Lucy Chapman

Delivered and presented by: Liz Tomlin – Head of Quality Improvement and Clinical Outcomes, Bradford Teaching Hospitals NHS Foundation Trust

Abstract

There are very few routine and reliable mechanisms for patients, carers and families to escalate past the primary team when concerned about standard care not meeting their needs. Failing to escalate in a timely manner timely can have adverse effects to patient outcomes. It has been recognised that having reliable patient and family escalation systems is also a quality marker of patient centred care. NHS England’s Worry and Concern Task and Finish Group (a subgroup of the Acute Deterioration Board) have run a national improvement collaborative from April 2023 for 12 months. Bradford Teaching Hospitals NHS Foundation Trust has participated in this pilot to develop, test, implement and evaluate methods to incorporate patients’ views of their wellness/illness and worries and concerns in the assessment and recognition of acute illness and risk of deterioration.
Using a Quality Improvement approach, we adopted the Patient Wellness Questionnaire as a tool to measure patient reported wellness. We have conducted small tests of change across three different wards (surgical and medical). We have demonstrated that when used by qualified nursing staff, supported by strong leadership at a ward level, the PWQ is a reliable and useful tool to identify ‘soft signs’ of deterioration and supports nursing staff to escalate to the Critical Care Outreach Team for an independent review.

Biography

Liz is Head of Quality Improvement and Clinical Outcomes at Bradford Teaching Hospitals NHS Foundation Trust. Qualifying as a Registered Nurse in 1990 in adult nursing, Liz has worked in the acute clinical setting for over 16 years. In 2007, Liz joined the Trust and has spent over a decade working in patient safety research at the Bradford Institute of Health Research. Following an MSc in Health Sciences at the University of York, Liz successfully completed a PhD in 2018, funded by the Health Foundation, at the University of Leeds. Her thesis explored the mechanisms of change underpinning a specific quality improvement (QI) methodology: experienced based co-design. Liz has pursued her interests with Improvement Science and has experience in patient and public involvement and engagement in the healthcare setting. Liz is committed to delivering meaningful changes to improve the quality and safety of patient care and improving the work experience for staff.

Presentation

Delivered and presented by:  Professor Ian Leistikow

Role and organisation

• Adviser at the Dutch Health & Youth Care Inspectorate
• Professor at Erasmus School of Health Policy & Management, Erasmus University Rotterdam, the Netherlands

Abstract

Challenges that health & care faces, translate to challenges for the regulatory authorities. Classic regulatory strategies aimed at compliance increasingly fall short in contributing to quality of (health)care. In this webinar Ian will use the model of ‘value driven regulation’ to show how the Dutch Inspectorate strives to keep up with the dynamics of the sectors it regulates, by keeping its eye on creating societal value. Ian will also give an overview of the broad range of scientific research projects within the Inspectorate aimed at improving the positive impact of its regulation.

NB The Dutch Inspectorate regulates/oversees all Dutch professionals and providers of healthcare, (long-term) care, youth care, pharmaceutical products and medical technology.

Biography

Ian Leistikow is inspector/advisor at the Dutch Health & Youth Care Inspectorate and professor at Erasmus University Rotterdam where he conducts and supervises research into ‘governmental regulation of health and care quality’. He is a non-practicing physician. In 2011 Ian became member of the Program Advisory Committee of the International Forum on Quality and Safety in Healthcare (BMJ/IHI). Ian is board member of SINC, an international collaboration of European health and care regulators. Ian teaches and publishes about patient safety and the role of regulation. In 2017 CRC Press published his book “Prevention is better than cure”, on learning from adverse events in healthcare.

Webinar Link

Delivered and presented by: Dr Laura Sheard

Associate Professor, University of York
Honorary Principal Research Fellow, Bradford Institute for Health Research

Abstract

The quality and safety of healthcare in prisons in the UK has had relatively little attention paid to it, in contrast with the abundance of research on these topics in the hospital environment. Prison based medicine is often viewed as a Cinderella area of healthcare provision; largely hidden away from public scrutiny whilst being an underfunded, undervalued and an unattractive sector for healthcare professionals to work in with a high number of complex patients living in overcrowded conditions. Only a few studies have examined everyday primary care provision in prisons (for example, asthma, diabetes or high blood pressure). Yet, the prison setting represents a unique opportunity to intervene and improve the healthcare trajectories of some of the most marginalised people in society.

In this presentation, Laura spoke about the importance of prison healthcare, how it can be improved and she is passionate about this topic. Laura drew on her own experience of the four years she worked in HMP Leeds alongside findings from several mixed methods studies she led in particular “Qual-P” which focused on understanding and improving the quality of and access to everyday primary care in prisons in the North of England.

A large part of the presentation discussed the major factors which influence the quality of primary care. These are: chronic understaffing; high variability of quality between sites, little to no quality measurement; excessive Did Not Attend rate; community-prison interface incompatibility including IT systems and opioid prescribing; facilitative relationships between healthcare staff and patients.

Presentation

Delivered and presented by: Professor Charles Vincent,  Emeritus Fellow of Jesus College and Professor of Psychology at the University of Oxford.

Abstract

The most prominent and effective patient safety interventions have been targeted at the reliability of basic processes and largely followed a quality improvement model.  There are however many other ways of improving safety.  Effective intervention requires a portfolio of strategies which can be customised to different healthcare contexts. There are five main families of strategies are the best practice quality improvement approach; broader system interventions; risk control; improving the capacity to adapt, monitor and respond and finally mitigation.  The five families can be broadly split into strategies which improve overall quality and safety and those which are primarily aimed at managing risk. These longer-term strategies need to be complemented by short term safety strategies to manage pressures and rapid change, which can be achieved by flexing resources, prioritisation and adaptive teamwork and leadership.  The effective management of risk requires a broad portfolio of both short and long-term strategies which can be customised to different problems and different contexts.

Webinar link

Presenter

Dr Justin Aunger, Research Fellow, Midlands Patient Safety Research Collaboration

Abstract

Unprofessional behaviour (UB) between staff encompasses various behaviours, including incivility, microaggressions, harassment, and bullying. It is pervasive in acute health care settings and disproportionately impacts minoritised staff. UB has detrimental effects on staff wellbeing, patient safety, and organisational resources. While interventions have been implemented to mitigate UB, there remains limited understanding of how and why they may work and for whom. Similarly, while contributors to these behaviours have been investigated, understanding of how they interact and how they can be targeted by interventions can be improved. To address these knowledge gaps, we performed a realist review, drawing on 148 literature sources and 42 reports of interventions, to better understand how these contributors lead to UB and worsening of its impacts. We also investigated when and how these complex, context-dependent interventions to reduce UB work. This presentation will explore our findings and present implementation guidance to help others address UB in the healthcare workplace in the future.

Biography

Dr. Justin Aunger is a researcher with a background in behavioural science applied at individual, team, and organisational levels. He is interested in addressing complex challenges in healthcare organisations and has recently worked on multiple projects drawing on realist methodology. This includes understanding how inter-organisational collaborations work, and how unprofessional behaviours between staff can be addressed. He has experience developing and delivering multiple kinds of research, including behaviour change interventions in a healthcare context, realist reviews and evaluations, and qualitative studies.

 Webinar link