Unlocking Solutions in Imaging: working together to learn from failings in the NHS [Report]

Parliamentary and Health Service Ombudsman | July 2021 | Unlocking Solutions in Imaging: working together to learn from failings in the NHS

This report highlights recurrent failings in the way X-rays and scans are reported on and followed up across NHS services.

This report shares findings from complaints made to the Parliamentary and Health Service Ombudsman (PHSO) about failings in imaging in the NHS. The majority of these complaints involve people who had cancer at the time they used imaging services.

In highlighting the learning from these complaints, PHSO’s objective is to support NHS services to improve. Doing this will require significant collaboration between NHS leaders in radiology services and those who work in other clinical specialties that request and act on the findings of X-ray, CT and MRI scans. This includes GPs, physicians, surgeons, physiotherapists, paediatricians and clinicians working in emergency departments.

It recommends a system-wide programme of improvements for more effective and timely management of X-rays and scan (Source: Ombudsman).

Image source: ombudsman.org.uk

Unlocking Solutions in Imaging: working together to learn from failings in the NHS

The power of the patient voice – free eBook

NEJM | nd |The power of the patient voice

This book is free (with registration or logging into your NEJM account), it will outline how to empower your own patients so they can take greater responsibility and be more accountable for their own care. We couple data from NEJM Catalyst Insights Council surveys with candid advice gleaned from one-on-one interviews with Insights Council members to deliver best practices for use in your own organization.

In this eBook, health care executives, clinical leaders, and clinicians share their experiences and ideas for elevating the patient voice by:

•Learning how to hear patients during critical discussions.

•Adapting health care access and delivery to align with patient needs.

•Ensuring a patient’s social determinants of health and values are understood throughout the continuum of care.

•Moving away from fee-for-service models that hamper a provider’s ability to spend more time with patients.

•Updating medical school training to include the importance of patient empowerment.

Further details are available from the NEJM

Quality improvement in general practice: what do GPs and practice managers think? Results from a nationally representative survey of UK GPs and practice managers

Gosling, J. et al | 2021| Quality improvement in general practice: what do GPs and practice managers think? Results from a nationally representative survey of UK GPs and practice managers| BMJ Open Quality | 10 | e001309| doi: 10.1136/bmjoq-2020-001309

Abstract

Background 

This paper presents the results of the first UK-wide survey of National Health Service (NHS) general practitioners (GPs) and practice managers (PMs) designed to explore the service improvement activities being undertaken in practices, and the factors that facilitated or obstructed that work. The research was prompted by growing policy and professional interest in the quality of general practice and its improvement. The analysis compares GP and PM involvement in, and experience of, quality improvement activities.

Methods 

This was a mixed-method study comprising 26 semistructured interviews, a focus group and two surveys. The qualitative data supported the design of the surveys, which were sent to all 46 238 GPs on the Royal College of General Practitioners (RCGP) database and the PM at every practice across the UK (n=9153) in July 2017.

Results

 Responses from 2377 GPs and 1424 PMs were received and were broadly representative of each group. Ninety-nine per cent reported having planned or undertaken improvement activities in the previous 12 months. The most frequent related to prescribing and access. Key facilitators of improvement included ‘good clinical leadership’. The two main barriers were ‘too many demands from external stakeholders’ and a lack of protected time. Audit and significant event audit were the most common improvement tools used, but respondents were interested in training on other quality improvement tools.

Conclusion 

GPs and PMs are interested in improving service quality. As such, the new quality improvement domain in the Quality and Outcomes Framework used in the payment of practices is likely to be relatively easily accepted by GPs in England. However, if improving quality is to become routine work for practices, it will be important for the NHS in the four UK countries to work with practices to mitigate some of the barriers that they face, in particular the lack of protected time.

The full paper is available from BMJ Open Quality 

Linking Quality, Safety, and Wellness Through Health Care Debriefing

Institute for Healthcare Improvement | July 2021 | Linking Quality, Safety, and Wellness Through Health Care Debriefing

This post from the Institute for Healthcare Improvement’s blog outlines how safety healthcare debriefing can link quality, safety and wellness.

Debriefings are most commonly conducted to analyze events and maximize quality improvement, patient safety, and overall culture of safety. For example, Rose and Rose (2018) implemented a novel process for utilizing debriefing checklists to improve value in surgical care that resulted in debrief-driven improvements such as reduced proportion of surgical cases with reported defects, significant reduction in the 30-day unadjusted surgical mortality, lowered costs, and better workforce safety climate. Debriefings after in-situ simulations done in the real clinical environment — as opposed to a simulation center — have been utilized to identify knowledge gaps, reinforce teamwork behaviors, and identify previously unreported safety threats, such as malfunctioning equipment and knowledge gaps concerning role responsibilities among health care workers.

Blog post from the Institute for Healthcare Improvement

How to sustainably build capacity in quality improvement within a healthcare organisation: a deep-dive, focused qualitative analysis

Hibbert, P.D.et al. | 2021|  How to sustainably build capacity in quality improvement within a healthcare organisation: a deep-dive, focused qualitative analysis| BMC Health Serv Res| 21 |  588 |https://doi.org/10.1186/s12913-021-06598-8

This study reveals interacting components that were deemed necessary for a successful QI program. These include an active involvement of leadership and management, a skilled faculty to assist teams, an agreed and robust QI system, and an understanding that teams matter. In addition there is a time commitment for staff to undertake projects was significant which can impact on maintaining momentum.

Abstract

Background

A key characteristic of healthcare systems that deliver high quality and cost performance in a sustainable way is a systematic approach to capacity and capability building for quality improvement. The aim of this research was to explore the factors that lead to successful implementation of a program of quality improvement projects and a capacity and capability building program that facilitates or support these.

Methods

Between July 2018 and February 2020, the Southern Adelaide Local Health Network (SALHN), a network of health services in Adelaide, South Australia, conducted three capability-oriented capacity building programs that incorporated 82 longstanding individual quality improvement projects. Qualitative analysis of data collected from interviews of 19 project participants and four SALHN Improvement Faculty members and ethnographic observations of seven project team meetings were conducted.

Results

We found four interacting components that lead to successful implementation of quality improvement projects and the overall program that facilitates or support these: an agreed and robust quality improvement methodology, a skilled faculty to assist improvement teams, active involvement of leadership and management, and a deep understanding that teams matter. A strong safety culture is not necessarily a pre-requisite for quality improvement gains to be made; indeed, undertaking quality improvement activities can contribute to an improved safety culture. For most project participants in the program, the time commitment for projects was significant and, at times, maintaining momentum was a challenge.

Conclusions

Healthcare systems that wish to deliver high quality and cost performance in a sustainable way should consider embedding the four identified components into their quality improvement capacity and capability building strategy.

How to sustainably build capacity in quality improvement within a healthcare organisation: a deep-dive, focused qualitative analysis