Abstract: Clinical evidence that can improve patient outcomes does not reliably find its way into everyday care. The gap between evidence and practice limits the health, social and economic impacts of clinical research. Dissemination of evidence-based practice via clinical guidelines is necessary but seldom sufficient by itself to ensure implementation. Furthermore, the general practice context presents particular challenges – especially given limited practice organisational capacity, increasing workload and complexity of care, and competing priorities.

This presentation will report the key methods and findings from a major programme of work involving general practices across West Yorkshire.  We aimed to develop and evaluate an implementation package to support the uptake of a range of guideline recommendations and sustainably integrate it within general practice systems and resources.  We made our evaluation as pragmatic as possible to ensure relevance to ‘real world’ primary care.  Seminar participants can judge for themselves to what extent we met our goals.

Biography: Robbie Foy is Professor of Primary Care at the Leeds Institute of Health Sciences and a general practitioner in inner-city Leeds.  His field of work, implementation research, aims to inform policy decisions about how best to use resources to improve the uptake of research findings by evaluating approaches to change professional and organisational behaviour.  His former posts include a clinical senior lectureship at Newcastle University, and an MRC training fellowship in health services research based jointly between the Universities of Edinburgh and Aberdeen.  He is also trained as a public health physician.  He was a 2006-7 Harkness / Health Foundation Fellow in Health Care Policy, based jointly between the Veteran’s Administration and RAND in Los Angeles.  He was formerly Deputy Editor-in-Chief of the open access journal, Implementation Science.

Abstract: The early stages of judgement are the most critical for the final outcome of the diagnostic process. I will present studies that used different methodologies to measure the influence of this early stage on the diagnostic process and outcome. I will also present the design of a computerised diagnostic support system (DSS) prototype for General Practitioners. Designed to support the early stages of the diagnostic process, the DSS prototype was recently evaluated in a study with GPs consulting with standardised patients (actors).

Biography: Olga studied Psychology at the National University of Athens, Greece, and obtained her MSc and PhD in Psychology from Cardiff University. Prior to her current position, she held academic positions at King’s College London, and the University of Birmingham. Her main research interest is the application of psychology theory and methods to the study of medical decisions. She has conducted research on medical judgement in a variety of healthcare settings, using predominantly quantitative experimental methods. She aims to understand the cognitive biases that can lead to diagnostic error and delay, and test ways of reducing bias and supporting judgement. Her research has been funded by Cancer Research UK, the EU and the DoH. She is Associate Editor of the journal Medical Decision Making, has served as elected Trustee on the Board of the Society, and has chaired the Society’s biennial European meeting in London (June 2016). She has given short courses and MSc modules on the psychology of medical decision making to UK and international audiences.

Abstract: The use of medication is one of the most common interventions in today’s healthcare. Medication use takes place in many different settings and involves many different health care professionals as well as patients and their carers – and errors can arise at any stage. This presentation will set the scene by describing some of the problems that can occur, before considering some solutions and challenges, drawing on evidence in this field. Potential solutions include the use of technology (both high tech and low tech), human factors, system design, communication strategies and greater patient involvement. Suitable solutions must also take into account both a ‘medical’ view of safety (the avoidance of harm) and a ‘patient’ view of safety (‘feeling safe’). Challenges include the importance of context (what works in what setting may not work in another), fidelity of implementation, unintended consequences, and the ubiquitous nature of medication use and wide range of stakeholders involved.

Biography: Professor Bryony Dean Franklin is Director of the Centre for Medication Safety and Service Quality (CMSSQ), a joint research unit between Imperial College Healthcare NHS Trust and UCL School of Pharmacy, where Bryony is Professor of Medication Safety. She is a theme lead for both the NIHR Imperial Patient Safety Translational Research Centre and the NIHR Health Protection Research Unit in Healthcare Associated Infection and Antimicrobial Resistance at Imperial College London.

Bryony has been involved with patient safety research for nearly twenty years, and has published widely on medication safety, the evaluation of various technologies designed to reduce errors, and how we can support the public role in patient safety. Her current post combines research, education and training, and clinical practice as a hospital pharmacist. Bryony is an associate editor for the journal BMJ Quality and Safety, and on the editorial board for BMC Safety in Health. She is co-editor of the textbook “Safety in Medication Use” and co-author of “Going into Hospital? A guide for patients, carers and families”, a book aimed at the general public.

Presentation slides available here

Abstract: I last spoke to the Bradford Institute for Health Research on the topic of Resilient health care: re-conceptualising patient safety. Two years on, and along with members of the Resilient Health Care Network, we have published another book (Braithwaite, Wears and Hollnagel, 2017, Reconciling Word-As-Imagined and Work-As-Done), with three more volumes in various stages of production. Leveraging from this work, I will analyse recent developments in patient safety and discuss a number of issues crucial to understanding where we are in the perennial search for better ways to care for patients in safe, effective environments.

I will draw not only on the compendiums making up the contributions of the Resilient Health Care Net, but also on two other recent contributions of note. One is The Sociology of Healthcare Safety and Quality (Allen, Braithwaite, Sandall, Waring, (eds.), 2016). The other is recent work on applying complexity science to health care (Braithwaite, Churruca, Ellis, Long, Clay-Williams, Damen, Herkes, Pomare, Ludlow, 2017, Complexity Science in Healthcare—Aspirations, Approaches, Applications and Accomplishments: A White Paper).

The bottom line is that despite the doomsayers saying that it is proving very hard to make progress in patient safety as it is such an intractable wicked problem, it’s better to say that we are at the end of the beginning of the patient safety movement rather than at the beginning of the end. But, in the end, that will be up to each individual in the audience. There will be time for discussion at the conclusion of this presentation.

Biography: Professor Jeffrey Braithwaite, BA, MIR (Hons), MBA, DipLR, PhD, FAIM, FCHSM, FFPHRCP (UK), FAcSS (UK), Hon FRACMA, is Foundation Director, Australian Institute of Health Innovation, Director, Centre for Healthcare Resilience and Implementation Science, and Professor of Health Systems Research, Macquarie University, Australia. His research examines patient safety, health care as a complex adaptive system, and applying complexity science to health care problems. He has attracted funding of more than AUD$102 million and has received 37 different national and international awards for his teaching and research.

Abstract: Emergency and urgent care provide substantial health benefit across the world but increasing demand is leading to unsustainable pressure on services and a need for innovative approaches to the delivery of emergency and urgent healthcare for patients. In the English NHS in 2012-13 there were 18.3 million attendances at major emergency departments, single specialty emergency departments, walk-in centres and minor injury units, at a cost of £2.1 billion; 5.3 million emergency hospital admissions, at a cost of £12.5 billion; 7 million ambulance service journeys; and approximately 24 million calls to NHS emergency and urgent care telephone services.

Failure of the emergency and urgent care system to manage increasing demand causes substantial public concern and political impact. Delays in ambulance response or emergency department assessment can lead to worse outcomes for patients. Emergency department crowding is internationally recognised and may be associated with avoidable mortality. These issues make the delivery of emergency and urgent care an important priority for policy-makers, service providers and the public. The emergency and urgent care system inextricably links services together that rely on each other, and also that work together to deliver care for patients. This study is using data from the Yorkshire Ambulance Service and NHS 111 and linking it with hospital data (ED/Inpatient) from every acute trust in Yorkshire and Humber to analyse patient demand, flow and outcomes through these parts of the system.  In addition to an overall view, we have focussed on patient groups who may benefit from a different approach to their emergency care. This includes vulnerable patient groups such as those who have mental health problems, the elderly, patients who attend frequently and also patients with primary care-related problems. The presentation will provide an overview of the project and describe some of the analyses and outputs to date.

Biography: Suzanne qualified in medicine from London University in 1990. She pursued her training initially in surgery and then specialised in Emergency Medicine. Suzanne spent a year as a Royal College of Surgeons of England Research Fellow and was awarded an MD whilst undertaking higher training in Emergency Medicine. She joined Sheffield University as a Senior Clinical Lecturer in 2001 and was promoted to Reader in 2007 and Personal Chair in 2010. She divides her time between the university and as a consultant at the Sheffield Teaching Hospitals Trust emergency department. Her main research interests include evaluating complex interventions in emergency and urgent care. She is particularly interested in the evaluation of new roles and alternative pathways of care.

Recent studies include evaluating junior doctor confidence and competence in carrying out their role in emergency medicine (The EDiT study), evaluating the use of a falls pathway by paramedics attending older people who have fallen (SAFER 2 Trial), and The AHEAD Study: Managing anticoagulated patients who suffer head injury, Using routine data to evaluate the Emergency and Urgent care System (http://clahrc-yh.nihr.ac.uk/our-themes/avoiding-attendance-and-admissions-in-long-term-conditions).