to recovery, Jen highlights what’s needed within a healthcare setting to make patients feel safe. Jen feels that highlighting what’s worked well to help her to feel safe and what needs to change is valuable and may help others in the future.

When someone you love is hospitalised, it can be scary-even terrifying-for the patient and for family and friends. A hospital may seem like a foreign land. Sounds, smells, and the culture are unfamiliar; even the medical terminology sounds like a different language. Understanding the hospital environment and knowing how to navigate its complicated pathways can make you a strong champion for your loved one. You are as critical to your loved one's recovery as the doctors and nurses. Your role is different, but vital. In some cases, you can make the difference between life and death. Hospital Warrior de-mystifies the process and provides the tools, understanding and insight you need to get the best care for your loved one. Based on the author, Bonnie Friedman's own experiences, Hospital Warrior lays out in direct, simple terms hard-learned and time-tested tactics to help ensure a loved one's medical needs are met. Hospital Warrior also includes checklists and interviews with doctors and other healthcare professionals who provide essential tips and advice for the reader. Bonnie Friedman is passionate about hospital healthcare. Her expertise is hard-won, based on more than 24 years of advocating for her husband through 14 separate hospitalisations – some fairly routine, some quite dramatic and some truly life-and-death experiences.

The prison population of England and Wales is around 86,000 prisoners. This report by the NHS Benchmarking Network summarises the results of an audit that has taken place across Health and Justice Commissioning services, Her Majesty’s Prison and Probation Service (HMPPS) and NHS England Specialised Commissioning to quantify the extent of prisoners waiting for assessment and waiting for transfer to mental health facilities (secure and non-secure services). The Benchmarking Network is the in-house benchmarking service of the NHS. The Network is hosted by East London NHS Foundation Trust.

For the fourth year, the Health Quality Council of Alberta (HQCA), in partnership with the Patient and Family Advisory Committee (PFAC), held the Patient Experience Awards programme to recognise and help spread knowledge about initiatives that improve the patient experience in accessing and receiving healthcare services in Alberta, Canada. Applications spanned all corners of the province and came from a wide variety of care settings, and ranged from “elegantly simple” to complex in nature. The initiatives described reflected the diverse healthcare needs of Albertans and were equally diverse in their approach to healthcare improvement. However, they all had one thing in common: A desire to make change and deliver a better patient and family member experience. The following four initiatives were selected to receive the HQCA’s 2019 Patient Experience Awards: NowICU Project, Neonatal Intensive Care Unit (NICU), Misericordia Community Hospital Rapid Access, Patient Focused Biopsy Clinic; Head and Neck Surgery, Pathology; University of Alberta Hospital Edmonton Prostate Interdisciplinary Cancer Clinic (EPICC), Northern Alberta Urology Centre Transitional Pain Service, South Health Campus Take a look at their presentations and find out more about these great initiatives.

Report of handling of complaints by NHS hospitals in England by Ann Clwyd MP and Professor Tricia Hart.