New ambulance service standards

NHS England has announced a new set of performance targets for the ambulance service which will apply to all 999 calls for the first time.

  • National response targets to apply to every single 999 patient for the first time
  • Faster treatment for those needing it to save 250 lives a year
  • An end to “hidden waits” for millions of patients
  • Up to 750,000 more calls a year to get an immediate response
  • New standards to drive improved care for stroke and heart attack
  • World’s largest clinical ambulance trial updates decades-old system

The new targets will save lives and remove “hidden” and long waits suffered by millions of patients, including reducing lengthy waits for the frail and elderly. The new system is backed by the Association of Ambulance Chief Executives, the Royal College of Emergency Medicine, the Stroke Association and the British Heart Foundation amongst others.

Call handlers will change the way they assess cases and will have slightly more time to decide the most appropriate clinical response. As a result cardiac arrest patients can be identified quicker than ever before, with evidence showing this could save up to 250 lives every year.

Full story via NHS England

 

Why UK hospital staff find it difficult to make improvements based on patient feedback

Patients are increasingly being asked for feedback about their healthcare experiences. However, healthcare staff often find it difficult to act on this feedback in order to make improvements to services | Social Science and Medicine

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This paper draws upon notions of legitimacy and readiness to develop a conceptual framework (Patient Feedback Response Framework – PFRF) which outlines why staff may find it problematic to respond to patient feedback.

A large qualitative study was conducted with 17 ward based teams between 2013 and 2014, across three hospital Trusts in the North of England. This was a process evaluation of a wider study where ward staff were encouraged to make action plans based on patient feedback.

Through the development of the PFRF, we found that making changes based on patient feedback is a complex multi-tiered process and not something that ward staff can simply ‘do’.

  • First, staff must exhibit normative legitimacy – the belief that listening to patients is a worthwhile exercise.
  • Second, structural legitimacy has to be in place – ward teams need adequate autonomy, ownership and resource to enact change. Some ward teams are able to make improvements within their immediate control and environment.
  • Third, for those staff who require interdepartmental co-operation or high level assistance to achieve change, organisational readiness must exist at the level of the hospital otherwise improvement will rarely be enacted.

Case studies drawn from our empirical data demonstrate the above. It is only when appropriate levels of individual and organisational capacity to change exist, that patient feedback is likely to be acted upon to improve services.

Full reference: Sheard, L. et al. (2017) The Patient Feedback Response Framework – understanding why UK hospital staff find it difficult to make improvements based on patient feedback: A qualitative study. Social Science & Medicine. 178. pp. 19-27.

 

New models of care in practice

The NHS Confederation has published briefings on new models of care and how they are working in practice:

Driving improvement: case studies from eight NHS trusts

Reviewing the culture of NHS trusts and addressing disconnects between clinicians and managers within the organisation is key to improving care, a new CQC report has revealed. | Care Quality Commission | via National Health Executive

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The CQC has published ‘Driving improvement: case studies from eight NHS trusts’.

The document examines how a number of different trusts improved care and subsequently their CQC rating by making simple changes to how services were run.

During its study, the inspectorate found that engaging with staff and allowing for open and honest conversations was vital to making improvements to care delivery.

The CQC also discovered that successful trusts tended to make their chief executives and senior staff more visible by having them spend more time on the ‘shop floor’ – meeting staff and setting up regular channels of communication. The report also highlights the increasing challenges faced by trusts.

Read more at National Health Executive

Full report: ‘Driving improvement: case studies from eight NHS trusts’.

Does home-based primary care improve patient outcomes?

An Overview Of Home-Based Primary Care: Learning From The Field | Commonwealth Fund

This Commonwealth Fund briefing synthesises the evidence and expert perspectives on how outcomes and costs are affected by utilising home-based primary care for housebound or functionally-limited patients. It finds that successful home-based primary care uses multidisciplinary teams, behavioural insights, social support and rapid response to acute care needs to reduce care costs and improve patient outcomes.

The briefing concludes that successful home-based care practices have achieved robust savings, but the future of the model will rely on innovative payment models and training initiatives.

Improving quality and safety in healthcare

NHS Improvement has published a shared learning resource on Improving quality and safety in healthcare. 

This resource contains case studies from providers that have been rated ‘good’ for safety by the Care Quality Commission.  They offer practical guidance to developing and spreading good practice on the following:

Read more at NHS Improvement

Caring for acutely ill patients

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The King’s Fund has published Organising care at the NHS front line: who is responsible? 

The report looks at the reality of caring for acutely ill medical patients at the NHS front line and asks how care in hospitals can be improved. It comprises a series of essays by frontline clinicians, managers, quality improvement champions and patients, and provides detail about how clinical care is currently provided and how it could be improved.

The report highlights that providing safe and high-quality care for acutely ill medical patients has always been challenging but has become more so as the volume and complexity of work has increased. Amongst its recommendations is that there should be a much stronger focus on how care is organised on hospital wards and in clinics throughout the NHS and greater standardisation of care processes.

The full report can be downloaded here