NIHR Patient Safety Translational Research Centre at Imperial College London and Imperial College Healthcare NHS Trust
There is no simple solution to improve safety, and no single intervention implemented in isolation will fully address the issue. This report highlights four pillars of a safety strategy:
1. A systems approach. The approach to reduce harm must be integrated and implemented at the system level.
2. Culture counts. Health systems and organisations must truly prioritise quality and safety through an inspiring vision and positive reinforcement, not through blame and punishment.
3. Patients as true partners. Healthcare organisations must involve patients and staff in safety as part of the solution, not simply as victims or culprits.
4. Bias towards action. Interventions should be based on robust evidence. However, when evidence is lacking or still emerging, providers should proceed with cautious, reasoned decision-making rather than inaction.
Fenton, K. Public Health England. Published online: 13 May 2016
If you have a passion for improving the public’s health it’s hard not to feel excited about the potential solutions to some of our biggest problems.
Take obesity; there’s no bigger challenge – and no single way of tackling it – but there are approaches which I see as real game-changers.
One of the great things about digital health is that it’s already making a mark and changing the game. I bet many readers of this blog use health apps or wearables, but there’s still so much further we can go.
This clear demand only whets our appetite to take this further so it was great to see PHE colleagues running the HealthX Hackathon in Manchester this week (hosted by Manchester Digital Council) which saw digital developers and health experts devising tools with a vital aim; to help children eat better and move more.
Two royal colleges have urged GPs and paediatricians to train together to boost their skills and help improve standards of care for children.
Interprofessional training will help clinicians, increase the quality of child care, and reduce strain on services, claimed the Royal College of Paediatrics and Child Health and the Royal College of General Practitioners in a joint position paper, published on 13 May.1
The colleges cited the success of a pilot scheme that brought together trainee GPs and paediatricians, which showed a reduction in parents taking their children to the emergency department, fewer referrals to specialist children’s services, and better adherence to national guidance.
The new report, Learning Together to Improve Child Health, detailed the Learning Together2 scheme in London, which involved GP and paediatric registrars in their final years of training working in child health training clinics together.
The National Association for Patient Participation (N.A.P.P.) has launched Building Better Participation, a guide to help patient participation groups (PPGs) and their GP practice work effectively together.
It is designed so a PPG can dip in to use the parts of most relevance and covers a range of topics from getting a PPG established to working to forming working relationships with patients and the wider community. Supported by NHS England, the guide can be downloaded and/or printed from N.A.P.P.’s website.
NHS pushes forward with ambition to create world class cancer services
The NHS in England has set out its plans to deliver world class cancer services, which includes a fund to find new ways of speeding up diagnosis with the potential to save thousands more lives every year.
The National Cancer Transformation Board has published a wide ranging plan designed to increase prevention, speed up diagnosis, improve the experience of patients and help people living with and beyond cancer.
Scientists have unearthed crucial new genetic information about how breast cancer develops and the genetic changes which can be linked to survival. via Science Daily
The Cancer Research UK funded researchers, from the University of Cambridge, analysed tumour samples from the METABRIC study — which revealed breast cancer can be classified as 10 different diseases — to get a deeper understanding of the genetic faults of these 10 subtypes.
They found 40 mutated genes that cause breast cancer to progress. Only a fraction of these genes were previously known to be involved in breast cancer development. They also discovered that one of the more commonly mutated genes, called PIK3CA, is linked to lower chances of survival for three of the 10 breast cancer subgroups. Crucially, this might help explain why drugs targeting PIK3CA work for some women but not for others.
And the researchers think the results could in the future help find drugs to target these genetic faults, stopping the disease from progressing. The research could also provide vital information to help design breast cancer trials and improved tests for the disease.
A new report by the Public Accounts Committee is calling for an urgent review of NHS clinical staffing in England.
Managing the supply of NHS clinical staff in England: Fortieth Report of Session 2015–16 raises serious concerns about supply, budgeting, agency costs and leadership. In particular, the committee finds that there has been no coherent attempt to assess the headcount implications of a 7-day NHS. In 2014, there was an overall shortfall of around 5.9% between the number of clinical staff that healthcare providers said they needed and the number of staff in post, equating to a gap of around 50,000 staff.
The PAC said that the Department of Health, NHS Improvement and Health Education England must report back by December 2016 on what co-ordinated efforts they have identified to address staffing shortages.
Jors, K. et al. Palliative Medicine. Published online: May 9 2016
Background/aim: Palliative care is based on multi-professional team work. In this study, we investigated how cleaning staff communicate and interact with seriously ill and dying patients as well as how cleaning staff cope with the situation of death and dying.
Design: Sequential mixed methods, consisting of semi-structured interviews, focus groups, and a questionnaire. Interviews and focus group discussions were content analyzed and results were used to create a questionnaire. Quantitative data were submitted to descriptive analysis.
Setting: Large university clinic in southern Germany.
Participants: A total of 10 cleaning staff participated in the interviews and 6 cleaning staff took part in the focus group discussion. In addition, three managerial cleaning staff participated in a separate focus group. Questionnaires were given to all cleaning staff (n = 240) working at the clinic in September 2008, and response rate was 52% (125/240).
Results: Cleaning staff described interactions with patients as an important and fulfilling aspect of their work. About half of participants indicated that patients talk with them every day, on average for 1–3 min. Conversations often revolved around casual topics such as weather and family, but patients also discussed their illness and, occasionally, thoughts regarding death with cleaning staff. When patients addressed illness and death, cleaning staff often felt uncomfortable and helpless.
Conclusion: Cleaning staff perceive that they have an important role in the clinic—not only cleaning but also supporting patients. Likewise, patients appreciate being able to speak openly with cleaning staff. Still, it appears that cleaning staff may benefit from additional training in communication about sensitive issues such as illness and death.
Providing information to enable informed choices about healthcare sounds immediately appealing to most of us. But Minna Johansson and colleagues argue that preventive medicine and expanding disease definitions have changed the ethical premises of informed choice and our good intentions may inadvertently advance overmedicalisation
The idea of informed patients who make reasoned decisions about their treatment based on personal preferences is appealing in a Western cultural context, with its focus on the autonomous individual. Rightly, many doctors now reject paternalism if the patient does not specifically ask for it. They prefer to elicit the patient’s preferences and embrace an open discussion of risks and benefits of different options within a shared decision making approach. However, the rise of preventive medicine, the transformation of risk factors and common life experiences into diseases, and the lowering of diagnostic thresholds have changed the ethical premises of informed choice by pushing responsibility on to often ill prepared citizens. We call for careful reflection on the potential downsides of trusting informed choice to resolve ethical problems and complex value judgments in an era of “too much medicine.”