Proportion Of Staff Research Articles

Evaluating the impact of the race equality charter on diversity staff outcomes

ABSTRACT The Race Equality Charter (REC) was established with the main objective of tackling persistent racial inequalities in the UK Higher Education sector. There are currently over 100 REC member institutions holding close to 50 awards between them. While the sector uptake of the REC is notable, there are currently no empirical studies evaluating its impact. Using data from the Higher Education Statistics Agency (HESA), this study uses a matched difference-in-difference approach to investigate the effect of the REC on the proportion of staff from Black, Asian, and minority ethnic groups, their corresponding share of total staff in professorial or senior academic posts, as well as their corresponding share of total staff holding permanent contracts. The results reveal non-significant treatment effects which indicates that there is no difference in diversity staff outcomes between REC and non-REC institutions.

Good School Toolkit-Secondary Schools to prevent violence against students: protocol for a pilot cluster randomised controlled trial

IntroductionNo whole-school interventions which seek to reduce physical, sexual and emotional violence from peers, intimate partners and teachers have been trialled with adolescents. Here, we report a protocol for a...

Direct and indirect vaccination effects on SARS-CoV-2 infection in day-care centres: Evaluating the policy for early vaccination of day-care staff in Germany, 2021.

To mitigate the known high transmission risk in day-care facilities for children aged 0-6years, day-care staff were given priority for SARS-CoV-2 vaccination in Rhineland-Palatinate, Germany, in March 2021. This study assessed direct and indirect effects of early vaccination of day-care staff on SARS-CoV-2 transmission in daycares with the aim to provide a basis for the prioritisation of scarce vaccines in the future. Data came from statutory infectious disease notifications in educational institutions and from in-depth investigations by the district public health authorities. Using interrupted time series analyses, we measured the effect of mRNA-based vaccination of day-care staff on SARS-CoV-2 infections and transmission. Among 566 index cases from day-care centres, the mean number of secondary SARS-CoV-2 infections per index case dropped by -0.60 case per month after March 2021. The proportion of staff among all cases reported from daycares was around 60% in the pre-interruption phase and significantly decreased by 27 percentage points immediately in March 2021 and by further 6 percentage points each month in the post-interruption phase. Early vaccination of day-care staff reduced SARS-CoV-2 cases in the overall day-care setting and thus also protected unvaccinated children. This should inform future decisions on vaccination prioritisation.

Foreign Healthcare Professionals in Germany: A Questionnaire Survey Evaluating Discrimination Experiences and Equal Treatment at Two Large University Hospitals.

To identify facilitators and barriers and derive concrete measures towards better workplace integration of migrants working in the German healthcare sector. Two-centre cross-sectional quantitative online survey of experiences of discrimination among healthcare professionals with a migration history in two large German university hospitals. 251 participants fully completed the questionnaires. Experiences of discrimination and perception of inequality. Fifty-five percent of migrant health workers had had at least some command of German before arriving in Germany. Members of all professional groups surveyed expressed experiences of discrimination related to language, nationality, race/ethnicity, and sex/gender. The proportions of staff with experiences of discrimination by peers differed significantly among occupational roles, with nurses and technologists having the most experiences of discrimination. The perception of inequality was reported more frequently than experiences of discrimination and had a negative impact on workplace satisfaction. Specifically, the compulsion to compete was a frequent feeling stated by participants. The mechanisms of discrimination and structural inequality revealed by our survey could inform specific measures, for example at the management level, to increase workplace satisfaction and attract migrant health workers in the long term.

Nursing Staff Involvement and Education in Sickle Cell Disease-a Single Institution Quality Improvement Initiative

Introduction: Sickle cell disease (SCD) is the most common inherited blood disorder in the US characterized by vaso-occlusive crisis leading to debilitating pain, organ dysfunction and reduced life expectancy. Despite this, health care staff receive little education on the illness and often feel uncomfortable managing it. The disease is often misunderstood and carries a perceived stigma. Our institution is faced with the additional challenge of lower staff diversity. As part of a larger quality improvement initiative at an institutional level of Sickle Cell Program development, we conducted this project to improve nursing staff level of knowledge and understanding of the disease. Aims: 1) Identify nursing staff who regularly take care of patients with SCD, evaluate their current knowledge and challenges when caring for patients with SCD, 2) Offer educational modules to address knowledge gaps and implement changes to improve comfort in caring for patients with SCD, 3) Provide a pathway that is reproducible for other institutions. Methods: The project was conducted at the University of Wisconsin Hospital by a multi-disciplinary SCD team with collaboration from the Nursing Education specialists and the Diversity Equity and Inclusion department. As a pilot cohort, we identified nursing champions who predominantly take care of patients with SCD and offered them to answer an anonymous survey. Based on their responses, educational modules on SCD were designed and video-recorded. Post-surveys were collected for feedback. The Plan-Do-Study-Act methodology was utilized to document progress and conduct tests of change. QI intervention: Educational module titled "Understanding Sickle Cell Disease and How Nursing Staff Can Help” was designed, video-recorded and uploaded on internal provider platform (U-Learn). Topics included Pathophysiology of SCD, Current treatments, Acute and chronic management of pain, Specialized nursing care for SCD and Addressing disparities, bias and stigma, specifically designed to raise awareness about the new sickle cell team, pain management plans and nursing interventions tailored to our institution. Continuing Education Units (CEU) of 1.5 hours were appointed for their completion. Following the modules, nursing champions answered a post-survey and participated in GRAPES trivia tool, known to improve knowledge and decrease negative attitudes towards patients with SCD. As next step, series of monthly Q&A meetings will be conducted with the nursing champions as an interactive platform for feedback. The nursing champion group will be expanded to form a task force that will serve as SCD patient advocates and help implement ongoing improvements. A best practice alert is being created to facilitate access to patient pain plans in the electronic chart. Patients will be offered surveys to evaluate change in satisfaction with care. Processes implemented at UW will be shared with other regional institutions. Results: Pre-intervention, 15 (65%) staff members completed the survey. The majority requested education on pain management and nursing care (Fig 1). Preliminary findings show that 20 (87%) nursing champions have signed up and 10 (43%) have completed the modules. 30% of members have completed the post-survey. The proportion of respondents reporting good/excellent disease understanding increased to 100% compared to 73% previously (Fig 2). Proportion of staff who report comfort in taking care of patients with SCD increased from 20% to 100% of the respondents (Figure 2). All respondents felt this module provided them with tools to address systematic racism faced by patients with SCD. Pre-intervention, 80% had acknowledged it's presence. Conclusion: Our preliminary data from this QI initiative shed light on deficiencies in the care delivered to an underserved patient population at our hospital, and identified areas of improvement. Lack of knowledge and misconceptions lead to low level of comfort by staff leading to sub-optimal care. Creating a nursing champions cohort interested in improving care of patients with SCD, and empowering them to be part of the change, is a feasible strategy to address institutional and systematic challenges. We started with an interactive CEU based, yet flexible educational strategy to engage staff and using their feedback, introduce ongoing improvements. Similar approach can be adopted at other institutions who face similar challenges. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

A Quality Improvement Approach to Enhance LGBTQ+ Inclusivity in Pediatric Primary Care.

Lesbian, gay, bisexual, transgender, and queer (LGBTQ+) teens are at higher risk of illness as a result of bias but are less likely than peers to attend well visits. Medical organizations recommend improving care through staff education, visual cues, and routine inquiry of sexual orientation and gender identity (SO/GI) and pronouns. It is unknown how to do this confidentially in pediatrics. This quality improvement (QI) project aimed to confidentially collect and document SO/GI and pronouns early in at least 90% of teen acute care visits. A diverse, representative QI team in a resident primary care clinic conducted a series of staff and clinician trainings to improve knowledge, then displayed welcoming signage and offered staff pronoun and rainbow pins. Multiple Plan-Do-Study-Act cycles developed methods of routine and private collection of SO/GI and pronouns. Outcome measures included proportion of teen acute visits with such documentation collected via weekly chart reviews. Process measures included staff/clinician preparedness, assessed by surveys. SO/GI and pronouns were documented in 0% of teen acute visits at baseline, 70% after 6 months, and 90% during the 20-week sustainment measurement phase. The proportion of staff and clinicians who felt prepared to provide care for LGB and transgender patients increased (53% to 68% for LGB, P = .07; and 30% to 57% for transgender, P = .002). QI methods can create protocols for confidential, sustainable SO/GI and pronoun collection from teens early in acute visits. This allows clinicians and staff to address patients appropriately and for clinicians to better meet their needs.

Covid-19 and orthopaedic trauma: Quantification of orthopaedic trauma workload and staff resource allocation during a global pandemic-related lockdown

IntroductionHealthcare systems across the world have struggled as a result of the Covid-19 pandemic. Most specialties have redeployed their staff and resources to deal with the pandemic whilst ceasing their planned elective activity. However acute specialties such as Trauma and Orthopaedics still have a significant emergency caseload that must be safely managed, even in a pandemic. The aim of this study was to investigate the change in Orthopaedic Trauma caseload in a Trauma Unit and a Major Trauma Centre during a pandemic compared to pre-pandemic levels and the associated staffing requirements. MethodsThe data presented was collected from a Trauma Unit and a Major Trauma Centre in the United Kingdom. We compared the number of accident and emergency referrals, fracture clinic appointments, inpatient admissions and operations during the six weeks of the first lockdown from 23rd March to May 3, 2020, to the same time period in 2019. ResultsThe results showed that the orthopaedic trauma caseload was approximately half that of pre-pandemic levels, reducing by an average of 54.2%. ConclusionA significant orthopaedic trauma caseload still remains to be safely managed during a pandemic and appropriate resources must be allocated. Staff allocation must take into account sick cover and staff wellbeing. A proportion of staff may need to be ring fenced from redeployment to facilitate this.

Exploring the psychological impact of the COVID-19 pandemic on PICU consultants, advanced nurse practitioners and trainee doctors

Background: Paediatric intensive care unit (PICU) staff members are at risk of burnout, stress, and fatigue. The COVID-19 pandemic has affected how we live and work; we postulate this increases the risk of stress-related disorders. Aims: To explore the impact of the COVID-19 pandemic on the wellbeing of PICU clinicians. Methods: An anonymised, single-centre survey was sent to clinicians, comprising four sections: burnout, work-related stress, work-related fatigue, and work-life balance. Two free-text questions explored perceptions of work-life balance and measures to improve wellbeing. Results: 55.6% of respondents returned scores suggesting high burnout risk. 55.6% had answers suggesting work-related stress. 82.4% reported work-related fatigue. 55.5% felt that work-life balance had not improved during the pandemic. Conclusions: The proportion of staff at risk of burnout in this study is higher than that reported in pre-pandemic studies. Perceived work-life balance has been negatively impacted, and high levels of work-related stress and fatigue were identified.

Evaluation of the Efficiency and Safety of a Safe Label System: A Prospective Simulation Study.

Our study aims to investigate the safety and efficiency of the Codonics Safe Label System (SLS) in a prospective simulation study. Three sets of simulated experiments involving 82 anesthetists were carried out on patient simulator mannequins. The primary outcome assessed through the simulated experiments was the effectiveness of the SLS in avoiding vial swap errors. Secondary outcomes analyzed included the efficacy of the SLS in preventing syringe swap and the difference in time taken to prepare standardized drugs as compared with conventional methods. The SLS was associated with a significant reduction in all 4 stages of vial swap error. The incidence of wrong ampoule breakage was significantly lower in the SLS group compared with the conventional group (12.1% versus 38.5%, P = 0.007). The number of staff who drew the wrong ampoule was similarly lower in the SLS group compared with the conventional group (4.9% versus 33.3%, P = 0.001). The proportions of staff who eventually wrongly labeled the loaded syringe were 0% in the SLS group and 17.9% in the conventional group (P = 0.005).Drug preparation time was longer for the SLS group than for the conventional group (239.6 ± 45.9 versus 160.3 ± 46.5 seconds, P < 0.001).There was no significant difference in the incidence of syringe swap with the use of the SLS. The use of the SLS is effective in reducing vial swap error, but not syringe swap errors, and is associated with increased time taken for anesthetic drug preparation.

Conception and development of Self-Management indicators to advance the quality of spinal cord injury rehabilitation: SCI-High Project

Context Although self-management is linked to reduced secondary health complications (SHCs) and enhanced overall quality of life post-spinal cord injury or disease (SCI/D), it is poorly integrated into the current rehabilitation process. Promoting self-management and assuring equity in care delivery is critical. Herein, we describe the selection of Self-Management structure, process and outcome indicators for adults with SCI/D in the first 18 months after rehabilitation admission. Methods Experts in self-management across Canada completed the following tasks: (1) defined the Self-Management construct; (2) conducted a systematic search of available outcomes and their psychometric properties; and (3) created a Driver diagram summarizing available evidence related to Self-Management. Facilitated meetings allowed development and selection following rapid-cycle evaluations of proposed structure, process and outcome indicators. Results The structure indicator is the proportion of staff with appropriate education and training in self-management principles. The process indicator is the proportion of SCI/D inpatients who have received a self-management assessment related to specific patient self-management goal(s) within 30 days of admission. The outcome indicator is the Skill and Technique Acquisition, and Self-Monitoring and Insight subscores of the modified Health Education Impact Questionnaire. Conclusion The structure indicator will heighten awareness among administrators and policy makers regarding the need to provide staff with ongoing training related to promoting self-management skill acquisition. Successful implementation of the Self-Management process and outcome indicators will promote self-management education and skill acquisition as a rehabilitation priority, allow for personalization of skills related to the individual’s self-management goal(s), and empower individuals with SCI/D to manage their health and daily activities while successfully integrating into the community.

The Psychological Impact of COVID-19 on Hospital Staff.

IntroductionThe coronavirus 2019 (COVID-19) pandemic has created a mental health crisis among hospital staff who have been mentally and physically exhausted by uncertainty and unexpected stressors. However, the mental health challenges and complexities faced by hospital staff in the United States has not been fully elucidated. To address this gap, we conducted this study to examine the prevalence and correlates of depression and anxiety among hospital staff in light of the COVID-19 pandemic.MethodsThe design is a single-center, cross-sectional, online survey evaluating depression and anxiety among all hospital employees (n = 3,500) at a safety-net hospital with a moderate cumulative COVID-19 hospitalization rate between April 30–May 22, 2020. We assessed depression with the Patient Health Questionnaire-9. Anxiety was measured with the Generalized Anxiety Disorder-7 scale. Logistic regression analyses were calculated to identify associations with depression and anxiety.ResultsOf 3,500 hospital employees, 1,246 (36%) responded to the survey. We included 1,232 individuals in the final analysis. Overall, psychological distress was common among the respondents: 21% and 33% of staff reported significant depression and anxiety, respectively, while 46% experienced overwhelming stress due to COVID-19. Notably, staff members overwhelmed by the stress of COVID-19 were seven and nine times more likely to suffer from depression and anxiety, respectively. In addition to stress, individuals with six to nine years of work experience were two times more likely to report moderate or severe depression compared to those with 10 or more years of work experience. Moreover, ancillary staff with direct patient contact (odds ratio [OR] 8.9, confidence interval (CI), 1.46, 173.03) as well as administrative and ancillary staff with indirect patient contact (OR 5.9, CI, 1.06, 111.01) were more likely to be depressed than physicians and advanced providers.ConclusionWe found that a considerable proportion of staff were suffering from psychological distress. COVID-19-associated depression and anxiety was widespread among hospital staff even in settings with comparatively lower COVID-19 hospitalization rates. Ancillary staff, administrative staff, staff with less job experience, and staff overwhelmed by the stress of COVID-19 are particularly susceptible to negative mental health outcomes. These findings will help inform hospital policymakers on best practices to develop interventions to reduce the mental health burden associated with COVID-19 in vulnerable hospital staff.

Patient safety culture improves during an in situ simulation intervention: a repeated cross-sectional intervention study at two hospital sites

ObjectivesThis study aimed to investigate staff’s perceptions of patient safety culture (PSC) in two Danish hospitals before and after an in situ simulation intervention.DesignA repeated cross-sectional intervention study.SettingTwo Danish hospitals....

A cluster-control approach to a coronavirus disease 2019 (COVID-19) outbreak on a stroke ward with infection control considerations for dementia and vascular units.

We sought to contain a healthcare-associated coronavirus disease 2019 (COVID-19) outbreak, to evaluate contributory factors, and to prevent future outbreaks. Quasi-experimental cluster-control outbreak evaluation. All patients and staff on the outbreak ward (case cluster), and randomly selected patients and staff on COVID-19 wards (positive control cluster) and a non-COVID-19 wards (negative control cluster) underwent reverse-transcriptase polymerase chain reaction (RT-PCR) testing. Hand hygiene and personal protective equipment (PPE) compliance, detection of environmental SARS-COV-2 RNA, patient behavior, and SARS-CoV-2 IgG antibody prevalence were assessed. In total, 145 staff and 26 patients were exposed, resulting in 24 secondary cases. Also, 4 of 14 (29%) staff and 7 of 10 (70%) patients were asymptomatic or presymptomatic. There was no difference in mean cycle threshold between asymptomatic or presymptomatic versus symptomatic individuals. None of 32 randomly selected staff from the control wards tested positive. Environmental RNA detection levels were higher on the COVID-19 ward than on the negative control ward (OR, 19.98; 95% CI, 2.63-906.38; P < .001). RNA levels on the COVID-19 ward (where there were no outbreaks) and the outbreak ward were similar (OR, 2.38; P = .18). Mean monthly hand hygiene compliance, based on 20,146 observations (over preceding year), was lower on the outbreak ward (P < .006). Compared to both control wards, the proportion of staff with detectable antibodies was higher on the outbreak ward (OR, 3.78; 95% CI, 1.01-14.25; P = .008). Staff seroconversion was more likely during a short-term outbreak than from sustained duty on a COVID-19 ward. Environmental contamination and PPE use were similar on the outbreak and control wards. Patient noncompliance, decreased hand hygiene, and asymptomatic or presymptomatic transmission were more frequent on the outbreak ward.

Asymptomatic carriage rates and case fatality of SARS-CoV-2 infection in residents and staff in Irish nursing homes.

BackgroundSARS-CoV-2 has disproportionately affected nursing homes (NH). In Ireland, the first NH case COVID-19 occurred on 16/03/2020. A national point-prevalence testing program of all NH residents and staff took place (18/04/2020–05/05/2020).AimsTo examine characteristics of NHs across three Irish Community Health Organisations (CHOs), proportions with COVID-19 outbreaks, staff and resident infection rates symptom-profile, and resident case-fatality.MethodsForty-five NHs surveyed requesting details on occupancy, size, COVID-19 outbreak, outbreak timing, total symptomatic/asymptomatic cases, and outcomes for residents from 29/02/2020–22/05/2020.ResultsSurveys were returned from 62.2% (28/45) of NHs (2043 residents, 2,303 beds). Three-quarters (21/28) had COVID-19 outbreaks (1741 residents, 1972 beds). Median time from first COVID-19 case in Ireland to first case in these NHs was 27.0 days. Resident incidence was 43.9% (764/1741): 40.8% (710/1741) laboratory-confirmed, with 27.2% (193/710) asymptomatic, and 3.1% (54/1741) clinically-suspected. Resident case-fatality was 27.6% (211/764) for combined laboratory-confirmed/clinically-suspected COVID-19. Similar proportions of residents in NHs with “early-stage” (<28 days) versus “later-stage” outbreaks developed COVID-19. Lower proportions of residents in “early” outbreak NHs had recovered compared to those with “late” outbreaks (37.4% vs 61.7%; χ2 = 56.9, P < 0.001). Of 395 NH staff across twelve sites with confirmed COVID-19, 24.7% (99/398) were asymptomatic. There was a significant correlation between the proportion of staff with symptomatic COVID-19 and resident numbers with confirmed/suspected COVID-19 (Spearman’s rho = 0.81, P < 0.001).ConclusionThis study demonstrates the significant impact of COVID-19 on the NH sector. Systematic point-prevalence testing is necessary to reduce risk of transmission from asymptomatic carriers and manage outbreaks in this setting.

The psychological impact of COVID-19 pandemic on medical staff in Guangdong, China: a cross-sectional study.

During previous pandemic outbreaks, medical staff have reported high levels of psychological distress. The aim of the current study was to report a snapshot of the psychological impact of the coronavirus disease 2019 (COVID-19) pandemic and its correlated factors on medical staff in Guangdong, China. On the 2nd and 3rd February 2020, soon after the start of the COVID-19 pandemic, we surveyed medical staff at four hospitals in Guangdong, China, to collect demographic characteristics, Hospital Anxiety and Depression Scale (HADS), Perceived Stress Scale (PSS-14), and Insomnia Severity Index (ISI) scores. Complete responses were received from 1045 medical staff. Respondents were divided into high- and low-risk groups according to their working environment of contacting with potential or confirmed COVID-19 cases. The proportion of staff with anxiety (55.4% v. 43.0%, p < 0.001) or depression (43.6% v. 36.8%, p = 0.028) was significantly higher in the high-risk group than the low-risk group. The percentage of staff with severe anxiety was similar in the two groups. Doctors were more susceptible to moderate-to-severe depressive symptoms. The high-risk group had higher levels of clinical insomnia (13.5% v. 8.5%, p = 0.011) and were more likely to be in the upper quartile for stress symptoms (24.7% v. 19.3%, p = 0.037) than the low-risk group. Additionally, work experience negatively correlated with insomnia symptoms. It is important for hospitals and authorities to protect both the physical and psychological health of medical staff during times of pandemic, even those with a low exposure risk.

Swedish national survey on MR safety compared with CT: a false sense of security?

ObjectivesThe objectives were to survey MR safety incidents in Sweden during a 12-month period, to assess severity scores, and to evaluate the confidence of MR personnel in incident-reporting mechanisms.MethodData were collected within a web-based questionnaire on safety in clinical MR environments with CT for comparison. Data reported MR and CT safety incidents (human injury, material damage, and close calls), incident severity, and confidence of participants in incident-reporting systems.ResultsThe study population consisted of 529 eligible participants. Participants reported 200 MR and 156 CT safety incidents. Among MR incidents, 16% were given the highest potential severity score. More MR workers (73%) than CT workers (50%) were confident in being aware of any incident occurring at their workplace. However, 69% MR workers (83% for CT) were not aware of reported incidents at their hospitals.ConclusionSafety incidents resulting in human injury, material damage, and close calls in clinical MR environments do occur. According to national risk assessment recommendations, risk level is high. Results indicated that MR personnel tend to a false sense of security, as a high proportion of staff members were sure that they would have been aware of any incident occurring in their own department, while in reality, incidents did occur without their knowledge. We conclude that false sense of security exists for MR.Key Points• Safety incidents in clinical MR environments still result in human injury and material damage.• Severity level of MR incidents—assessed using Swedish national risk assessment recommendations—is high.• Confidence of MR personnel in incident-reporting mechanisms is high, but reflects a false sense of security, as a high proportion of staff is unaware of reported incidents in the same workplace.

Development of Emotional Well-Being indicators to advance the quality of spinal cord injury rehabilitation: SCI-High Project

Context: Emotional Well-Being (EWB) post-spinal cord injury or disease (SCI/D) is a critical aspect of adjustment to disability. Advancing care and assuring equity in care delivery within this rehabilitation care domain is essential. Herein, we describe the selection of EWB structure, process and outcome indicators for adults with SCI/D in the first 18 months after rehabilitation admission.Methods: A pan-Canadian Working Group completed the following tasks: (1) defined the EWB construct; (2) conducted a systematic review of available outcomes and their psychometric properties; (3) constructed a Driver diagram summarizing available evidence associated with EWB; and, (4) prepared a process map. Facilitated meetings allowed selection and review of feedback following rapid-cycle evaluations of proposed structure, process and outcome indicators.Results: The structure indicator is the proportion of staff with appropriate education and training in EWB and access to experts and resources. The process indicator is the proportion of SCI/D patients who were screened for depression and anxiety symptoms at rehabilitation admission and rehabilitation discharge. The intermediary outcome is the proportion of SCI/D patients at risk for depression or anxiety at rehabilitation discharge based on screening symptom scores. The final outcomes are: (a) proportion of individuals at risk for depression or anxiety based on screening symptom scores; and (b) proportion of individuals who received referral for EWB services or intervention.Conclusion: The proposed indicators have a low administrative burden and will ensure feasibility of screening for depression and anxiety at important transition points for individuals with SCI/D. We anticipate that the current structures have inadequate resources for at-risk individuals identified during the screening process.

Impact of a peer-review network on the quality of inpatient low secure mental health services: cluster randomised control trial

BackgroundPeer-review networks aim to help services to improve the quality of care they provide, however, there is very little evidence about their impact. We conducted a cluster randomized controlled trial of a peer-review quality network for low-secure mental health services to examine the impact of network membership on the process and outcomes of care over a 12 month period.MethodsThirty-eight low secure units were randomly allocated to either the active intervention (participation in the network n = 18) or the control arm (delayed participation in the network n = 20). A total of 75 wards were assessed at baseline and 8 wards dropped out the study before the data collection at 12 month follow up. The primary outcome measure was the quality of the physical environment and facilities of the services. The secondary outcomes included: safety of the ward, patient mental wellbeing and satisfaction with care, staff burnout, training and supervision. We hypothesised that, relative to control wards, the quality of the physical environment and facilities would be higher on wards in the active arm of the trial 12 months after randomization.ResultsThe difference in the primary outcome between the groups was not statistically significant (4.1; 95% CI [− 0.2, 8.3] p = 0.06). The median number of untoward incidents rose in control services and remained the same at the member of the network (Difference between members and non-members = 0.55; 95% IC [0.29, 1.07] p = 0.08). At follow up, a higher proportion of staff in the active arm of the trial indicated that they felt safe on the ward relative to those in the control services (p = 0.04), despite reporting more physical assaults (p = 0.04). Staff working in services in the active arm of the trial reported higher levels of burnout relative to those in the control group. No difference was seen in patient outcomes.ConclusionsWe did not find evidence that participation in a peer-review network led to marked changes in the quality of the physical environment of low secure mental health services at 12 months. Future research should explore the impact of accreditation schemes and examine longer term outcomes of participation in such networks.Trial registrationISRCTN79614916. Retrospectively registered 28 March 2014.

Testing interventions to improve response to a National Health Service Staff Survey.

The National Health Service Staff Survey is an annual, England-wide survey of staff employed by National Health Service organisations. It is administered using online and paper questionnaires. Response rates have fallen over time, while the proportion of staff receiving the online version – which historically has a lower response rate – has increased. Three interventions to increase online response were tested using an experimental design: more reminders; change of signatory to the invitation to participate and concise messaging in the invitation. Thirteen thousand staff members in five National Health Service trusts received the online survey. Results were analysed using contingency tables and logistic regression to determine the effect of interventions independently and in combination. More reminders improved response by six percentage points (odds ratio 1.33, 95% CI 1.23–1.43) and concise messaging by two percentage points (odds ratio 1.08, 95% CI 1.00–1.17). Change of signatory had no statistically significant effect and neither did any combination of the interventions. Given that costs for the successful interventions were minimal, more reminders in combination with concise messaging are recommended as a strategy to improve online response to the survey.

Care pathway and organisational features driving patient experience: statistical analysis of large NHS datasets

ObjectiveThe aim of this study was to identify the care pathway and organisational factors that predict patient experience.DesignStatistical analysis of large National Health Service (NHS) datasets.Setting andparticipantsEngland; acute NHS organisational-level...