Large National Health Service Trust Research Articles

‘Speaking Up’ for patient safety and staff well-being: a qualitative study

BackgroundFreedom To Speak Up Guardians (FTSUGs) and Confidential Contacts (CCs) were appointed nationally following the Mid Staffordshire inquiry to listen to and support staff who were unable to address concerns...

Transitioning EPMA applications in a large multisite teaching hospital

IntroductionUniversity Hospitals of Leicester (UHL) has co-developed and deployed a novel Electronic Prescribing and Medicines Administration (EPMA) application as part of the trust electronic patient record (EPR) programme that meets...

The organization and impacts of clinical research delivery workforce redeployment during the COVID-19 pandemic: a qualitative case study of one research-intensive acute hospital trust

BackgroundCOVID-19 has tested healthcare and research systems around the world, forcing the large-scale reorganization of hospitals, research infrastructure and resources. The United Kingdom has been singled out for the speed and scale of its research response. The efficiency of the United Kingdom’s research mobilization was in large part predicated on the pre-existing embeddedness of the clinical research system within the National Health Service (NHS), a public, free-at-point-of-delivery healthcare system. In this paper we discuss the redeployment of the clinical research workforce to support the pandemic clinical services, detailing the process of organizing this redeployment, as well as the impacts redeployment has had on both staff and research delivery at one research-intensive acute NHS trust in London.MethodsA social science case study of one large research-active NHS trust drawing on data from an online questionnaire; participant observation of key research planning meetings; semi-structured interviews with staff involved in research; and document analysis of emails and official national and trust communications.ResultsWe found that at our case-study hospital trust, the research workforce was a resource that was effectively redeployed as part of the pandemic response. Research delivery workers were redeployed to clinical roles, to COVID-related research and to work maintaining the research system during the redeployment itself. Redeployed research workers faced some difficulties with technology and communication, but many had a positive experience and saw the redeployment as a significant and valuable moment in their career.ConclusionsThis study explicates the role of the research delivery workforce for the United Kingdom’s COVID response. Redeployed research workers facilitated the emergency response by delivering significant amounts of patient care. The public also benefited from having a well-developed research infrastructure in place that was able to flexibly respond to a novel virus. Many research workers feel that the NHS should provide more support for this distinctive workforce.

Using a comprehensive audit to identify local context prior to care bundle design and implementation for inadvertent perioperative hypothermia in colorectal surgery

BackgroundThe first step in bundle design or implementation is to identify the problem being addressed. Several validated approaches are recommended to facilitate this. These include using systematic reviews, adverse event...

COVID-19 and student nurses: A view from England.

COVID-19 and student nurses: A view from England.

Qualitative interview study exploring frontline managers’ contributions to hand hygiene standards and audit: Local knowledge can inform practice

Frontline managers promote hand hygiene standards and adherence to hand hygiene protocols. Little is known about this aspect of their role. Qualitative interview study with frontline managers on 2 acute admission wards in a large National Health Service Trust in the United Kingdom. Managers reported that hand hygiene standards and audit were modeled on World Health Organization guidelines. Hand hygiene outside the immediate patient zone was not documented but managers could identify when additional indications for hand hygiene presented. They considered that audit was worthwhile to remind staff that hand hygiene is important but did not regard audit findings as a valid indicator of practice. Managers identified differences in the working patterns of nurses and doctors that affect the number and types of hand hygiene opportunities and barriers to hand hygiene. Ward managers were accepted as the custodians of hand-hygiene standards. Frontline managers identified many of the issues currently emerging as important in contemporary infection prevention practice and research and could apply them locally. Their views should be represented when hand hygiene guidelines are reviewed and updated.

A mixed-methods examination of patient feedback within forensic and non-forensic mental healthcare services

ABSTRACTBackground: The literature surrounding patient feedback is limited, despite government policy integrating patient feedback into how the care quality of the National Health Service (NHS) is assessed. The aim of the study is to examine the detailed contextualised accounts of patient feedback within forensic and non-forensic settings through qualitative and quantitative analyses.Method: Responses which reflected positive or negative/neutral overall feedback were analysed using Chi-Square tests on a total of 906 patient responses in a large NHS Trust in England. Conventional content analysis was conducted on 222 patient free-text comments, deriving codes and distributing these into categories.Findings: Forensic patients were more likely to give negative feedback on mental healthcare services than non-forensic patients. The service’s level of security-impacted patient’s willingness to engage with giving feedback. The qualitative analysis provided further insight into these differences by identifying themes in the data.Conclusion: The findings of the present study highlight the challenges faced by staff and volunteers when collecting patient feedback, exploring important differences between services. The study makes recommendations to practice-based interventions to reduce the consequence of these challenges and explores recommendations for future research.

Implementation of individual placement and support (IPS) into community forensic mental health settings: Lessons learned

Introduction Assessment of the effectiveness of individual placement and support in forensic mental health settings is a relatively new field of research despite evidence demonstrating its effectiveness in generic mental health settings. Method IPS was implemented into a community forensic mental health setting within a large National Health Service trust in the United Kingdom over 6 months. Using the Consolidated Framework for Implementation Research this paper describes the lessons learned from implementing individual placement and support into such settings. Results Our findings suggest that implementation of individual placement and support in forensic mental health settings is complex and requires robust planning and collaboration with internal and external agencies. Barriers to implementation included staff attitudes, difficulty engaging employers and lack of employment related performance indicators, and facilitators included the support of service managers and outside groups. Adaptations to the IPS model were made to address challenges encountered, including difficulty starting rapid job searches, concerns about stigma, lack of confidence, uncertainty around employment opportunities, offence restrictions and lack of interest from potential employers. Conclusion This paper adds to the limited literature in the field. Findings are relevant to practitioners and service providers who wish to implement individual placement and support services for people with mental disorder and offending histories.

A discrete event simulation model to evaluate the use of community services in the treatment of patients with Parkinson\u2019s disease in the United Kingdom

BackgroundThe number of people affected by Parkinson’s disease (PD) is increasing in the United Kingdom driven by population ageing. The treatment of the disease is complex, resource intensive and currently there is no known cure to PD. The National Health Service (NHS), the public organisation delivering healthcare in the UK, is under financial pressures. There is a need to find innovative ways to improve the operational and financial performance of treating PD patients. The use of community services is a new and promising way of providing treatment and care to PD patients at reduced cost than hospital care. The aim of this study is to evaluate the potential operational and financial benefits, which could be achieved through increased integration of community services in the delivery of treatment and care to PD patients in the UK without compromising care quality.MethodsA Discrete Event Simulation model was developed to represent the PD care structure including patients’ pathways, treatment modes, and the mix of resources required to treat PD patients. The model was parametrised with data from a large NHS Trust in the UK and validated using information from the same trust. Four possible scenarios involving increased use of community services were simulated on the model.ResultsShifting more patients with PD from hospital treatment to community services will reduce the number of visits of PD patients to hospitals by about 25% and the number of PD doctors and nurses required to treat these patients by around 32%. Hospital based treatment costs overall should decrease by 26% leading to overall savings of 10% in the total cost of treating PD patients.ConclusionsThe simulation model was useful in predicting the effects of increased use of community services on the performance of PD care delivery. Treatment policies need to reflect upon and formalise the use of community services and integrate these better in PD care. The advantages of community services need to be effectively shared with PD patients and carers to help inform management choices and care plans.

Impact of infectious diseases consultation on the management of Staphylococcus aureus bacteraemia in children

ObjectivesInfectious diseases consultation (IDC) in adults with Staphylococcus aureus bacteraemia (SAB) has been shown to improve management and outcome. The aim of this study was to evaluate the impact of...

A shared purpose framework to deliver person-centred, safe and effective care: organisational transformation using practice development methodology

Background: A shared purpose is an essential part of developing effective workplace cultures and one of the founding principles of practice development in establishing person-centred, safe and effective practices that enable everyone to flourish. Aims and objectives: The paper describes the aims of a piece of work first commissioned in 2011 (Phase 1) to review specialist practice – initially nursing and midwifery – across a large National Health Service trust in England. It then focuses on how this piece of work informed the development of a trustwide, shared purpose framework relevant to all staff, culminating in the strategies, processes and systems being used at individual, team and organisational levels to embed the framework, with the workplace as the main resource for learning. The challenges and successes along the way are highlighted. Methods: Practice development, a complex intervention, is used together with a strong partnership joint appointment model between the trust and the England Centre for Practice Development at Canterbury Christ Church University, to enable a transformational journey of cultural change across the organisation, starting with the creation of a shared purpose framework. Results: Examples from the trust’s workplace programmes are presented to demonstrate how the shared purpose and the skills required for transforming culture are brought to life, enabling a critical mass of people with transformational leadership skills to grow. Conclusions and implications for practice: The strength of this work is underpinned by the partner relationship, which drives the focus of innovative programmes of research, scholarship and continuing professional development so that the local university offers systematic support to the organisational strategic objectives of delivering person-centered, safe and effective evidence informed care. The support is designed to develop these skills, using learning and development strategies that draw on the power of the workplace for active learning, as well as focusing on the outcomes and impact important to service providers. Key messages include: Regardless of the size of any initiative, it is important to establish a shared purpose at the start Collaboration, inclusion and participation principles, and associated practice development methodology, enable a focus on achieving person-centred, safe and effective cultures at organisational and at micro-systems levels Once shared purpose is agreed, ways of working that reflect it also need to be agreed Systems for learning, development, research, innovation and evaluation need to be established that enable shared purposes and values to be embedded in everyday activity

The experiences of staff in a specialist mental health service in relation to development of skills for the provision of person centred care for people with dementia

It is estimated that 820,000 people in the UK have dementia. Dementia costs the UK 17 billion a year and in the next 30 years this will treble to over £50 billion a year. There is a need to raise competence of staff delivering care to people living with dementia across health, social and voluntary sector provision. Effective education and training will build capacity and improve staff knowledge. However, at present not enough is known about the experiences of staff involved in gaining the skills, knowledge and attitudes required to support provision of high quality care for people with dementia. This study was conducted within a large National Health Service Trust in the UK serving an urban, ethnically mixed population, in collaboration with a local university. The trust responded to government policy by seeking to identify staff training needs. The aim was to explore the experiences of staff working within a specialist mental health service in relation to development of skills for the provision of person-centred care for people with dementia. To achieve this, staff roles, experiences of dementia training and the ways in which staff feel they learn were explored through focus group interviews. Relatives' views of staff competencies necessary for effective care provision were also explored to supplement the data from staff. A total of 70 staff and 16 family carers participated and data were subjected to inductive thematic analysis. Five themes emerged: competency-based skills, beliefs, enablers and barriers and ways of learning. Findings suggested participants felt that skills for person-centred care were innate and could not be taught, while effective ways of learning were identified as learning by doing, learning from each other and learning from experience.

Assessing data sources for sustainable and continuous surveillance: surgical site infections following coronary artery bypass grafts in England

Multiple national and local data sources collected by healthcare systems across Europe contain information regarding coronary artery bypass grafts (CABG). Currently surveillance for surgical site infections (SSIs) in this patient group is voluntary in the UK. To investigate and compare the currently available data sources in England for SSI surveillance in CABG patients. Data were extracted from the Society for Cardiothoracic Surgery in Great Britain and Ireland (SCTS) Adult Cardiac Surgery Registry, the Health Protection Agency SSI surveillance, and the Patient Administration System (PAS) from a single large National Health Service Trust. These data were deterministically linked using patient identifiers, anonymized, and then underwent descriptive analysis. From 1 January 2011 to 30 June 2011, 306 patients were recorded in at least one dataset as having undergone CABG. Of these, 76% were recorded by all three data sources being investigated. Of the discordant patients, 5% were recorded by both the local cardiac registry and PAS, and 18% by both the HPA surveillance and PAS. A total of 28 surgical site infections were recorded, of which 21% were identified by all the data sources. Currently, the databases which collect and store data relating to CABG patients suffer from duplications and discrepancies. Integration of the discordant systems is recommended to create a streamlined, sustainable electronic surveillance system.

Safety subcultures in health-care organizations and managing medical error

Leadership has been proposed as a key latent factor influencing the safety culture of an organization, the likelihood of errors occurring and the way in which these are managed. Therefore, when an error occurs, managers have an integral role to ensure that the most desirable outcomes are achieved for patients, health-care staff and their organization. Semistructured interviews were conducted in a large UK teaching hospital to explore the perspectives of staff who are tasked in some way with managing patient safety. Data from 26 transcripts were analysed using an adapted version of Spencer's (2003) qualitative framework, which revealed five primary themes. This paper reports findings from two overarching primary themes, described as being management and safety subcultures. These themes describe experiences of managing medical errors and the subgroup variations between professions, ranks and specialties in attitudes and behaviours towards error, and its management in a large National Health Service Trust. We discuss implications for health-care managers and health professionals in developing a stronger and more unified safety culture in their organizations, along with considerations for academic researchers when undertaking health services research.

Beliefs about personal control and self-management in 30–40 year olds living with Inflammatory Bowel Disease: A qualitative study

Background Inflammatory Bowel Disease is a collective term for two distinct long term conditions: Ulcerative Colitis and Crohn's disease. There is increasing emphasis on patients taking greater personal control and self-management of this condition, reflecting earlier research into the management of chronic illness. Nurses play a pivotal role in this process, yet how optimal personal control is self-assessed and self-managed in Inflammatory Bowel Disease is poorly understood. Objectives This study set out to explore beliefs about personal control and self-management of Inflammatory Bowel Disease. It focused on the role of physical, psychological and socio-economic factors within the individual's life experience. Design A qualitative approach was used comprising 24, one-to-one, semi-structured interviews with participants aged 30–40 years. Participants with a histological diagnosis of Inflammatory Bowel Disease for at least 12 months were eligible and recruited by gastrointestinal specialist staff from outpatient clinics at a large National Health Service Trust in the United Kingdom. Interviews were transcribed verbatim. Data analysis was informed by existing theories of personal control and used the ‘systematic framework analysis’ approach. Results In addition to existing theories of personal control, self-discrepancy theory helped to explain how people viewed the control and self-management of Inflammatory Bowel Disease. One main theme emerged from the findings: ‘Reconciliation of the self in IBD’, this was supported by three sub-themes and eight basic themes. Some participants found that being unable to control and predict the course of their condition was distressing, however for others this limited control was not viewed as a negative outcome. Being able to share control of IBD with specialist health care staff was beneficial, and participants stated that other priorities in life were as equally important to manage and control. A key barrier to ensuring greater personal control and self-management was a lack of knowledge and awareness by non-specialist health care staff, employers and the wider society. Conclusions Nurses involved in the care of individuals with Inflammatory Bowel Disease should support and prepare patients for the discrepancies and uncertainties of living with the condition. Greater training about Inflammatory Bowel Disease is recommended, specifically for non-specialist health care staff and employers.

The team survey: a tool for health care team development.

The aim of this study was to validate a psychometric tool, the team survey, in a health care setting with a range of teams from a Large National Health Service (NHS) Trust. The team survey was developed by Millward and Ramsay (1998) to measure the team dimensions identified in the cognitive-motivational model of team effectiveness (Millward & Purvis 1998). The team dimensions are team potency, team identification, Shared Mental Models and team meta-cognitions. The psychometric properties of the tool as a reliable and valid predictor of team effectiveness was assessed by way of a survey of 10 teams (comprising 124 members in all) located on different premises, within a large NHS Trust. Team size ranged between 5 and 19 members, with average team size being 10 members. Two independent ratings of 'effectiveness' were made for each team. Factor and multiple regression analyses were employed to identify the most powerful predictors of health care team effectiveness from a cognitive and motivational perspective. The results suggest that the team survey is psychometrically robust within a health care setting. It is concluded that the tool has a potentially key role in informing and evaluating team development initiatives in support of the work of practice development nurses and nursing team leaders.

Computer simulation of A&E department

As a result of the National Health Service (NHS) reforms, the publication of the Patients Charter and Performance League Tables, providers are under persistent pressure to improve their efficiency. This article describes a recent simulation study of an Accident and Emergency (A&E) department in a large NHS Trust. A data collection survey is described which was essential for identifying patient flows and activity times in the A&E department We then discuss in more detail how to model patient arrivals which proved to be the most difficult part of the simulation. Some light is also shed on the attempt we made to develop a valid and credible model. Finally the preliminary findings are presented.