Challenges experienced by clinical teams in measuring improvement

Woodcock, T., Liberati, E.G., Dixon-Woods, M. (2021). BMJ Quality Safety. 30. 106–115.

This article published in the BMJ Quality and Safety uses data from a mixed-methods independent evaluation of a nine-site UK patient safety improvement programme to report on clinical teams’ experiences of using locally selected measures. The researchers aimed specifically to describe their experiences of planning and conducting measurement activities, collecting data and analysing and interpreting data for their improvement projects.

Abstract

Objective Measurement is an indispensable element of most quality improvement (QI) projects, but it is undertaken to variable standards. We aimed to characterise challenges faced by clinical teams in undertaking measurement in the context of a safety QI programme that encouraged local selection of measures.

Methods Drawing on an independent evaluation of a multisite improvement programme (Safer Clinical Systems), we combined a qualitative study of participating teams’ experiences and perceptions of measurement with expert review of measurement plans and analysis of data collected for the programme. Multidisciplinary teams of frontline clinicians at nine UK NHS sites took part across the two phases of the programme between 2011 and 2016.

Results Developing and implementing a measurement plan against which to assess their improvement goals was an arduous task for participating sites. The operational definitions of the measures that they selected were often imprecise or missed important details. Some measures used by the teams were not logically linked to the improvement actions they implemented. Regardless of the specific type of data used (routinely collected or selected ex novo), the burdensome nature of data collection was underestimated. Problems also emerged in identifying and using suitable analytical approaches.

Conclusion Measurement is a highly technical task requiring a degree of expertise. Simply leveraging individual clinicians’ motivation is unlikely to defeat the persistent difficulties experienced by clinical teams when attempting to measure their improvement efforts. We suggest that more structural initiatives and broader capability-building programmes should be pursued by the professional community. Improving access to, and ability to use repositories of validated measures, and increasing transparency in reporting measurement attempts, is likely to be helpful.

[Full paper] A mixed-methods study of challenges experienced by clinical teams in measuring improvement

5 Things High-Performing Teams Do Differently

Harvard Business Review | October 2021 | 5 Things High-Performing Teams Do Differently

New research suggests that the highest-performing teams have found subtle ways of leveraging social connections during the pandemic to fuel their success. The findings offer important clues on ways any organization can foster greater connectedness — even within a remote or hybrid work setting — to engineer higher-performing teams. Doing so takes more than simply hiring the right people and arming them with the right tools to do their work. It requires creating opportunities for genuine, authentic relationships to develop. The authors present five key characteristics of high-performing teams, all of which highlight the vital role of close connection among colleagues as a driver of team performance.

1. High-Performing Teams Are Not Afraid to Pick Up the Phone
2. High-Performing Teams Are More Strategic With Their Meetings
3. High-Performing Teams Invest Time Bonding Over Non-Work Topics
4. High-Performing Teams Give and Receive Appreciation More Frequently
5. High-Performing Teams Are More Authentic at Work (Source: HBR)

5 Things High-Performing Teams Do Differently

BMA: Moral distress and moral injury Recognising and tackling it for UK doctors

BMA | June 2021 | Moral distress and moral injury Recognising and tackling it for UK doctors

This report is based on the findings of the BMA’s review of moral distress in the UK medical workforce. This included interviews and discussions with doctors, analysis of academic research, and the first ever pan-profession survey of doctors in the UK on moral distress

Moral distress is defined simply by the BMA as the feeling of unease stemming from situations where institutionally required behaviour does not align with moral principles. Moral injury can arise where sustained moral distress leads to impaired function or longer-term psychological harm. It has also been linked to severe mental health issues;
– Both terms are increasingly being applied to physicians in high-resource health settings

Source BMA

Moral distress and moral injury Recognising and tackling it for UK doctors

See also

BMJ Covid 19: Eight in 10 doctors have experienced moral distress during pandemic, BMA survey finds

Collaborating regionally on apprenticeships

This briefing highlights out how regions have worked together to deliver apprenticeships and maximise the apprenticeship levy | NHS Employers

Apprenticeships can develop and upskill new and existing staff, build career pathways and, when included within workforce planning, can help to address skills shortages across the workforce. The latter is something that more organisations are approaching collaboratively to address skills shortages and increase the amount of apprenticeship levy spent across STPs and ICSs.

This resource would be useful for sustainability and transformation partnerships (STP) or integrated care systems (ICS) leads interested in what other regions are doing, as well as workforce leaders who are looking to work more collaboratively on apprenticeships.

Full briefing:  collaborating regionally on apprenticeships briefing.

Steps To Expand Placement Capacity

This document sets out questions to consider and some suggested actions that could help  expand and improve organisation’s capacity for work placements in a sustainable way | NHS Employers

The NHS Long Term Plan sets out ambitions to increase the number of people in learning placements across the NHS. To meet these ambitions, employers will have to scale up the ability to offer a safe and high-quality learning environment that supports workforce development. Based on conversations with those organisations which have already grown their capacity, this briefing sets out a series questions and actions, under six key areas to help employers reflect on what more they can do to increase placement capacity in a way that is sustainable for their organisation.

Full briefing: Steps to expand placement capacity

Which health care jobs are the most likely to be affected by automation?

The Health Foundation |September 2019 | Which health care jobs are the most likely to be affected by automation?

Much has been written about the likely impact of automation and particularly the potential for job displacement.  Now in a new release The Health Foundation considers: which health care jobs are the most likely to be affected by automation?

In health and social care, ONS (Office for National Statistics) analysis suggests medical practitioners have an estimated risk of automation of 18%, compared to over 50% risk for care workers and home carers. 

 

Image source: health.org.uk

Key points

• The automation of work will impact the future labour market. Office for National Statistics (ONS) analysis suggests that 7.4% of jobs in England are at high risk of automation (defined as 70% chance of being automated).
• The ONS analysis estimates that medical practitioners have an 18% probability of automation, compared to over 50% probability for care workers and home carers.
• However there is optimism about opportunities technology could bring too, such as creating new roles. There are also limits to the tasks that technology can perform—human skills, intelligence and perception are likely to be of enduring value

The briefing also indicates that while there will be some job displacement of the jobs we currently have; as some roles are replaced, others will be adapted and integrated with technology, and new ones will be created. As automation replaces routine tasks, people could be freed to undertake more rewarding work — as has been illustrated, for instance, through research on automation in primary care (Source: The Health Foundation).

Read the full article from The Health Foundation 

You can explore the analysis from the ONS here

How to set up and run a workplace exchange

This document sets out how to run a workplace exchange using the Wessex Exchange Model.  The model was developed to overcome challenges with fragmented working and ineffectual delegation of workload by building trust and relationships between professionals and creating time for professionals to find solutions mutually towards providing joined-up care for patients.

Full document: The Wessex Model – How to set up and run a workplace exchange | NHS England and NHS Improvement

Professionalism and cultural transformation (PACT) toolkit

The Professionalism and Cultural Transformation (PACT) toolkit aims to educate and empower staff to improve professionalism within their workplace, helping organisations move towards making the NHS the best place to work | NHS Employers

The toolkit is based on tried and tested work undertaken by Hull University Teaching Hospitals NHS Trust and is designed to help managers embed the PACT programme in their organisation. It contains practical information, advice and solutions to equip staff to deal with unprofessional attitudes and behaviours in the workplace.

The PACT programme has four steps which should be followed in sequence.

Step 1: Assess your current culture
Step 2: Determine levels of professionalism
Step 3: Action plan and management
Step 4: Evaluate

Full resource: Professionalism and Cultural Transformation (PACT) toolkit. A toolkit to support managers to improve professional attitudes and behaviours in the workplace

Interim NHS People Plan

NHS Improvement| June 2019 | Interim NHS People Plan

NHS Improvement has published Interim NHS People Plan, developed collaboratively with national leaders and partners, sets a vision for how people working in the NHS will be supported to deliver care and identifies the actions we will take to help them

Interim NHS People Plan

Further resources available from NHS Improvement 

 

New guide to cross-sector working

This guide reinforces the benefits of cross-sector working for patients and NHS transformation and includes case studies demonstrating how this can be achieved | AHSN Network | Association of British Pharmaceutical Industry 

Image source: http://www.ahsnnetwork.com

The ABPI and the AHSN Network has published a new guide to cross-sector working between NHS Sustainable Transformation Partnerships (STPs), Integrated Care Systems (ICSs) and industry. The guide sets out governance and process recommendations to make collaboration more straightforward.

The guidance makes it easier for STPs, ICSs and industry to develop and implement local collaborative initiatives that improve patient outcomes, make more efficient use of NHS resources and generate evidence of impact for industry.

 

Full document: Simplifying cross-sector working between NHS Integrated Care Systems, Sustainability and Transformation Partnerships and industry. Guidance on governance and process.