Health systems are under more pressure than ever before, and the challenges are multiplying and accelerating. Economic forces, new technology, genomics, AI in medicine, increasing demands for care—all are playing a part, or are predicted to increasingly do so. Above all, ageing populations in many parts of the world are exacerbating the disease burden on the system and intensifying the requirements to provide effective care equitably to citizens.
In this first of two companion articles on behalf of the Innovation and Systems Change Working Group of the International Society for Quality in Health Care (ISQua), in consultation with representatives from over 40 countries, we assess this situation and discuss the implications for safety and quality. Health systems will need to run ahead of the coming changes and learn how to cope better with more people with more chronic and acute illnesses needing care. This will require collective ingenuity, and a deep desire to reconfigure healthcare and re-engineer services. Chief amongst the successful strategies, we argue, will be preventative approaches targeting both physical and psychological health, paying attention to the determinants of health, keeping people at home longer, experimenting with new governance and financial models, creating novel incentives, upskilling workforces to fit them for the future, redesigning care teams and transitioning from a system delivering episodic care to one that looks after people across the life cycle. There are opportunities for the international community to learn together to revitalise their health systems in a time of change and upheaval.
This report discusses the progress and impact made by England’s Patient Safety Collaboratives (PSCs) in their first four years. It was commissioned by The AHSN Network and written by The King’s Fund.
The report notes how interest is shifting from supporting the improvement of individual services to improving how different services work together in local systems. It highlights the role the PSC programme has had in creating a movement for change and cultivating a shared vision among health and care organisations.
It also suggests some areas PSCs and national NHS bodies could focus on to further support innovation, quality improvement and patient safety.
A new case study on NHS England’s atlas of shared learning explores how a Deputy Chief Nurse responsible for safeguarding and harm-free care at Barking, Havering and Redbridge University Hospitals NHS Trust (BHRUT) identified an opportunity to use new digital technology to introduce electronic Child Protection-Information Sharing (CP–IS) to the Trust. The CP-IS is now being used to help identify children with particular safeguarding needs whenever they are registered as a patient.
Implementation of the CP-IS has facilitated better information sharing, better outcomes for patient safety and better use of resources, as its introduction has reduced cost and time in supporting children and young people’s administrative process (Source: NHS England).
Royal College of Surgeons of Edinburgh (RCSEd), 2017
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.
Keeping medical practitioners healthy is an important consideration for workforce satisfaction and retention, as well as public safety | Journal of Patient Safety
However, there is limited evidence demonstrating how to best care for this group. The absence of data is related to the lack of available funding in this area of research. Supporting investigations that examine physician health often “fall through the cracks” of traditional funding opportunities, landing somewhere between patient safety and workforce development priorities. To address this, funders must extend the scope of current grant opportunities by broadening the scope of patient safety and its relationship to physician health. Other considerations are allocating a portion of doctors’ licensing fees to support physician health research and encourage researchers to collaborate with interested stakeholders who can underwrite the costs of studies. Ultimately, funding studies of physician health benefits not only the community of doctors but also the millions of patients receiving care each year.
A patient safety intervention was tested in a 33-ward randomised controlled trial | BMJ Open
Objectives: No statistically significant difference between intervention and control wards was found. We conducted a process evaluation of the trial and our aim in this paper is to understand staff engagement across the 17 intervention wards.
Findings: First, there were palpable differences in the ways that the 17 ward teams engaged with the key components of the intervention. Five main engagement typologies were evident across the life course of the study: consistent, partial, increasing, decreasing and disengaged. Second, the intensity of support for the intervention at the level of the organisation does not predict the strength of engagement at the level of the individual ward team. Third, the standardisation of facilitative processes provided by the research team does not ensure that implementation standardisation of the intervention occurs by ward staff.
Conclusions: A dilution of the intervention occurred during the trial because wards engaged with Patient Reporting and Action for a Safe Environment (PRASE) in divergent ways, despite the standardisation of key components. Facilitative processes were not sufficiently adequate to enable intervention wards to successfully engage with PRASE components.
This resource outlines case studies on improving incident reporting culture, providing feedback to staff involved in incidents, sharing learning across the organisation and changing practice to prevent recurrence.