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Oct 09

Six Steps to De-implementation: A Toolkit for Leaders

By Toolkits, Interventions & Change Strategies

De-Implementation logoWhat is the problem?

Some healthcare practices are implemented without any evidence that they are of benefit, and can add an unnecessary burden to the day-to-day work of healthcare staff. It’s sometimes difficult to identify these practices – they might have become routine, or they might be seen as a regular part of someone’s role. This practical, step-by-step toolkit is a guide to help you think about the healthcare you provide, and identify tasks and processes that you may feel:

  • are not the best use of your time
  • duplicate other tasks and processes
  • do not provide benefits for patients

 

How will this toolkit help?

The toolkit provides tools and resources to help you identify which tasks or processes might be suitable for streamlining, and a step-by-step a guide to developing an evidence-based strategy for safely rethinking, reducing or removing a practice. It has been developed by a team of researchers with experience in this area, through consultation with healthcare professionals and public contributors. The toolkit also provides links to improvement models, ideas from behavioural science and case study examples from healthcare to increase your understanding and help you streamline care while keeping staff and patient experiences and wellbeing at the heart of what you do.

Cover of De-Implementation toolkitYou can find the toolkit here.

What does this mean to patients, the public, health and social care services?

We would like to hear your experiences

We will be building a collection of case studies on this site to share people’s experiences of using the toolkit. You can see an example here.

Share your experiences here

 

Sep 24

By Academic Resources, Publications

Supporting Older People Living With Frailty to Self-Manage Multiple Medicines: An Experience-Based Co-Design of a Complex Intervention Developed in UK Primary Care

Previdoli, G., Simms-Ellis, R., Silcock, J., Alldred, D.P., Cheong, V.-L., Tyndale-Biscoe, S., Tomlinson, J. and Fylan, B. (2025), Supporting Older People Living With Frailty to Self-Manage Multiple Medicines: An Experience-Based Co-Design of a Complex Intervention Developed in UK Primary Care. Health Expectations, 28: e70364. https://doi.org/10.1111/hex.70364

Read the full paper here

Access the ‘I Manage My Meds’ toolkit here

Sep 24

By Academic Resources, Publications

What can patients tell us about the quality and safety of hospital care? Findings from a UK multicentre survey study

O’Hara JK, et al. BMJ Qual Saf 2018;27:673–682. doi:10.1136/bmjqs-2017-006974

Read the full paper here

Sep 24

By Academic Resources, Publications

Can staff and patient perspectives on hospital safety predict harm-free care? An analysis of staff and patient survey data and routinely collected outcomes

Lawton R, et al. BMJ Qual Saf 2015;24:369–376. doi:10.1136/bmjqs-2014-003691

Read the full paper here

Sep 11

Making medicines safer for care home residents

By Toolkits, Interventions & Change Strategies

care home staff giving a resident their medicineWhat was the problem?

Care home residents are often prescribed many medicines. Medicines can be beneficial, but taking multiple medications can sometimes cause side effects and affect residents’ quality of life. It’s important that people living in care homes have their medications regularly checked with a healthcare professional to make sure they are still suitable.

What have we done to address this problem?

We worked with residents, relatives, care home staff and healthcare professionals to develop a set of resources so that residents and care home staff can be actively involved in discussions about medicines. They include questions that residents might want to ask, such as “Do I still need all my medicines?” and “How do I know they are helping me?”.

What did we produce and who is this useful for and why? Picture of resources

The resources are designed for healthcare professionals, care home staff and residents and relatives to use when reviewing medicines. They have been launched by the Health Innovation Network in September 2025, and build on the success of resources designed by our group which are used across England for older people living in their own homes.

You can find all of these here.

 

Jul 29

Lessons from the frontline: The impact of redeployment during Covid-19 on nurse well-being, engagement and retention

By Guidelines & Recommendations

The Problem

During the Covid-19 crisis staff redeployment was extensive and varied. Some staff were redeployed into high risk areas from their relatively safe ‘home’ wards while others were moved off wards to different duties. Nurses dealt with risk and uncertainty, huge changes to their ways of working over short periods of time and the constant worry for themselves and their close networks that they may be transmitters of the disease.   The emotional impacts of such redeployment and the longer-term consequences are unknown.

 

What we did to address this problem

We spoke to 100 nurse managers and nurses in three NHS Trusts in England.  This included those involved in redeploying nurses and those who were redeployed or worked in teams that received redeployed nurses.  We used interviews, (nurses and nurse managers) and surveys (nurses only) to gather data.  We looked for patterns and themes in the interview data and also explored nurse experiences over time in both the survey and interview data.  Staff and patient groups of volunteers advised us throughout.  We shared our findings with key organisations such as the Royal College of Nursing and NHS England and Improvement who helped us to develop recommendations that could influence policy and clinical practice.

What we found

We found that nurse managers experienced a lot of uncertainty and stress, having to make decisions about how to rapidly redeploy nurses to meet demands with limited guidance from their organisations.  They were unsure how to support nurses during redeployment and how to re-build their teams after redeployment.  A few nurses enjoyed their redeployment experience.  Many experienced a lot of distress with about half thinking about leaving their jobs.

What we produced and who it is useful for and why

From these findings we developed 11 recommendations for the management of redeployment and workforce recovery.

With funding from the National Institute of Health Research (NIHR) developed two resources:

  1. National recommendations for the management of NHS nurse redeployment and crisis workforce recovery: A guide for acute NHS Trusts
  2. A best practice guide to support those tasked with implementing nurse redeployment

Both these resources are available to download here.

Jul 24

Attitudes to Patient Safety

By Measurement Tools

In 2009 we published a paper (Carruthers et al., 2009) reporting on the development and validation of a measure of patient safety attitudes which can distinguish responses between different groups. Although the predictive validity of the measure has not been assessed, it has been used widely across the world to measure patient safety attitudes in a wide range of contexts and for different groups of trainees in healthcare. It has also been used to evaluate undergraduate curricular in patient safety and any changes thereof. Here we provide the original paper (measure is described in the paper). Please note that there is a minor error in the original paper and the item ‘Most medical errors result from careless nurses’ should also be reverse scored before calculating the overall or domain score.

We later (in 2013) updated and extended the measure and this too has been used in a number of studies. Here we provide the original paper (and tool). We have produced scoring guidance for this tool. If you would like to use either of these measures, please provide a short request and details of your study.

You can download the questionnaire, guidance and paper here.

Jul 24

Learn Together: Supporting Involvement during Patient Safety Incident Investigations

By Websites

After a safety event in healthcare, NHS Trusts may conduct a Patient Safety Incident Investigation. Listening to and valuing different perspectives within a Patient Safety Incident Investigation can support patients and families to heal, and can support organisations to learn.

We have developed resources that were designed together with people who have experienced patient safety incidents and investigations, to provide you with the information and support you might need.

You can access them here

Jul 24

Your Care Needs You

By Websites

Your Care Needs You! is designed to empower, encourage and support patients and their families to know more and do more in hospital, so that people have the skills and confidence to manage their own health and care more safely when they return home. There are resources to guide patients and families through the key things to do in hospital to prepare for living at home again.

You can find the resources here

 

Jul 24

Reducing the risk of older people being readmitted into hospital

By Toolkits, Interventions & Change Strategies

What was the problem?

Moving from hospital to home (the ‘transition’) is a risky time for older patients (75+ years). Around 18% of patients end up back in hospital as an emergency. Most of the time, these re-admissions cannot be avoided, but oftentimes they can.

What have we done to address this problem?

We wanted to understand and improve the experience and safety of care for older people as they move from hospital to home to reduce unnecessary hospital re-admissions. To do this, we conducted six pieces of research (called work packages). First, we tried to understand from patients, families and staff how they experienced care transitions. Next, we developed a tool to measure these experiences. We then worked with staff and patients and members of the public to develop an approach (called ‘Your Care Needs You’), to help involve and prepare older people for going home after a hospital stay.

What did we find?

We then ran a trial to find out if people who received ‘Your Care Needs You’ were less likely to go back into hospital. For this, we put ‘Your Care Needs You’ into 18 wards and compared hospital re-admissions there with 21 wards which delivered care as usual. We found that the rate at which patients were re-admitted to hospital was better in the ‘Your Care Needs You’ wards but this was not significantly better. Three months after discharge, the number of people being re-admitted to the hospital was 13% less in the ‘Your Care Needs You’ wards. The approach also reduced the problems that people experienced (such as falls) around 1 month after discharge. We found that many of the wards did not deliver the approach as planned, so not all patients got ‘Your Care Needs You’. This was mainly because of staffing pressures after the COVID-19 pandemic. While some patients found the approach useful, others thought it was not for them. The approach is cheap to deliver and, on balance, is worth the cost.

What did we produce and who is this useful for and why?

‘Your Care Needs You’ included a booklet, an advice sheet for managing at home, and a film for patients.

You can find all of these here.

   Advice sheet

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