QI Evidence Update for August 2022

Andrea Gibbons & Jess Pawley | Somerset NHS Foundation Trust

The ‘QI Evidence Update’ for August is now available. The bulletin, compiled by Andrea Gibbons and Jess Pawley at Somerset NHS Foundation Trust, brings together the latest research and developments in quality improvement, integrated care, population health, patients and people, NHS performance, workforce and technology, plus events and training. This month’s bulletin includes links to papers on overlapping surgical scheduling, antimicrobial stewardship in a digital setting, reducing inappropriate echocardiograms, using QI to address racism, a ‘What Matters to You?’ in a London Intensive Care Unit, a new report on improving the wellbeing of NHS staff, and much more.

QI Evidence Update for July 2022

Andrea Gibbons & Jess Pawley | Somerset NHS Foundation Trust

The ‘QI Evidence Update’ for July is now available. The bulletin, compiled by Andrea Gibbons and Jess Pawley at Somerset NHS Foundation Trust, brings together the latest research and developments in quality improvement, integrated care, population health, patients and people, NHS performance, workforce and technology, plus events and training. This month’s bulletin includes links to papers on a perinatal care quality improvement package, standardised hospital information cards, encouraging openness in healthcare, a bitesize guide to overseas recruitment, remote consulting in general practice, and much more.

Healthcare Quality Improvement Partnership: New reports published

The following 11 new resources have been published on the HQIP website this week

• Asthma & COPD Wales Primary Care Clinical Audit 2021
• Pulmonary Rehabilitation 2021 Organisational Audit: Summary report
• Early Intervention in Psychosis Audit Report (England)
• Early Intervention in Psychosis Audit Report (Wales)
• National Diabetes Audit, 2020-21 Report: Care processes and treatment targets
• Diabetes Prevention Programme Non-diabetic Hyperglycaemia Report, 2020/21
• A annual survey of GIRFT recommended staffing, systems and pathways
• Epilepsy12 Report (England and Wales 2019-21)
• NCMD: The contribution of newborn health to child mortality across England
• NACEL: Third round of the audit (2021/22) report
• Mental health spotlight audit summary report 2021/22

Full detail: New reports published – July 2022 | Healthcare Quality Improvement Partnership

Making sense of complaints – using AI to improve learning from patient complaints

Tech UK | May 2022 | Making sense of complaints – using AI to improve learning from patient complaints

Complaints to hospitals are increasingly common but are often dealt with inefficiently and lessons for the future aren’t learnt. AI can help with this. Dr. Tom Palser, Consultant Surgeon and clinical lead at Methods Analytics explores how for techUK’s AI Week #AIWeek2022

Full details from Tech UK

The impact of lean management on frontline healthcare professionals

Mahmoud, Z. et al | 2021| The impact of lean management on frontline healthcare professionals: a scoping review of the literature | BMC Health Services Research | 21| 383 | 10.1186/s12913-021-06344-0

This review of the literature is, according to the authors, the first of its kind to synthesise and critically reflect on the literature on healthcare workers and the impact of lean on this population. It finds that studies that holistically examine cases of Lean implementation in healthcare by attending to its sociotechnical and human dimensions remain scarce

Abstract

Background

Lean management practices are increasingly used in hospitals. However, their impacts on staff have not been systematically synthesised. This scoping review aims to synthesise the evidence on the effects of Lean Management practices on frontline healthcare professionals.

Methods

A search was conducted in February 2020 on multiple databases to identify relevant sources. Studies had to satisfy the following inclusion criteria to be considered: published in English or French, peer-reviewed, empirical, studied the use of Lean in a healthcare setting and focused on its impacts on frontline workers. The studies included were heterogeneous in terms of participants. Findings were coded and classified using a thematic analysis. The quality and methodological rigour of the reviewed articles were assessed to establish a level of confidence in their findings.

Results

Of 998 identified articles, 17 were included in the review. The findings were coded into four themes: (1) Morale, motivation and job satisfaction (n equal to 9, 2) work intensification, job strain, anxiety, stress and dehumanisation (n equal to 7, 3) teamwork, communication and coordination (n equal to 6); and (4) learning, innovation and personal development (n equal to 3). Overall, the articles reported positive (n equal to 11), negative (n equal to 3) and mixed (n equal to 3) impacts of Lean on frontline healthcare professionals.

Conclusion

This review is the first to synthesise and highlight the gaps in the existing literature examining the impacts of Lean on frontline health professionals. The review revealed a range of both positive, negative and mixed effects, and points to the need for more empirical research to identify the underlying reasons leading to these outcomes.

The impact of lean management on frontline healthcare professionals: a scoping review of the literature

So close to love: compassionate leadership in healthcare

Evans, D. (2022). So close to love: compassionate leadership in healthcare. British Journal of Healthcare . https://doi.org/10.12968/bjhc.2021.0135

This review, published in the British Journal of Healthcare Management explores the need for compassionate leadership and the context in which it has developed, as well as definitions of compassionate leadership according to existing literature. It also considers how compassionate leadership is conceptualised in both theory and practice.

Abstract

Compassionate leadership has received significant attention in the UK health system, particularly following the COVID-19 pandemic. This scoping literature review aimed to explore current knowledge about compassionate leadership in healthcare. A search of MEDLINE, CINAHL, PsycINFO, PubMed and ASSIA databases identified 34 papers published between 2015 and 2020. The review found broad agreement regarding the definition of and need for compassionate leadership, as well as the existence of differences in practice, dependent on the hierarchical levels in healthcare organisations. However, current research lacks clarity and depth concerning the theoretical underpinnings of compassionate leadership. The question ‘how can you be critical of something so close to love?’ draws attention to the paucity of critical analysis and research. As a result, the ability of compassionate leadership to define a new way of working and deliver real change is unclear.

So close to love: compassionate leadership in healthcare

Instruments for measuring patient safety competencies in nursing: a scoping review

Mortensen, M. et al. (2022). Instruments for measuring patient safety competencies in nursing: a scoping review. BMJ Open Quality . 11. e001751. doi: 10.1136/bmjoq-2021-001751

Abstract

Background Patient safety competencies in nursing are essential for the quality of healthcare. To develop practices and collaboration in nursing care, valid instruments that measure competencies in patient safety are needed.

Objective To identify instruments that measure the patient safety competencies of nurses.

Design A scoping review.

Data sources The Cochran Library, Epistemonikos, Eric, Ovid Medline, CINAHL, Embase and Web of Science databases were searched for articles reporting on instruments measuring patient safety competence in nursing. The search was limited to English peer-reviewed scientific papers published from January 2010 to April 2021.

Review method A blinded selection of articles fulfilling the inclusion criteria was performed by two researchers based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. Data were then extracted, synthesised and presented in tables and text.

Results Our search identified 1,426 papers, of which 32 met the inclusion criteria. The selected papers described nine instruments, of which the ‘Health Professional Education in Patient Safety Survey’ was the most used instrument. The identified instruments comprised domains for patient safety skills, attitudes, knowledge, communication, teamwork and errors. The instruments had been tested for content (face) and construct validity as well as for reliability. However, sensitivity and responsiveness were rarely assessed.

Conclusions Over the last decade, there has been a growing body of instruments aimed at measuring patient safety competencies among nurses. The future development of new instruments should consider including the important dimension of ethics in patient safety as well as evaluating the instrument’s responsiveness to be able to track changes over time.

BMJ Instruments for measuring patient safety competencies in nursing: a scoping review

Speech and Language Therapy team decide to implement text message reminders

East London NHS Foundation Trust | April 2022 | How PDSA testing helped the Early Years Speech and Language Therapy team decide to implement text message reminders

This 6-minute read, from the East London NHS Foundation Trust sets out how the Early Years Speech and Language Therapy (SLT) Quality Improvement (QI) project team in the Specialist Children and Young People’s Service (SCYPS) collaborated effectively, and used Plan-Do-Study-Act cycles rigorously, to test their change idea of introducing text message reminders.

First PDSA cycle, the other three are available from East London NHS Foundation Trust

How PDSA testing helped the Early Years Speech and Language Therapy team decide to implement text message reminders

There’s also an audio clip of ELFT’s Patient Pathway Coordinator (PPC), Ola, who gives her personal reflection and description of the way the team approached application of the PDSA method.

Better, Broader, Safer: Using Health Data for Research and Analysis

Department of Health and Social Care | April 2022 | Better, Broader, Safer: Using Health Data for Research and Analysis A review commissioned by the Secretary of State for Health and Social Care

The NHS has some of the most powerful health data in the world. Almost every interaction with
the health service leaves a digital trace: the diagnoses, treatments, tests and outcomes for almost every citizen in the country.

But raw data is not powerful on its own. It must be shaped, checked, and curated into shape. It must be housed, and managed securely. It must be analysed. And then it must be communicated, and acted upon. That work all requires people, with modern data skills, in teams, using platforms that protect patients’ privacy and avoid needless duplication of effort. This review sets out a practical vision of how we can collectively achieve this goal.

Front cover of the report

This review was tasked with finding ways to deliver better, broader, safer use of NHS data for analysis and research: more specifically, it was asked to identify the strategic or technical blockers to such work, and how they can be
practically overcome. It was commissioned to inform, and sit alongside, the NHS Data Strategy. The recommendations are derived from extensive engagement with over 300 individuals, 8 focus groups, 100 written submissions,
substantial desk research, and detailed discussion with our Senior Stakeholder Group.

See also:

Goldacre recommendations to improve care through use of data [blog post]

Virtual wards empower the people we care for [Case study]

NHS England | n.d. | Case study: virtual wards empower the people we care for in east Kent

This case study published by NHS England, outlines how virtual wards empower the people we care for in east Kent. The region is a coastal area which has traditionally attracted retirees, meaning healthcare services provide services in locations with a higher frailty need than much of the UK.

Clinicians in Kent are supporting people living with frailty in their own home, through a frailty Hospital at Home virtual ward.

Summary

Our frailty Hospital at Home virtual ward was set up in response to COVID-19, to help people living with frailty avoid going to hospital.

By October 2021:

• We saw 3,721 patients
• We had 200 referrals on average each month
• We helped 90 per cent of patients stay at home
• 45 per cent of our assessments were virtual (higher during COVID peaks)
• 7 per cent of our patients were readmitted to our virtual ward.

Our top tips for setting up a virtual ward:

• You can undertake a good virtual assessment of the patient in their own home, often supported by the paramedic team or a patient’s family
• A daily morning multidisciplinary team meeting is vital to make sure the team know what’s going on and learn from each other
• We all had to learn new skills
• Don’t just buy point-of-care testing equipment without spending time learning the quality control and protocols
• Virtual assessments using video technology work well for frailty assessments and reviews
• Make sure you have a really good way to run a caseload
• Pharmacy support is essential
• Hold a steady nerve, especially if you are doing what the person wants

Full case study available from NHS England