Effectiveness of customised safety intervention programmes to increase the safety culture of hospital staff

Wong, S. Y., Allan Chak, L. F., Han, J., Lin, J., & Mun, C. L. | 202| Effectiveness of customised safety intervention programmes to increase the safety culture of hospital staff| BMJ Open Quality| 10 | 4 | doi:http://dx.doi.org/10.1136/bmjoq-2020-000962

This 4-year longitudinal prospective study used review and audits to evaluate changes in safety culture after implementing safety interventions from 2014 to 2018 in a regional rehabilitation hospital with approximately 230 staff members and 300 beds.  This study assessed the impact of interventions on four staff-related themes:

• leadership commitment
• promotion of a culture of trust, reporting and learning
• teamwork and communication establishment
• creation of a supportive organisational environment for safety culture for all working staff. It was hypothesised that customised multifaceted interventions and safety surveys would enhance and consolidate safety culture.

Abstract

The aim of this study was to investigate the effectiveness of customised safety interventions in improving the safety cultures of both clinical and non-clinical hospital staff. This was assessed using the Safety Attitude Questionnaire-Chinese at baseline, 2 years and 4 years after the implementation of safety interventions with a high response rate ranging from 80.5 per cent to 87.2 per cent and excellent internal consistency (Cronbach’s alpha equal to 0.93). The baseline survey revealed a relatively low positive attitude response in the Safety Climate (SC) domain. Both SC and Working Conditions (WC) domains were shown to have increased positive attitude responses in the second survey, while only the Management Perception domain had gained 3.8 per cent in the last survey. In addition, safety dimensions related to collaboration with doctors and service delays due to communication breakdown were significantly improved after customised intervention was applied. Safety dimensions related to safety training, reporting and safety awareness had a high positive response in the initial survey; however, the effect was difficult to sustain subsequently. Multilevel analysis further illustrated that non-clinical staff were shown to have a more positive attitude than clinical staff, while female staff had a higher positive attitude percentage in job satisfaction than male staff. The results showed some improvements in various safety domains and dimensions, but also revealed inconsistent changes in subsequent surveys. The change in positive safety culture over the years and its sustainability need to be further explored. It is suggested that hospital management should continuously monitor and evaluate their strategies while delivering multifaceted interventions to be more specifically focused and to motivate staff to be enthusiastic in sustaining patient safety culture.

Effectiveness of customised safety intervention programmes to increase the safety culture of hospital staff [paper]

QI Project: Asking patients what is important to them

Kent Community Health | n.d | Asking patients what is important to them

A quality improvement (QI) project, led by allied health professional Martyne May, Adult Speech and Language Therapy Quality Lead, aimed to improve how patients moved through the system at Kent Community Health NHS Foundation Trust (KCHFT). The project was guided by patients: asking participants what is important to them.

As part of a series of interviews and consultation with patients with language difficulties, staff provided an explanation of how the service worked and was funded. The issues facing the service at KCHFT were discussed, as well as some ideas for change that had been gathered from clinicians and administration colleagues. Everyone’s ideas were used to see how things could be done better.

Prior to the project the team prioritised referrals as high, medium or low risk, based on information gained from referral documents. They would be placed on a waiting list and seen in chronological order.  The patients could be seen by any member of the team, who would work with them until they were ready to be discharged.

In response to participants’ feedback and suggestions, the new process saw all patients receive an initial, one-off appointment where their needs could be fully assessed by a clinician, they could receive immediate advice and support and they were then added to a treatment waiting list, based on clinical needs.  For some patients, this was not appropriate and separate pathways were developed. These included those who needed rapid access, such as patients with motor neurone disease.

The pilot ran from October 2019 to February 2020. A rollout of the changes was delayed by the COVID-19 pandemic, but the new way of working was introduced across the service at the end of 2020.

The project has resulted in:

• reducing all waiting times to under 18 weeks
• reduced waiting list numbers
• clearer patient pathways through the service.

Adapted from the blog post from Kent Community Health

See also: The reducing waiting times and engaging service users project on a page

Increasing the number of patients seen project on a page

Full details are available from Kent Community Health

NIHR: Advice in the post is an effective intervention to prevent falls fractures

NHIR | September 2021 | Advice by mail is as effective as targeted interventions at preventing fall-related injuries in older people

This NIHR Alert provides a summary of a three-armed RCT which assessed the clinical effectiveness and cost-effectiveness of a brief falls-risk screening questionnaire, sent by mail, followed by an exercise program or a multifactorial intervention targeted to persons at increased risk for falls, as compared with no screening in community-dwelling older people. All participants received advice by mail.

The trial’s findings are consistent with the broader evidence base, including a recent trial of multifactorial fall prevention in women

When applied in pragmatic settings, screening by mail followed by a targeted exercise intervention or multifactorial approach for prevention of falls did not result in a lower rate of fractures than advice by mail alone.

NIHR Advice by mail is as effective as targeted interventions at preventing fall-related injuries in older people

Background

Community screening and therapeutic prevention strategies may reduce the incidence of falls in older people. The effects of these measures on the incidence of fractures, the use of health resources, and health-related quality of life are unknown.

Methods

In a pragmatic, three-group, cluster-randomized, controlled trial, we estimated the effect of advice sent by mail, risk screening for falls, and targeted interventions (multifactorial fall prevention or exercise for people at increased risk for falls) as compared with advice by mail only. The primary outcome was the rate of fractures per 100 person-years over 18 months. Secondary outcomes were falls, health-related quality of life, frailty, and a parallel economic evaluation.

Results

We randomly selected 9803 persons 70 years of age or older from 63 general practices across England: 3223 were assigned to advice by mail alone, 3279 to falls-risk screening and targeted exercise in addition to advice by mail, and 3301 to falls-risk screening and targeted multifactorial fall prevention in addition to advice by mail. A falls-risk screening questionnaire was sent to persons assigned to the exercise and multifactorial fall-prevention groups. Completed screening questionnaires were returned by 2925 of the 3279 participants (89 per cent) in the exercise group and by 2854 of the 3301 participants (87 per cent) in the multifactorial fall-prevention group. Of the 5779 participants from both these groups who returned questionnaires, 2153 (37 per cent) were considered to be at increased risk for falls and were invited to receive the intervention. Fracture data were available for 9802 of the 9803 participants. Screening and targeted intervention did not result in lower fracture rates; the rate ratio for fracture with exercise as compared with advice by mail was 1.20 (95 per cent confidence interval [CI], 0.91 to 1.59), and the rate ratio with multifactorial fall prevention as compared with advice by mail was 1.30 (95 per cent CI, 0.99 to 1.71). The exercise strategy was associated with small gains in health-related quality of life and the lowest overall costs. There were three adverse events (one episode of angina, one fall during a multifactorial fall-prevention assessment, and one hip fracture) during the trial period.

Conclusions

Advice by mail, screening for fall risk, and a targeted exercise or multifactorial intervention to prevent falls did not result in fewer fractures than advice by mail alone. (Funded by the National Institute of Health Research; ISRCTN number, ISRCTN71002650.)

The paper- Screening and Intervention to Prevent Falls and Fractures in Older People- has now been published in the NEJM

Trust-wide improvement: Board bites

NHS Providers | September 2021 | Trust-wide improvement: Board bites

How do boards support this evolution? This is the over-arching question considered in the first of three of their first virtual webinar sessions NHS Providers, supported by The Health Foundation as part of their trust-wide improvement programme, delved into what it really means to have a systematic approach to improvement and what learning we can draw from the experiences of COVID-19. The Health Foundation purposefully explored diverse experiences of organisation-wide improvement, with differing investment levels, and type and rigour of method used. The accompanying briefing highlights what’s worked so far

Trust-wide improvement [briefing]

Trust-wide improvement: Board bites [news release]

Click to access qi-board-bites-1d.pdf

Patients shouldn’t wait: Enhancing patient access to a virtual fracture clinic with process improvement

NHS Providers | September 2021 | Patients shouldn’t wait: Enhancing patient access with process improvement

This blog post describes how Dr Murali Bhat, a senior orthopedic surgeon at the virtual fracture clinic at Surrey and Sussex Healthcare NHS Trust (SaSH), made a crucial discovery: more than half of the clinic’s ED referrals didn’t actually require an in-person follow-up; and how Dr Bhat transformed this using  strategies like standardisation and daily management to make these improvements

To this end So Dr Bhat and his team devised a way to screen ED referrals ahead of time and send injury-specific standardised care plans in place of an in-person office visit. The new process had immediate impact:

• 61 per cent of all ED referrals were identified as low-risk and required no in-person follow-up, freeing up appointment capacity for patients who required more in-depth care.
• All patients are contacted within 72 hours after leaving the ED, either with a remote care plan or information about an appointment at the clinic. Tests and other recommendations for patients coming to the clinic are outlined in advance so that patients know what to expect and staff can plan for and treat them efficiently.
• Follow-up patients needing an operation are now seen within one to three days of being referred, rather than one to four weeks.
• The clinic became so efficient that primary care providers are now able to send urgent referrals through the emergency channel, rather than adding them to the elective backlog as they did before.

Patients shouldn’t wait enhancing patient access with process improvement [blog post]

Interventions targeted at reducing diagnostic error: systematic review

Dave, N.,et al | Interventions targeted at reducing diagnostic error: systematic review |BMJ Quality & Safety|  Published Online First: 18 August 2021. doi: 10.1136/bmjqs-2020-012704

This review set out to update and add to the an earlier review, in addition the reviewers also sought to:

• Describe the types of published interventions for reducing diagnostic error that have been evaluated in terms of a patient outcome since 2012.
• Assess the risk of bias in the included interventions and perform a sensitivity analysis of the findings.
• Determine the effectiveness of included interventions with respect to their intervention type.

Abstract

Background

 Incorrect, delayed and missed diagnoses can contribute to significant adverse health outcomes. Intervention options have proliferated in recent years necessitating an update to McDonald et al’s 2013 systematic review of interventions to reduce diagnostic error.

Objectives 

(1) To describe the types of published interventions for reducing diagnostic error that have been evaluated in terms of an objective patient outcome; (2) to assess the risk of bias in the included interventions and perform a sensitivity analysis of the findings; and (3) to determine the effectiveness of included interventions with respect to their intervention type.

Methods 

MEDLINE, CINAHL and the Cochrane Database of Systematic Reviews were searched from 1 January 2012 to 31 December 2019. Publications were included if they delivered patient-related outcomes relating to diagnostic accuracy, management outcomes and/or morbidity and mortality. The interventions in each included study were categorised and analysed using the six intervention types described by McDonald et al (technique, technology-based system interventions, educational interventions, personnel changes, structured process changes and additional review methods).

Results 

Twenty studies met the inclusion criteria. Eighteen of the 20 included studies (including three randomised controlled trials (RCTs)) demonstrated improvements in objective patient outcomes following the intervention. These three RCTs individually evaluated a technique-based intervention, a technology-based system intervention and a structured process change. The inclusion or exclusion of two higher risk of bias studies did not affect the results.

Conclusion

 Technique-based interventions, technology-based system interventions and structured process changes have been the most studied interventions over the time period of this review and hence are seen to be effective in reducing diagnostic error. However, more high-quality RCTs are required, particularly evaluating educational interventions and personnel changes, to demonstrate the value of these interventions in diverse settings.

Full paper available from the BMJ