A journey to improved staff engagement – in our shoes

NHS Employers, August 2017

Imperial-college

Source: NHS Employers

 

This case study looks at how Imperial College Healthcare NHS Trust has significantly improved their staff engagement levels using new and innovative methods. Through engaging with staff to understand more about how they are feeling at work, engagement levels have improved from the 2015 score of 3.71 to 3.8 in 2016, which was the largest year-on-year increase of all acute trusts in London.

 

 

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CHOICE: Choosing Health Options In Chronic Care Emergencies

Guthrie E, Afzal C, Blakeley C, Blakemore A, Byford R, Camacho E, et al. CHOICE: Choosing Health Options In Chronic Care Emergencies. Programme Grants Appl Res 2017;5(13)

Over 70% of the health-care budget in England is spent on the care of people with long-term conditions (LTCs), and a major cost component is unscheduled health care. Psychological morbidity is high in people with LTCs and is associated with a range of adverse outcomes, including increased mortality, poorer physical health outcomes, increased health costs and service utilisation.

Objectives
The aim of this programme of research was to examine the relationship between psychological morbidity and use of unscheduled care in people with LTCs, and to develop a psychosocial intervention that would have the potential to reduce unscheduled care use. We focused largely on emergency hospital admissions (EHAs) and attendances at emergency departments (EDs).

Design
A three-phase mixed-methods study. Research methods included systematic reviews; a longitudinal prospective cohort study in primary care to identify people with LTCs at risk of EHA or ED admission; a replication study in primary care using routinely collected data; an exploratory and feasibility cluster randomised controlled trial in primary care; and qualitative studies to identify personal reasons for the use of unscheduled care and factors in routine consultations in primary care that may influence health-care use. People with lived experience of LTCs worked closely with the research team.

Setting
Primary care. Manchester and London.

Participants
People aged ≥ 18 years with at least one of four common LTCs: asthma, coronary heart disease, chronic obstructive pulmonary disease (COPD) and diabetes. Participants also included health-care staff.

Results
Evidence synthesis suggested that depression, but not anxiety, is a predictor of use of unscheduled care in patients with LTCs, and low-intensity complex interventions reduce unscheduled care use in people with asthma and COPD. The results of the prospective study were that depression, not having a partner and life stressors, in addition to prior use of unscheduled care, severity of illness and multimorbidity, were independent predictors of EHA and ED admission. Approximately half of the cost of health care for people with LTCs was accounted for by use of unscheduled care. The results of the replication study, carried out in London, broadly supported our findings for risk of ED attendances, but not EHAs. This was most likely due to low rates of detection of depression in general practitioner (GP) data sets. Qualitative work showed that patients were reluctant to use unscheduled care, deciding to do so when they perceived a serious and urgent need for care, and following previous experience that unscheduled care had successfully and unquestioningly met similar needs in the past. In general, emergency and primary care doctors did not regard unscheduled care as problematic. We found there are missed opportunities to identify and discuss psychosocial issues during routine consultations in primary care due to the ‘overmechanisation’ of routine health-care reviews. The feasibility trial examined two levels of an intervention for people with COPD: we tried to improve the way in which practices manage patients with COPD and developed a targeted psychosocial treatment for patients at risk of using unscheduled care. The former had low acceptability, whereas the latter had high acceptability. Exploratory health economic analyses suggested that the practice-level intervention would be unlikely to be cost-effective, limiting the value of detailed health economic modelling.

Limitations
The findings of this programme may not apply to all people with LTCs. It was conducted in an area of high social deprivation, which may limit the generalisability to more affluent areas. The response rate to the prospective longitudinal study was low. The feasibility trial focused solely on people with COPD.

Conclusions
Prior use of unscheduled care is the most powerful predictor of unscheduled care use in people with LTCs. However, psychosocial factors, particularly depression, are important additional predictors of use of unscheduled care in patients with LTCs, independent of severity and multimorbidity. Patients and health-care practitioners are unaware that psychosocial factors influence health-care use, and such factors are rarely acknowledged or addressed in consultations or discussions about use of unscheduled care. A targeted patient intervention for people with LTCs and comorbid depression has shown high levels of acceptability when delivered in a primary care context. An intervention at the level of the GP practice showed little evidence of acceptability or cost-effectiveness.

Future work
The potential benefits of case-finding for depression in patients with LTCs in primary care need to be evaluated, in addition to further evaluation of the targeted patient intervention.

Improving new starter turnover: case study

NHS Employers

East-Kent-Starter-Turnover

Source: NHS Employers

This case study outlines how East Kent Hospitals University NHS Foundation Trust worked to improve experiences of staff in their first year of employment at the trust. The trust improved the overall on-boarding experience including starting induction before day one in the role and introducing an online portal for new starters, along with the benefits and the challenges of doing so. This work has resulted in an improvement in new starter turnover of nearly 20 per cent.

 

Encouraging speaking up through trust wide engagement

NHS Employers

York-Speaking-up

Source: NHS Employers

This shared learning example describes how Lisa Smith, Freedom to Speak Up guardian in York Teaching Hospital NHS Foundation Trust has engaged with multiple sites to help foster a positive, safe culture of speaking up.

With one of the largest NHS geographies in the UK, find out more about the methods being used by Lisa at York to promote awareness of raising concerns, including attending flu clinics to reach out to as many staff as possible.

Improving the working environment for safe surgical care

Royal College of Surgeons of Edinburgh (RCSEd), 2017

 

working-environment-cover

Source: Royal College of Surgeons of Edinburgh

The Royal College of Surgeons of Edinburgh (RCSEd) has published a number of critical recommendations to government to greatly improve safety in the delivery of surgical treatment and patient care, with seven recommendations for best practice.

The RCSEd surveyed opinions from a cross-section of the UK surgical workforce – from trainees to consultants – which highlighted broad inefficiencies on the frontline which impact the working environment and the delivery of a safe service.

The report notes factors adversely affecting morale, including a lack of team structure, poor communication, high stress levels, and limited training opportunities. The report also records how staff, at times, feel diverted away from the patient-centred care they strive to deliver because of administrative and IT issues, and believe that being more innovative and efficient with existing resources could make a positive difference.

And while there is no doubt the NHS needs more funding, the report indicates improvements can be made by changing how funding is allocated.