Research reveals ‘long way to go’ to close digital skills gap

Digital Health | October 2021 | Research reveals ‘long way to go’ to close digital skills gap

A research project, led by researchers at Coventry University, set out to examine the importance of technological change to combat the challenges facing the healthcare sector. The project took a qualitative approach and utilised interviews with healthcare staff to identify specific gaps in knowledge. In conjunction with this, they undertook a literature search to enable this discovery and idetnfication. They found a lack of sufficient skills and knowledge in leading digital transformation in the NHS; adapting to state-of-the-art technologies; data analytics; and educating others.

Workers lack basic skills

Poor digital skills were revealed across all levels, from frontline healthcare workers and senior management through to support officers working at the back end to analyse collected data.

Many interviewees felt that there is a large number of NHS workers who do not possess basic digital skills. As one person interviewed revealed: “We’re trying to put in digital systems. I think a lot of people work on the assumption that everybody can actually use a computer with competence, and that’s certainly not the case.”

Resisting change still an issue

One of the challenges related to the continuing skills gap was identified as a resistance to adopting digital health technology.

“Generally, the resistance has already led to delays in adopting up-to-date technologies and substantially made the process more costly and less efficient,” the report states.

To address this skills gap and to upskill workers, the researchers recommend the following:

 the research made recommendations for five training programmes to boost NHS workers’ digital skills:

1. Training for senior managers to deliver a level of understanding on the importance and urgency of digital transformation with enough information so that they can make strategic decisions to support this.
2. Training for front-line health practitioners to boost confidence, familiarity and skills with digital technologies.
3. Training to combat security concerns and deliver a basic knowledge of data analysis.
4. Training on communication skills to address concerns surrounding communication efficiency between front-line and back-end staff.
5. Training focused on improving data analytical skills within healthcare.

Source: Digital Health

Research reveals ‘long way to go’ to close digital skills gap

A hospital-based mixed-methods observational study to evaluate a hip and knee replacement quality improvement project

Wainwright, T. & McDonald, D. | 2021 | A hospital-based mixed-methods observational study to evaluate a hip and knee replacement quality improvement project | The TQM Journal | Vol. 33| No. 7 | DOI 10.1108/TQM-12-2020-0301

A a review of the current enhanced recovery after surgery (ERAS) pathway was undertaken at the Golden Jubilee National Hospital (GJNH), in Glasgow, Scotland, a recognised national centre for hip and knee replacement within Scotland. This came in response to ongoing national improvement work driving hospital boards across Scotland to improve, the outcomes at the GJNH became average when benchmarked nationally. This review would help ascertain where further improvements could be made that would improve clinical outcomes and maximise capacity.

Abstract

Purpose – Health services continue to face economic and capacity challenges. Quality improvement (QI) methods
that can improve clinical care processes are therefore needed. However, the successful use of current QI methods
within hospital settings remains a challenge. There is considerable scope for improvement of elective clinical
pathways, such as hip and knee replacement, and so the use and study of QI methods in such settings is warranted.

Design/methodology/approach – A model to manage variability was adapted for use as a QI method and
deployed to improve a hip and knee replacement surgical pathway. A prospective observational study, with a
mixed-methods sequential explanatory design (quantitative emphasised) that consisted of two distinct phases,
was used to assess its effectiveness.

Findings – Following the use of the novel QI method and the subsequent changes to care processes, the length
of hospital stay was reduced by 18 per cent. However, the interventions to improve care process highlighted by the QI
method were not fully implemented. The qualitative data revealed that staff thought the new QI method (the
model to manage variability) was simple, effective, offered advantages over other QI methods and had
highlighted the correct changes to make. However, they felt that contextual factors around leadership, staffing
and organisational issues had prevented changes being implemented and a greater improvement being made.

Originality/value – The quality of QI reporting in surgery has previously been highlighted as poor and
lacking in prospective and comprehensively reported mixed-methods evaluations. This study therefore not
only describes and presents the results of using a novel QI method but also provides new insights in regard to
important contextual factors that may influence the success of QI methods and efforts.

A hospital-based mixed-methods observational study to evaluate a hip and knee replacement quality improvement project [paper]

Listening to the Patient Voice and Learning from the Patient Experience

Perfetto, E.M. & Pomerantz, P. | 2021| Listening to the Patient Voice and Learning from the Patient Experience|  ASA Monitor|  85:27–29 | doi: https://doi.org/10.1097/01.ASM.0000795168.75245.f6

The objective of this paper is to provide a high-level overview of what patient-centricity means and the value that listening to the patient voice can have for health care providers and researchers. The authors also provide some examples and suggestions on how a patient-centered approach can optimize the future of care and research in anesthesiology.

Illustration shows patient at the centre of a circle, 7 healthcare staff encircle the patient

Image source: pubs.asahq.org

Listening to the Patient Voice and Learning from the Patient Experience [paper]

Fidelity and the impact of patient safety huddles on teamwork and safety culture: an evaluation of the Huddle Up for Safer Healthcare (HUSH) project

Lamming, L.et al | 2021| Fidelity and the impact of patient safety huddles on teamwork and safety culture: an evaluation of the Huddle Up for Safer Healthcare (HUSH) project| BMC Health Serv Res | 21 | 1038| https://doi.org/10.1186/s12913-021-07080-1

Recent attempts to reduce avoidable harms in hospitals include Patient Safety Huddles (PSHs): brief, daily, multidisciplinary meetings that allow teams to convene, review and ensure safe care.

Coproduced by the HUSH implementation team, the operational definition of a PSH is as follows:

1. 1.Takes place at the same venue and time every day
2. 2.Is led by the most senior clinician
3. 3.Includes a review of the number of days since the last harm
4. 4.Includes a review of an improvement run chart
5. 5.Includes a de-brief of any harms since the last huddle
6. 6.Includes discussion of who is at risk today and what needs to be put in place
7. 7.Participants are asked if anyone has any other concerns
8. 8.Is short and sweet (less than or equal to 0–15 min)
9. 9.Is a non-judgemental and fear-free space.

This paper discusses how the HUSH project followed on from a successful huddle implementation pilot of eight wards at Leeds NHS Trust; and how the HUSH implementation team set out to scale up PSHs in 136 inpatient wards in three Yorkshire and Humberside NHS Trust.

The authors report that patient safety huddles are a feasible intervention to improve teamwork and safety culture in hospitals, especially among nurses. The most consistent changes were seen in perceptions that briefings were common, the culture made it easy to learn from others’ errors, and the overall safety grade of the ward. However, the latter was not reflected in changes across other measurement items, questioning the factors that influence this decision. The defining criteria of PSH may need changing to those deemed most useful by staff – an important influence on outcomes – for different staff groups. The research team believe that this a major point of their paper, that fidelity criteria may change subject to revision based on experience and evidence (Source: Lamming et al, 2021).

Abstract

Background

The Patient Safety Huddle (PSH) is a brief multidisciplinary daily meeting held to discuss threats to patient safety and actions to mitigate risk. Despite growing interest and application of huddles as a mechanism for improving safety, evidence of their impact remains limited. There is also variation in how huddles are conceived and implemented with insufficient focus on their fidelity (the extent to which delivered as planned) and potential ways in which they might influence outcomes. The Huddle Up for Safer Healthcare (HUSH) project attempted to scale up the implementation of patient safety huddles (PSHs) in five hospitals – 92 wards – across three UK NHS Trusts. This paper aims to assess their fidelity, time to embed, and impact on teamwork and safety culture.

Methods

A multi-method Developmental Evaluation was conducted. The Stages of Implementation Checklist (SIC) was used to determine time taken to embed PSHs. Observations were used to check embedded status and fidelity of PSH. A Teamwork and Safety Climate survey (TSC) was administered at two time-points: pre- and post-embedding. Changes in TSC scores were calculated for Trusts, job role and clinical speciality.

Results

Observations confirmed PSHs were embedded in 64 wards. Mean fidelity score was 4.9/9. PSHs frequently demonstrated a ‘fear free’ space while Statistical Process Control charts and historical harms were routinely omitted. Analysis showed a positive change for the majority (26/27) of TSC questions and the overall safety grade of the ward.

Conclusions

PSHs are feasible and effective for improving teamwork and safety culture, especially for nurses. PSH fidelity criteria may need adjusting to include factors deemed most useful by frontline staff. Future work should examine inter-disciplinary and role-based differences in TSC outcomes.

Fidelity and the impact of patient safety huddles on teamwork and safety culture: an evaluation of the Huddle Up for Safer Healthcare (HUSH) project

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Urgent changes needed to global guidelines designed to stop surgical infection

NIHR Global Research Health Unit on Global Surgery | 2021 | Reducing surgical site infections in low-income and middle-income countries (FALCON): a pragmatic, multicentre, stratified, randomised controlled trial |The Lancet | DOI:https://doi.org/10.1016/S0140-6736(21)01548-8

NIHR’s Global Research Health Unit on Global Surgery undertook a large-scale, pragmatic, multicountry, randomised trial to evaluate the effectiveness of these interventions in LMICs. They aimed to establish generalisable, high-quality evidence to inform future global clinical guidelines that are relevant across resource-limited settings.

In this patient and outcome-assessor masked, international, multicentre randomised trial, 5788 patients were allocated to receive a combination of two in-theatre interventions to reduce SSI in a stratified, factorial design, from 54 hospitals in seven countries (Benin, Ghana, India, Mexico, Nigeria, Rwanda, and South Africa). This included a broad and representative range of patients (including contaminated or dirty surgery, emergency surgery, children, and caesarean section) with representative perioperative practices and surgical safety checklist completion rates consistent with those in higher income settings (85·6 per cent). The overall SSI rate was high (22·0 per cent) and there were no differences between the intervention groups or across strata. We could find no evidence to support the superiority of either 2 per cent alcoholic chlorhexidine skin preparation or triclosan-coated sutures for surgical patients in low-income and middle-income countries. The design and execution of the trial were pragmatic, efficient, and generalisable.

Reducing surgical site infections in low-income and middle-income countries (FALCON): a pragmatic, multicentre, stratified, randomised controlled trial [primary paper]

See also:

NIHR Urgent changes needed to global guidelines designed to stop surgical infection

Spotlight on quality improvement

British Society for Rheumatology | nd | Spotlight on quality improvement: Dr Iona Thorne

In this blog post the British Society for Rheumatology speak to Dr Iona Thorne, a consultant acute/obstetric physician and rheumatologist at Chelsea and Westminster Hospital NHS Trust.

Dr Thorne is one of the founding members of British Society for Rheumatology (BSR’s) QI special interest group. She spent a year at the Care Quality Commission (CQC) visiting organisations with an embedded QI programme. She explains how she became involved in QI work and some of the benefits to undertaking and implementing QI generally, and what BSR is doing with QI specifically.

Read the full post from the British Society for Rheumatology

Improving a dietetic service for care home residents

Kent Community Health NHS Foundation Trust | nd | Improving a dietetic service for care home residents

A project, which aimed to improve a dietetic service for care home residents who need nutritional support, has resulted in patients being discharged quicker and increased staff capacity.

A review by the Community Dietetic Team within Kent Community Health NHS Foundation Trust (KCHFT), indicated that some residents were staying on caseloads for a prolonged period of time. The project looked to see if things could be done differently, so that patients could be discharged sooner, while also making sure patients would still receive quality care. It also wanted to make sure dietetic staff time was being spent in the most efficient and effective way.

Two pilot studies were set up involving 30 patients each. The studies tested various changes to see what would lead to an improvement (Source: Kent Community Health NHS Foundation Trust

Full details of the quality improvement project are available from Kent Community Health NHS Foundation Trust

Changing healthcare cultures – through collective leadership

NHS England | October 2021 | Changing healthcare cultures – through collective leadership

Within these case studies NHS England present organisations’ or system’s journey is as unique as their teams, but it often helps to have an insight into how colleagues across the country have used the Culture and Leadership Programme in their context.

The Chief Executive

The Clerical Officer

The Facilities Manager

The Junior Doctor

The Physiotherapist

The Workforce Programmes Director

Medication safety at hospital discharge: improvement guide and resource

Royal College of Physicians | October 2021 | Medication safety at hospital discharge: improvement guide and resource

Medication errors are common at the hospital discharge transition but there’s a lot we can do to improve this. The RCP is delighted to announce a new resource focusing on medication safety at hospital discharge that takes teams through the quality improvement process step-by-step.

The project was developed in close consultation with a multidisciplinary task and finish group and with input from across health and social care, including patient and carer representatives. This enabled a better understanding of problems that cross sector boundaries, such as medication safety at the hospital discharge transition, and ensured the problem was approached from multiple perspectives.  

Project lead and RCP medicines safety clinical fellow Jen Flatman says: ‘We hope that these resources will act as an essential guide and reference source for you and your team, as you embark on your quality improvement project and make improvements in medication safety within and between your organisations.’ (Source: Royal College of Physicians)

Medication safety at hospital discharge improvement guide and resource 1.41 MB 

Medication safety – Cause and effect template 286.66 KB 

Medication safety – Impact matrix 432.96 KB 

Medication safety – Roles and responsibilities matrix 384.63 KB 

Medication safety – Self assessment 321.02 KB 

Medication safety – Stakeholder analysis matrix 419.64 KB