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Lucy Chapman

Prison healthcare possibly the most important setting for improving quality and access – 22 February 2024

By Previous Seminars

Presenter

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

Safety strategies for today and tomorrow – Wednesday 10 January 2024

By Previous Seminars

Presenter

Professor Charles Vincent

Role and organisation

Professor Charles Vincent is an 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

Understanding how unprofessional behaviours between staff in acute care arise, whom they impact, and how they can be addressed: findings from a realist review – 15 November 2023

By Previous Seminars

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

JOURNAL ARTICLE

By Publications

Lea, W., Lawton, R., Vincent, C., & O’Hara, J. (2023). Exploring the “Black Box” of Recommendation Generation in Local Health Care Incident Investigations: A Scoping Review. Journal of Patient Safety, 10-1097 – could easily be included as a Safer Systems, culture and practices.

DEveloping A Complex Intervention for DEteriorating Patients using Theoretical Modelling (DECIDE study), Dr Duncan Smith, Senior Lecturer in Advanced Practice – City, University of London Hon. Nurse Consultant in Critical Care Outreach – University College London Hospitals NHS Foundation Trust – Wednesday 21 June 2023

By Previous Seminars

Abstract

Background

Patients who clinically deteriorate without recognition and/or response are at risk of unplanned admission to intensive care, cardiac arrest, and/or death (termed Serious Adverse Events (SAEs)). To mitigate SAEs, track-and-trigger tools are used internationally to prompt healthcare practitioners (typically nursing staff) to recognise physiological changes that signal deterioration, and to contact a practitioner with expertise in acute/critical illness. In the United Kingdom and parts of Europe, the National Early Warning Score (NEWS) (track-and-trigger tool) was developed and disseminated widely to standardise practice. Despite evidence track-and-trigger tools (like NEWS) improve patient outcomes, their translation into clinical practice is inconsistent. This is partly attributed to nursing staff failing to change their behaviour.

Aim

The aim of the project was to develop a theory-based behaviour change intervention to enhance enablers and overcome barriers, to Registered Nurses (RNs) and Healthcare Assistants (HCAs) enacting expected behaviours in recognising and responding to signs of patient deterioration.

Methods

A mixed methods design was used with three phases: 1. Focused ethnography on two clinical floors in an acute hospital to compare directly observed behaviours (of RNs and HCAs) with those specified in policy. From directed content analysis of field notes, target behaviours were identified, specified, and shortlisted; 2. Brief (not audio-recorded but recorded in field notes) interviews were conducted soon after direct observation of relevant behaviour. Some brief interview participants were recruited for an audio-recorded, semi-structured, interview informed by a Theoretical Domains Framework (TDF) topic guide. Interview data were analysed deductively (the 14 TDF domains were coding categories) and inductively to identify determinants (i.e. barriers and enablers) of target behaviours. TDF domains representing important determinants were identified using published criteria and linked to Behaviour Change Techniques (BCTs) from expert consensus literature; 3. BCTs were shortlisted by the research team and presented to clinical stakeholders alongside example applications (i.e. concrete strategies for operationalising BCTs). Using Nominal Group Technique, stakeholders ranked BCTs and their potential applications for acceptability and feasibility. Ranking data were used to inform the content of a preliminary intervention.

Results

During 300 hours of fieldwork, 499 items of data (i.e. an episode of observation or a set of vital signs from chart review) were recorded; 289 (58%) associated with expected (i.e. policy-specified) behaviour; 210 (42%) associated with unexpected behaviour (i.e. alternative behaviour or no behaviour). Ten behaviours were identified as potential behaviours for change; shortlisted to seven target behaviours. Brief interviews were conducted with 39 RNs and 50 HCAs, and semi-structured interviews with 16 RNs and 16 HCAs. Quotes from interviews were linked to nine (for brief interviews) and 14 (for semi-structured interviews) TDF domains. Nine TDF domains were identified as being of high importance: Knowledge, Social Professional Role and Identity, Beliefs about Consequences, Reinforcement, Intentions, Goals, Memory, Attention and Decision Processes, Environmental Context and Resources, Social Influences. These domains were linked to 50 BCTs; shortlisted to 14. Ranking data from two nominal groups held with 19 stakeholders were used to shortlist further, resulting in a preliminary intervention that includes an educational package and 12 BCTs that will be delivered through workshops and on acute wards, using 18 applications.

Conclusion

This research made a unique contribution to the international body of evidence, as it is the first study where a theoretical framework of behaviour change and a taxonomy of BCTs were used to model an intervention to improve responses to clinically deteriorating patients. The intervention is preliminary, as it is anticipated that it will be piloted in clinical practice and refined during a subsequent feasibility study.

Biography

Dr Smith  is a clinical-academic nurse with a background in acute and critical care spanning two decades. Duncan holds a Senior Lecturer post in the School of Health and Psychological Sciences at City, University of London where he is a module leader for the MSc in Advanced Clinical Practice and a contributor to the PGCert in Critical Care. Alongside his academic role, Dr Smith is an honorary Consultant Nurse with the Patient Emergency Response and Resuscitation Team (PERRT) at University College London Hospitals (UCLH) NHS Foundation Trust where he continues to work clinically. Duncan’s clinical experience as a critical care outreach nurse in several organisations across London shaped his research activities pre-doctorally and informed his PhD. In April 2018 Dr Smith was awarded a National Institute of Health Research (NIHR) Clinical Doctoral Research Fellowship to complete a programme of work titled: DEveloping a Complex Intervention for DEteriorating Patients using Theoretical Modelling (DECIDE study). The aim of his doctoral research was to develop a theory-based, complex, behaviour change intervention to optimise recognition of, and response to, patients with signs of clinical deterioration. Dr Smith has recently been awarded a NIHR Development and Skills (DSE) Enhancement grant to upskill ahead of applying for an advanced clinical academic fellowship. For his post-doctoral work, Dr Smith anticipates designing and delivering a feasibility study to pilot the intervention at multiple hospital sites and to test the feasibility of using a cluster RCT to evaluate its efficacy.

‘Nurses Whisper’ Who nurses make sense of who they are and what they do as they work with trainee doctors to keep patients safe, Dr Ray Samuriwo , Associate Professor in Adult Nursing, School of Nursing and Healthcare Leadership, University of Bradford – Wednesday 24 May 2023

By Previous Seminars

Abstract

Nurses play a key role in patient safety, but little is known about how they make sense of who they are and what they do when they work alongside trainee doctors with regards to patient safety and being competent as the latter progress in their medical careers. In this seminar, Dr Ray Samuriwo will present his work on how experienced nurses make sense of who they are and what they do, in terms of their identity as they work with trainee doctors to keep patients safe. This work has helped to describe the different identities and roles that nurses have and occupy as they strive to keep patients safe with trainee doctors. Ray will share his findings about how nurses make sense of who they are and what they do to ensure patients are safe when working with trainee doctors, and to support the latter to develop their competence as doctors.

Biography

Dr Ray Samuriwo is an Associate Professor in Adult Nursing at the University of Bradford, who carries out research on patient safety and decision-making in healthcare. His work is informed by principles and ideas from the humanities and social sciences.  The focus of Ray’s work is on creating, testing, and improving theories that can be that people receiving healthcare are kept safe and always receive the best possible care.

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Recipients, reporters, or co-creators? The many roles of patients and families in supporting system safety, Prof Jane O’Hara, Professor of Healthcare Quality and Safety, School of Healthcare, University of Leeds and Deputy Director of Yorkshire Quality & Safety Research Group – Thursday 30 March 2023

By Previous Seminars

Abstract

It is now well accepted that patients, their families and carers should be engaged in their care. What is only more recently becoming accepted is their wide ranging contribution to both their own safety, the safety of others, and the safety of healthcare systems. In this talk, Professor O’Hara presented a brief social history of the ‘patient involvement in patient safety’ movement, describing how it emerged alongside wider patient safety theory, policy and practice. She also described how patients and families have moved from being seen as passive recipients of care, to valuable partners in the provision of safe care. To illustrate, Professor O’Hara used examples from over a decade of research by the Yorkshire Quality & Safety Research Group, and discussed what it means for today’s policy and practice, and what it might mean for the future.

Biography

Jane O’Hara is Professor of Healthcare Quality and Safety, based within the School of Healthcare, University of Leeds. Since 2019, Jane has led a large, NIHR-funded programme of work aimed at co-designing and testing new processes for involving and engaging families in investigations and learning responses following healthcare safety events (https://learn-together.org.uk/). This work has had a significant impact, most recently informing the development of the new national level policy guidance: ‘Engaging and involving patients, families and staff following a patient safety incident’, with the NHSEI and Healthcare Safety Investigation Branch. Jane also leads the NIHR-funded Response Study, which seeks to evaluate the implementation of the new Patient Safety Incident Response Framework (PSIRF) across the English NHS (May 2022-July 2025). Jane is Deputy Director of the Yorkshire Quality and Safety Research Group, and as of April 2023, jointly leads a theme entitled ‘Safer Systems, Cultures and Practices’ with Professor Carl Macrae, within the NIHR Yorkshire & Humber Patient Safety Research Collaboration. Jane has over thirteen years’ experience of leading patient safety research, and a further eight years of applied psychological research prior to that. Her interests include: involving patients and families in investigations, safety initiatives and quality improvement; the measurement and monitoring of patient safety; safety theory and resilient healthcare approaches; and, co-production.

Webinar Link