Mid Staffordshire NHS Foundation Trust Research Articles

Intentional rounding: a realist evaluation using case studies in acute and care of older people hospital wards

BackgroundIn response to concerns about high hospital mortality rates, patient and carer complaints, a Mid Staffordshire NHS Foundation Trust public inquiry was conducted at the request of the UK government. This inquiry found serious failures in the quality of basic care provided and as a consequence, recommended that patients should have more regular visits, organised at predictable times from nursing staff. Intentional rounding, also known as nursing ward rounds, was widely adopted to meet this need.ObjectiveTo test, refine or refute eight programme theories to understand what works, for whom, and in what circumstances.SettingSix wards (older people and acute wards) in three NHS trusts in England.ParticipantsBoard level and senior nursing managers (N = 17), nursing ward staff (N = 33), allied health and medical professionals (N = 26), patients (N = 34) and relatives (N = 28) participated in an individual, in-depth interview using the realist method. In addition, ward-based nurses (N = 39) were shadowed whilst they conduced intentional rounds (240 rounds in total) and the direct care of patients (188 h of patient care in total) was observed.MethodsThe mixed methods design included: Phase (1) Theory development - A realist synthesis was undertaken to identify any programme theories which were tested, refined and/or refuted, using data from phases 2 and 3; Phase (2) A survey of all English NHS acute Trusts; Phase (3) Six case studies of wards involving realist interviews, shadowing and non-participant observations, analysis of ward outcome and cost data; and Phase (4) Synthesis of findings from phases 1, 2 and 3.ResultsThe realist synthesis identified eight programme theories of intentional rounding: ‘Consistency and comprehensiveness’, ‘Accountability’, ‘Visibility of nurses’, ‘Anticipation’, ‘Allocated time to care’, ‘Nurse-patient relationships’, ‘Multi-disciplinary teamwork and communication’ and ‘Patient empowerment’. Key findings showed that of the original eight programme theories of intentional rounding, only two partially explained how the intervention worked (‘Consistency and comprehensiveness’ and ‘Accountability’). Of the remaining six programme theories, the evidence for two was inconclusive (‘Visibility of nurses’ and ‘Anticipation’) and there was no evidence for four (‘Allocated time to care’; ‘Nurse-patient relationships’; ‘Multi-disciplinary teamwork and communication’; and ‘Patient empowerment’).ConclusionsThis first theory-informed evaluation of intentional rounding, demonstrates that the effectiveness of intentional rounding in the English healthcare context is very weak. Furthermore, the evidence collected in this study has challenged and refuted some of the underlying assumptions about how intentional rounding works. This study has demonstrated the crucial role context plays in determining the effectiveness of an intervention and how caution is needed when implementing interventions developed for the health system of one country into another.

Corporatising compassion? A contemporary history study of English NHS Trusts' nursing strategy documents.

The purpose of this contemporary history study is to analyse nursing strategy documents produced by NHS Trusts in England in the period 2009-2013, through a process of discourse analysis. In 2013 the Francis Report on the Mid-Staffordshire NHS Foundation Trust was published. The Report highlighted the full range of organisational failures in a Trust that valued financial efficiency over patient care. The analysis that followed, however, dwelt heavily on the failings of the nurses. Nursing strategy documents at that time served to set the future direction for NHS Trusts, prescribing specific value frameworks for each nursing workforce. However, the values chosen frequently conflicted with each other pitting nursing values against a managerial trope. It is argued that documents provided a response to wider NHS concerns and high-profile failures in care, particularly the Francis Report, paying lip service to staff engagement whilst maintaining a corporate focus. Nursing values were placed firmly within a managerialist discourse, one that has needed to be re-evaluated in the current Covid-19 pandemic. Wider implications of the research suggest discussion of value conflict may be beneficial within nursing education and a truly local approach to strategy creation would potentially promote staff buy-in to strategy documents.

Gwên am Byth: a programme introduced to improve the oral health of older people living in care homes in Wales - from anecdote, through policy into action.

Introduction and context This paper describes how research and evidence influenced Welsh Government policy to fund a programme (Gwên am Byth - A Lasting Smile) with the aim of improving the oral health of older people living in care homes. It describes how collaborative multi-agency working supported development and delivery of the programme. The context was policy in Wales. This included the Welsh Government response to the public inquiry into Mid Staffordshire NHS Foundation Trust, the report into care homes by the Older People's Commissioner for Wales, and the Welsh Government Health and Care Standards for Wales which include a standard relating to oral health. The aim was to introduce a programme, Gwên am Byth, to support 'oral hygiene and mouth care for older people living in care homes through the development of a consistent all-Wales approach'; this aligns with contemporaneous NICE guidelines.Materials and methods Recurrent Welsh Government funding was identified to support a community dental service (CDS) led programme (Gwên am Byth). A multi-professional team led the development and testing of materials and resources to support the programme, underpin training for care home staff, and allow them to assess and provide safe mouth care for residents. A Welsh Health Circular was published to ensure a consistent all-Wales approachResults New staff have been employed in all health boards, and an assessment tool has been developed and is in the final stages of validation. All Wales resources have been published for induction, training and education, and to support care home staff. Evidence-based care plans have been produced which link to individual residents' risks and needs. There is close working with other health and social care professionals. By March 2019, half of all care homes were participating in the programme to a greater or lesser extent. Over 5,000 health and care staff had been trained, and over 5,600 residents had been assessed and supported with delivery of an individual mouth care plan. There has been positive feedback from care home staff, residents, carers and CDS staff, although barriers to delivery remain.Discussion This paper describes programme delivery in the four years since Gwên am Byth began. The drivers for change are described and the need to influence Welsh Government policy decisions when funding was available. The authors discuss issues which can impact on the pace of change, and ways in which health and care staff can effectively work together to implement improvements.Conclusions Starting with a blank page, a national programme has been established with the aim of improving the oral health of older people living in care homes in Wales. The paper describes the lessons learnt in implementing the programme and notes that Welsh Government has recognised the value of Gwên am Byth by committing to double the recurrent programme funding.

Analysing the implementation and effects of safe staffing policies in acute hospitals.

Several high-profile inquiries and reports, including the Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry, by Sir Robert Francis QC, have identified that nurse staffing is an essential factor in patient safety and patient mortality rates. Since the Francis report, several policies and initiatives aimed at ensuring safe staffing in the NHS have been developed alongside guidance and evidence-based safe staffing tools, while the Care Quality Commission has been tasked with ensuring compliance with these policies. In 2015, the National Institute for Health Research (NIHR) Policy Research Programme commissioned research to examine the extent to which safe staffing policies have translated into practice locally in the NHS. This article summarises and examines the main findings of this research and suggests that, although policies have raised the profile of nurse staffing, nursing shortages have impeded their implementation.

What is a therapeutic environment?

British Journal of NursingVol. 29, No. 7 CommentWhat is a therapeutic environment?Angela GraingerAngela Grainger(E-mail Address: [email protected])Senior Nurse Lecturer, BPP School of Nursing, DoncasterSearch for more papers by this authorAngela GraingerPublished Online:11 Apr 2020https://doi.org/10.12968/bjon.2020.29.7.388AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Business Dictionary. Competence. 2020. https://tinyurl.com/wusxlb4 (accessed 31 March 2020) Google ScholarCoulter A, Collins A for The King's Fund. Making shared decision-making a reality. No decision about me without me. 2011. https://tinyurl.com/y7653vwd (accessed 31 March 2020) Google ScholarDepartment of Health. Equity and excellence. Liberating the NHS. 2010. https://tinyurl.com/ply8lm2 (accessed 31 March 2020) Google ScholarEllis P, Bach S. Leadership, management and team working in nursing. 2nd edn. London: Sage; 2015 Google ScholarFrancis R. Report of the Mid Staffordshire NHS Foundation Trust public inquiry. London: The Stationery Office; 2013 Google ScholarNursing and Midwifery Council. The code. London: NMC; 2018 Google Scholar FiguresReferencesRelatedDetails 9 April 2020Volume 29Issue 7ISSN (print): 0966-0461ISSN (online): 2052-2819 Metrics History Published online 11 April 2020 Published in print 9 April 2020 Information© MA Healthcare LimitedPDF download

In praise of nursing associates

In praise of nursing associates

Intentional rounding in hospital wards to improve regular interaction and engagement between nurses and patients: a realist evaluation

© Crown copyright 2013. Contains public sector information licensed under the Open Government Licence v3.0© Queen’s Printer and Controller of HMSO 2019. This work was produced by Harriset al.under the terms of a commissioning contract issued by the Secretary of State for Health and Social Care. This issue may be freely reproduced for the purposes of private research and study and extracts (or indeed, the full report) may be included in professional journals provided that suitable acknowledgement is made and the reproduction is not associated with any form of advertising. Applications for commercial reproduction should be addressed to: NIHR Journals Library, National Institute for Health Research, Evaluation, Trials and Studies Coordinating Centre, Alpha House, University of Southampton Science Park, Southampton SO16 7NS, UK.20132019Crown copyrightQueen’s Printer and Controller of HMSOBackgroundThe government response to the care failures at the Mid Staffordshire NHS Foundation Trust led to the policy imperative of ‘regular interaction and engagement between nurses and patients’ (Francis R.Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry. London: The Stationery Office; 2013. © Crown copyright 2013. Contains public sector information licensed under the Open Government Licence v3.0) in the NHS. The pressure on nursing to act resulted in the introduction of the US model, known as ‘intentional rounding’, into nursing practice. This is a timed, planned intervention that sets out to address fundamental elements of nursing care by means of a regular bedside ward round.ObjectivesThe study aims were to examine what it is about intentional rounding in hospital wards that works, for whom and in what circumstances.DesignA multimethod study design was undertaken using realist evaluation methodology. The study was conducted in four phases: (1) theory development; (2) a national survey of all NHS acute trusts in England; (3) in-depth case studies of six wards, involving individual interviews, observations, retrieval of routinely collected ward outcome data and analysis of costs; and (4) synthesis of the study findings.SettingThe study was conducted in acute NHS trusts in England.ParticipantsA total of 108 acute NHS trusts participated in the survey. Seventeen senior managers, 33 front-line nurses, 28 non-nursing professionals, 34 patients and 28 carers participated in individual interviews. Thirty-nine members of nursing staff were shadowed during their delivery of intentional rounding and the direct care received by 28 patients was observed.Review methodsA realist synthesis was undertaken to identify eight context–mechanism–outcome configurations, which were tested and refined using evidence collected in subsequent research phases.ResultsThe national survey showed that 97% of NHS trusts had implemented intentional rounding in some way. Data synthesis from survey, observation and interview findings showed that only two of the original eight mechanisms were partially activated (consistency and comprehensiveness, and accountability). The evidence for two mechanisms was inconclusive (visibility of nurses and anticipation); there was minimal evidence for one mechanism (multidisciplinary teamwork and communication) and no evidence for the remaining three (allocated time to care, nurse–patient relationships and communication, and patient empowerment). A total of 240 intentional rounds were observed within 188 hours of care delivery observation. Although 86% of all intentional rounding interactions were observed to be documented, fidelity to the original intervention [i.e. the Studer Group protocol (Studer Group.Best Practices: Sacred Heart Hospital, Pensacola, Florida. Hourly Rounding Supplement. Gulf Breeze, FL: Studer Group; 2007)] was generally low.LimitationsIntentional rounding was often difficult for researchers to observe, as it was rarely delivered as a discrete activity but instead undertaken alongside other nursing activities. Furthermore, a lack of findings about the influence of intentional rounding on patient outcomes in the safety thermometer data limits inferences on how mechanisms link to clinical outcomes for patients.ConclusionsThe evidence from this study demonstrates that the effectiveness of intentional rounding, as currently implemented and adapted in England, is very weak and falls short of the theoretically informed mechanisms. There was ambivalence and concern expressed that intentional rounding oversimplifies nursing, privileges a transactional and prescriptive approach over relational nursing care, and prioritises accountability and risk management above individual responsive care.Future workIt is suggested that the insights and messages from this study inform a national conversation about whether or not intentional rounding is the optimum intervention to support the delivery of fundamental nursing care to patients, or if the time is right to shape alternative solutions.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

Freedom to speak up – the role of freedom to speak up guardians and the National Guardian’s Office in England

Following the events at Mid Staffordshire NHS Foundation Trust, Sir Robert Francis was commissioned to undertake a public inquiry. During this process, from speaking to NHS workers and from the evidence submitted to the inquiry, he found that staff had tried to speak up about their concerns, but that they had been ignored, or victimised as a result. This experience was not confined to Mid Staffordshire and a further report, Freedom to speak up, was commissioned. Freedom to speak up made two recommendations, which were accepted by all NHS organisations and the Department of Health. The report included principles and actions about the culture and practice in the NHS, the appointment of freedom to speak up guardians in NHS trusts and foundation trusts and a national guardian to lead this network, undertake case reviews and provide support and challenge to the system. In this article, I will describe the work of freedom to speak up guardians and the National Guardian's Office, the impact of these on workers in NHS trusts and other organisations, and the next steps in the journey to make speaking up business as usual.

Giving clinicians and patients the remote control.

British Journal of Community NursingVol. 24, No. 8 Long-Term ConditionsGiving clinicians and patients the remote controlNadine MilesNadine MilesE-mail Address: [email protected]Director of Business Development, Spirit HealthSearch for more papers by this authorNadine MilesPublished Online:1 Aug 2019https://doi.org/10.12968/bjcn.2019.24.8.368AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Berwick D. A promise to learn—a commitment to act: improving the safety of patients in England. 2013. https://tinyurl.com/yyt9zmll (accessed 24 July 2019) Google ScholarFaiz O, Nachiappan S, Anele C, Roberts EJ, Barker C. An observational study to assess the feasibility of remote monitoring of patients in the early postoperative period after elective surgery. 2019. https://tinyurl.com/yyk68cxa (accessed 21 July 2019) Google ScholarFrancis R. Report of the The Mid Staffordshire NHS Foundation Trust Public Inquiry. 2013. https://tinyurl.com/y4d28lgp (accessed 24 July 2019) Google ScholarNHS England. House of care—a framework for long term condition care. 2016. https://tinyurl.com/y678y5vv (accessed 24 July 2019) Google ScholarKingston A, Robinson L, Booth H, Knapp M, Jagger C; the MODEM project. Projections of multi-morbidity in the older population in England to 2035: estimates from the Population Ageing and Care Simulation (PACSim) model. Age Ageing. 2018; 47(3):374–380. https://doi.org/10.1093/ageing/afx201 Crossref, Medline, Google Scholar FiguresReferencesRelatedDetails 2 August 2019Volume 24Issue 8ISSN (print): 1462-4753ISSN (online): 2052-2215 Metrics History Accepted 1 June 2019 Published online 1 August 2019 Published in print 2 August 2019 Information© MA Healthcare LimitedPDF download

A realist informed mixed-methods evaluation of Schwartz Center Rounds® in England

BackgroundSchwartz Center Rounds®(Rounds) were introduced into the UK in 2009 to support health-care staff to deliver compassionate care, something the Francis report (Francis R.Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry. London: The Stationery Office; 2013) identified as lacking. Rounds are organisation-wide forums that prompt reflection and discussion of the emotional, social and ethical challenges of health-care work, with the aim of improving staff well-being and patient care.ObjectivesHow, in which contexts and for whom Rounds participation affects staff well-being at work, increases social support for staff and improves patient care.Design(1) A scoping review of Rounds literature and comparison with alternative interventions; (2) mapping Rounds providers via a survey, telephone interviews and secondary data; (3) a two-wave survey of (i) new attenders/non-attenders in 10 sites to determine the impact on staff engagement and well-being; and (ii) interviews with Rounds attenders, non-attenders, facilitators, clinical leads, steering group members, board members and observations in nine case study sites to (4) describe experiences and (5) test candidate programme theories by which Rounds ‘work’ (realist evaluation).Setting(1) International literature (English); (2) all Rounds providers (acute/community NHS trusts and hospices) at 1 September 2014 (survey/interview) and 15 July 2015 (secondary data); (3) 10 survey sites; and (4 and 5) nine organisational case study sites (six of which also took part in the survey).Participants(1) Ten papers were reviewed for Rounds and 146 were reviewed for alternative interventions. (2) Surveys were received from 41 out of 76 (54%) providers and interviews were conducted with 45 out of 76 (59%) providers. (3) Surveys were received from 1140 out of 3815 (30%) individuals at baseline and from 500 out of 1140 (44%) individuals at follow-up. (4 and 5) A total of 177 interviews were conducted, as were observations of 42 Rounds, 29 panel preparations and 28 steering group meetings.Results(1) The evidence base is limited; compared with 11 alternative interventions, Rounds offer a unique organisation-wide ‘all staff’ forum in which disclosure/contribution is not essential. (2) Implementation rapidly increased between 2013 and 2015; Rounds were implemented variably; challenges included ward staff attendance and the workload and resources required to sustain Rounds; and costs were widely variable. (3) There was no change in engagement, but poor psychological well-being (12-item General Health Questionnaire) reduced significantly (p < 0.05) in Rounds attenders (25% to 12%) compared with non-attenders (37% to 34%). (4 and 5) Rounds were described as interesting, engaging and supportive; four contextual layers explained the variation in Rounds implementation. We identified four stages of Rounds, ‘core’ and ‘adaptable’ components of Rounds fidelity, and nine context–mechanism–outcome configurations: (i) trust, emotional safety and containment and (ii) group interaction were prerequisites for creating (iii) a countercultural space in Rounds where staff could (iv) tell stories, (v) self-disclose their experiences to peers and (vi) role model vulnerability; (vii) provide important context for staff and patient behaviour; (viii) shining a spotlight on hidden staff and patient stories reduced isolation and enhanced support/teamwork; and (ix) staff learned through reflection resulting in ripple effects and outcomes. Reported outcomes included increased empathy and compassion for colleagues and patients, support for staff and reported changes in practice. The impact of Rounds is cumulative and we have identified the necessary conditions for Rounds to work.LimitationsRounds outcomes relied on self-report, fewer regular attenders were recruited than desired, and it was not possible to observe staff post Rounds.ConclusionRounds offer unique support for staff and positively influence staff well-being, empathy and compassion for patients and colleagues.Future workThe adaptation of Rounds to new contexts and to increase reach needs evaluation.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

Avoidance of unnecessary hospital admissions through the implementation of a digital health programme

Introduction: 62% of hospital bed days are occupied by older adults 65 and older in the UK and it is estimated that there is a cost to the NHS of £820 million1. Elderly patients admitted to hospital have worse morbidity and mortality outcomes and often have a poorer experience2,3,. To reduce emergency admissions Tameside and Glossop Integrated Care NHS Foundation Trust developed a Digital Health Service, which supports frail people to stay within the community where their care can be managed, avoiding an Emergency room attendance and potential emergency admission. Practice change: To enhance the value of care provided to the local community a digital health service has been implemented in care homes. The service provides digital technology that enables care home staff to access a hospital specialist for advice and guidance on residents who have a deterioration in health before considering an Ambulance/ GP visit. Aim and theory of change: The aim is to use technology to enable care home staff to maintain older people with complex co-morbidities, within their home setting and avoiding unnecessary hospital admissions. Timeline: The programme was launched in March 2017 and will run for 3 years Highlights: In the period April and September 2017 94 Emergency and 258 GP attendances were avoided. Total hospital bed days saved 1268. Deflection rate of Emergency room attendance is currently 70% Comments on sustainability: The programme has now been expanded across the whole of the residential care home sector and will launched as a 24/7 service this year. Limitations: Awaiting more long term finding, ongoing evaluation is required to ensure that early results are sustainable overtime. Comments on transferability A joint End of Life bid is being developed. Conclusions: Elderly people suffer worsening health and poor experience when in hospital 3, 5. There is also a significant financial cost to systems treating frail elderly patients in hospitals 3. The Digital health programme enabled care staff to access acute hospital specialists for advice and guidance, which has led to a significant deflection in attendance. Discussions: The programme has proven successful at reducing admissions and in Emergency room attendance within the population group, data appears to show that the service has the potential to support people to remain within their place of residence rather than be treated in hospital. Lessons learned: General practitioners are key influencers within community setting and proved key to promoting and service

Risk avoidance and safety assurance: an overview

British Journal of Healthcare ManagementVol. 24, No. 7 Risk ManagementRisk avoidance and safety assurance: an overviewKate Harmond AllanKate Harmond AllanSearch for more papers by this authorKate Harmond AllanPublished Online:2 Jul 2018https://doi.org/10.12968/bjhc.2018.24.7.320AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References BBC One. The doctor who gave up drugs. 2018;May:23 Google ScholarFrancis R (2013) Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry: Executive Summary. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/279124/0947.pdf (accessed 20 June 2018) Google ScholarHearn B. Screening flaw. The Times, Letters to the editor. 2018;May:5 Google ScholarKay A. This is going to hurt: Secret diaries of a junior doctor. Picador: London; 2018 Google ScholarLe Fanu J. Too many pills: How too much medicine is endangering our health and what we can do about it. Little Brown: London; 2018 Google ScholarMcCarthy M (2017) WHO surgical checklist cuts post-surgical deaths by 22%, US studies find. www.bmj.com (accessed June 2018) Google ScholarNHS Choices (2018) NHS Choices: breast cancer screening. https://www.nhs.uk/conditions/breast-cancer-screening/ (accessed June 2018) Google ScholarNightingale F. (2017 [1858]). Notes on nursing: what it is, and what it is not. Enhanced Media Publishing; Kindle Edition, BOO2RKR811, 07 July Google ScholarParliament (2018) Statement: breast cancer screening: 2 May 2018. https://www.parliament.uk/business/news/2018/may/statement-breast-cancer-screening-2-may-2018/ (accessed 20 June 2018) Google ScholarLeake J, Razman I. Each baby costs hospitals £1000 injury insurance. The Sunday Times. 2018;May:6 Google ScholarThe Times Screening flaw. Letters to the Editor. 2018;May:5 Google ScholarWHO (2008) Topic 6: understanding and managing risk. http://www.who.int/patientsafety/education/curriculum/PSP_mpc_topic-06.pdf accessed June 2018 Google ScholarWHO (2009) Health topics, risk factors, global health risks. http://www.who.int/healthinfo/global_burden_disease/global_health_risks/en/ (accessed 12 June 2018) Google ScholarWHO (2009) Patient safety, WHO surgical checklist. http://www.who.int/patientsafety/safesurgery/checklist/en/ (accessed June 2018) Google Scholar FiguresReferencesRelatedDetails 2 July 2018Volume 24Issue 7ISSN (print): 1358-0574ISSN (online): 1759-7382 Metrics History Published online 2 July 2018 Published in print 2 July 2018 Information© MA Healthcare LimitedPDF download

The changing role of management in the first 70 years of the NHS

British Journal of Healthcare ManagementVol. 24, No. 7 NHS at 70The changing role of management in the first 70 years of the NHSAdam LaylandAdam LaylandSearch for more papers by this authorAdam LaylandPublished Online:2 Jul 2018https://doi.org/10.12968/bjhc.2018.24.7.346AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Abualrub RF, Gharaibeh HF, Bashayreh AEI. The relationships between safety climate, teamwork, and intent to stay at work among Jordanian hospital nurses'. Nursing Forum. 2012;47(1):65–75. https://doi.org/https://doi.org/10.1111/j.1744-6198.2011.00253.x Crossref, Google ScholarBerwick D (2013) A promise to learn – a commitment to act. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/226703/Berwick_Report.pdf (accessed 13 June 2018) Google ScholarDarzi A (2008) High Quality Care for All NHS Next Stage Review Final Report. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/228836/7432.pdf (accesed 13 June 2018) Google ScholarFrancis R (2013)Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry: Executive Summary. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/279124/0947.pdf (accessed 13 June 2018) Google ScholarGreengross P, Grant K, Collins E. The history and development of the UK National Health Service 1948-1999. Health Systems Resource Centre: London; 1999 Google ScholarGriffiths R (1983) NHS Management Inquiry. http://www.nhshistory.net/griffiths.html (accessed 13 June 2018) Google ScholarKeogh B (2014) Transforming urgent and emergency care services in England. https://www.england.nhs.uk/wp-content/uploads/2015/06/trans-uec.pdf (accessed 13 June 2018) Google ScholarMinistry of Health (1954) Report of the committee on the internal administration of hospitals. https://navigator.health.org.uk/content/bradbeer-committee-report-internal-administration-hospitals-central-health-services-council (accessed 13 June 2018) Google ScholarMinistry of Health (1967) First Report of the Joint Working Party on the Organisation of Medical Work in Hospitals. Google ScholarRhodes D (2018) ‘Hospitals recruit managers faster than doctors or nurses’. BBC. http://www.bbc.co.uk/news/uk-england-43794816 (accessed 15 May 2018) Google ScholarRose L (2015) Better leadership for tomorrow: NHS Leadership Review. https://www.gov.uk/government/publications/better-leadership-for-tomorrow-nhs-leadership-review (accessed 13 June 2018) Google ScholarSofarelli D, Brown D. The need for nursing leadership in uncertain times. Journal of Nursing Management. 1998;6:201–7 Crossref, Google ScholarFurther readingJones D. A brief history of the National Health Service. BJHCM. 2015;21(2):77–79. https://doi.org/https://doi.org/10.12968/bjhc.2015.21.2.77 Google Scholar FiguresReferencesRelatedDetailsCited byChange management in the NHS: distributed leadershipBryan McIntosh, Adam Layland17 July 2019 | British Journal of Healthcare Management, Vol. 25, No. 7Paramedic leaders: past, present and futureAdam Layland5 October 2018 | Journal of Paramedic Practice, Vol. 10, No. 10 2 July 2018Volume 24Issue 7ISSN (print): 1358-0574ISSN (online): 1759-7382 Metrics History Published online 2 July 2018 Published in print 2 July 2018 Information© MA Healthcare LimitedPDF download

Quality and safety between ward and board: a biography of artefacts study

BackgroundThere have been concerns about the quality and safety of NHS hospital services since the turn of the millennium. This study investigated the progress that acute NHS hospital trusts have made in developing and using technology infrastructures to enable them to monitor quality and safety following the publication in 2013 of the second Francis report on the scandal at Mid Staffordshire NHS Foundation Trust (The Mid Staffordshire NHS Foundation Trust Public Inquiry. Chaired by Sir Robert Francis QC.Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry. HC 898. London: The Stationery Office; 2013).MethodsA telephone survey of 15 acute NHS trusts in the Yorkshire and the Humber region, and a review of board papers of all acute NHS trusts in England for January 2015, were undertaken. The telephone survey was used to identify trusts for a larger field study, which was undertaken in four acute NHS trusts between April 2015 and September 2016. The methods included the direct observation of the use of whiteboards and other technologies on two wards in each trust, an observation of board quality committees, semistructured interviews and an analysis of the quality and safety data in board papers. Published sources about national and local agencies were reviewed to identify the trust quality and safety data that these agencies accessed and used. An interview programme was also undertaken with those organisations. The Biography of Artefacts approach was used to analyse the data.FindingsThe data and technology infrastructures within trusts had developed over many years. The overall design had been substantially determined by national agencies, and was geared to data processing: capturing and validating data for submission to national agencies. Trust boards had taken advantage of these data and used them to provide assurance about quality and safety. Less positively, the infrastructures were fragmented, with different technologies used to handle different quality and safety data. Real-time management systems on wards, including electronic whiteboards and mobile devices, were used and valued by nurses and other staff. The systems support the proactive management of clinical risks. These developments have occurred within a broad context, with trusts focusing on improving the quality and safety of services and publishing far more data on their performance than they did just 3 years earlier. Trust-level data suggest that quality and safety improved at all four trusts between 2013 and 2016. Our findings indicate that the technology infrastructures contributed to these improvements. There remains considerable scope to rationalise those infrastructures.LimitationsThe four trusts in the main study were, in part, purposively selected, and deliberately biased towards sites that had made progress with designing and deploying real-time ward management systems. This limits the generalisability of the study. The study focused more on the work of nurses and nurse managers, and has relatively little to say about the experiences of doctors or allied health professionals.Future workFuture research might focus on the effects of mobile technologies and electronic whiteboards on acute wards, the value of current national data returns, and the uses and value of trust data warehouses.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

Dentists are humans too - education in human factors within dental care.

The role of human factors in healthcare has become increasingly well recognised, particularly following the Francis inquiry into the failings in care at the Mid Staffordshire NHS Foundation Trust and Berwick Reports. The recognition of human factors in dentistry, particularly in primary care, is less well developed. This paper aims to explore the relevance of human factors in dentistry and highlight the importance of considering their role in any adverse patient outcomes and, importantly for the future, the continued recognition and integration of teaching about human factors in healthcare in both undergraduate and postgraduate education.

The calm before the 'perfect storm'.

British Journal of Community NursingVol. 23, No. 5 EditorialThe calm before the ‘perfect storm’Julie Anne HughesJulie Anne HughesSearch for more papers by this authorJulie Anne HughesPublished Online:30 Apr 2018https://doi.org/10.12968/bjcn.2018.23.5.213AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Adams R, Nursing degree applications slump after NHS bursaries abolished, 2017. The Guardian. https://tinyurl.com/hyftq5q Google ScholarFrancis R. The Mid Staffordshire NHS Foundation Trust Public Inquiry. 2013. https://tinyurl.com/omsm882 (accessed 18 April 2018) Google ScholarHealth Foundation. In short supply: pay policy and nurse numbers – nurse staffing. 2017. https://tinyurl.com/y9daw6dg (accessed 18 April 2018) Google ScholarKing's Fund. Reimagining community services. 2018. https://tinyurl.com/ycajmjpc (accessed 18 April 2018) Google ScholarRoyal College of Nursing. Safe and effective staffing: the real picture. 2017 https://tinyurl.com/yaqxkl8a (accessed 18 April 2018) Google Scholar FiguresReferencesRelatedDetails 2 May 2018Volume 23Issue 5ISSN (print): 1462-4753ISSN (online): 2052-2215 Metrics History Published online 30 April 2018 Published in print 2 May 2018 Information© MA Healthcare LimitedPDF download

NHS Present Complaint Handling System about Healthcare. Is it Fit for the Purpose?

Introduction: Despite massive recent changes in the complaint handling process of NHS, the process is still complex. There is increase in the number of complaints and inconsistency in the complaint handling. According to the Secretary of State for Health’s statement to the parliament standing committee, “there are 12,000 avoidable hospital deaths every year. More than 10,000 serious incidents are reported to NHS England, out of a total of 1.4 million mostly low-harm or no-harm incidents annually. There were 338 recorded “never events” (such as wrong site surgery) during 2013-14 and NHS England received 174,872 written complaints. The NHS Litigation Authority’s latest estimate of clinical negligence liabilities is £26.1 billion. The cost of the Francis Inquiry into the Mid Staffordshire NHS Foundation Trust was £13.6 million. Good quality complaints handling is an indicator of continuous improvement in the quality and safety of health care. The objective of this review was to analyse whether the current NHS complaint handling system is fit for the purpose. Materials & Methods: A narrative review of the relevant literature known to the author was conducted. Conclusion: Whilst the Government has brought major changes in the complaint handling process of NHS, the patients are still dissatisfied with the current process. There are some perceived gaps and lack of coherence in the current complaint handling system indicating that it is not fit for the purpose.

Why is trust important for effective healthcare teams?

British Journal of Healthcare ManagementVol. 24, No. 2 DiscussionWhy is trust important for effective healthcare teams?Adam LaylandAdam LaylandSearch for more papers by this authorAdam LaylandPublished Online:10 Feb 2018https://doi.org/10.12968/bjhc.2018.24.2.61AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Abualrub RF, Gharaibeh HF, Bashayreh AEI. The relationships between safety climate, teamwork, and intent to stay at work among Jordanian hospital nurses. Nursing Forum. 2012;47(1):65–75 Crossref, Google ScholarCIPD. Where has all the trust gone? Research Report. [Internet]. 2012. [cited 2017 Nov 21]. Available from: http://www.trustinorganizations.com/Resources/Documents/WhereHasAllTheTrustGone.pdf.pdf Google ScholarCommittee on Standards in Public Life. 7 principles of public life. [Internet]. 1995. [Cited 2017 Nov 21]. 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Relocation, relocation: perspectives on the spatio‐temporal impacts of health services transitions

Within the context of an ageing population and the need to sustain hospital budgets, the nature and future of UK healthcare is changing. In the late 2000s, Stafford Hospital in Staffordshire was the centre of substantial public concern over poor care and high mortality rates. The dissolution of Mid Staffordshire NHS Foundation Trust (which ran the hospital) combined with the University Hospital of North Staffordshire NHS Trust led to the creation of the University Hospitals of North Midlands NHS Trust in November 2014. The rebranding of Stafford Hospital (now County Hospital) and the University Hospital of North Staffordshire (now Royal Stoke University Hospital) to eliminate all mention of ‘Staffordshire’ reflects a sense of renewal and reorganisation of services. Despite this, the transfer of a number of services such as consultant‐led maternity, acute surgery and inpatient paediatrics services from the County Hospital to Royal Stoke University Hospital has led to substantial public outcry. This paper presents the results from five focus groups highlighting substantial concerns, emotions and implications regarding the spatial and temporal changes to accessing hospital services in Staffordshire. Perspectives towards the spatio‐temporal impacts of health services transitions reflected attitudes to, and experiences of, (relocated) services; accessibility and transport; communication and engagement; concern about capacity. Drawing on these results, the paper concludes with a new conceptual framework outlining the perspectives towards the spatio‐temporal impacts of health services transitions, and with implications for Trusts seeking to engage service users with changes to local provision.

'Always be true to your values'.

Helene Donnelly qualified as a nurse in 2002 and became a nurse practitioner in the emergency department at Stafford Hospital in 2005. After becoming concerned about poor patient care, she raised more than 100 complaints and was a key witness at the inquiry into care failings at Mid Staffordshire NHS Foundation Trust. She took up her current role as ambassador for cultural change at Staffordshire and Stoke on Trent Partnership NHS Trust in 2013, and was awarded an OBE for services to the health service the same year.