Discussion: utilization of resources

Discussion: utilization of resources ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS ON Discussion: utilization of resources I don’t know how to handle this Health & Medical question and need guidance. Discussion: utilization of resources please we have to follow the 9 research steps. she will be looking for them. we have Topic, identifying problems, research questions, literature review, research design methodology, data collection, data analysis, conclusion and recommendation. This is a group presentation. My portion is the Literature Review, Data Collection, Recommendation. if there is any confusion, please let me know so that I clarify. Remember topic is Patient safety. This is what we are going to use. disregard every information/file/Attachment I gave you before. Please make the speaker notes very clear and detailed and full of information. 4 to 5 bullet point per slide. Thanks a lot We are going to use the attached file running_a_hospital_patient_safety.pdf The current issue and full text archive of this journal is available at www.emeraldinsight.com/1477-7266.htm JHOM 28,4 Running a hospital patient safety campaign: a qualitative study Piotr Ozieranski 562 Received 21 February 2013 Revised 23 October 2013 Accepted 29 October 2013 Department of Health Sciences, University of Bath, Bath, UK Victoria Robins Renal Medicine, St James University Hospital, Leeds, UK Joel Minion and Janet Willars Department of Health Sciences, University of Leicester, Leicester, UK John Wright Bradford Institute for Health Research, Bradford, UK Simon Weaver Department of Sociology and Communications, Brunel University, Uxbridge, UK, and Graham P. Martin and Mary Dixon Woods Department of Health Sciences, University of Leicester, Leicester, UK Abstract Purpose – Research on patient safety campaigns has mostly concentrated on large-scale multiorganisation efforts, yet locally led improvement is increasingly promoted. The purpose of this paper is to characterise the design and implementation of an internal patient safety campaign at a large acute National Health Service hospital trust with a view to understanding how to optimise such campaigns. Design/methodology/approach – The authors conducted a qualitative study of a campaign that sought to achieve 12 patient safety goals. Discussion: utilization of resources The authors interviewed 19 managers and 45 frontline staff, supplemented by 56 hours of non-participant observation. Data analysis was based on the constant comparative method. Findings – The campaign was motivated by senior managers’ commitment to patient safety improvement, a series of serious untoward incidents, and a history of campaign-style initiatives at the trust. While the campaign succeeded in generating enthusiasm and focus among managers and some frontline staff, it encountered three challenges. First, though many staff at the sharp end were aware of the campaign, their knowledge, and acceptance of its content, rationale, and relevance for distinct clinical areas were variable. Second, the mechanisms of change, albeit effective in creating focus, may have been too limited. Third, many saw the tempo of the campaign as too rapid. Overall, the campaign enjoyed some success in raising the profile of patient safety. However, its ability to promote change was mixed, and progress was difficult to evidence because of lack of reliable measurement. Originality/value – The study shows that single-organisation campaigns may help in raising the profile of patient safety. The authors offer important lessons for the successful running of such campaigns. Journal of Health Organization and Management Vol. 28 No. 4, 2014 pp. 562-575 r Emerald Group Publishing Limited 1477-7266 DOI 10.1108/JHOM-02-2013-0035 No authors have a conflict of interest to declare. Funding for this project was received from the Department of Health Policy Research programme as part of a wider programme of research on behavioural and cultural change to support quality and safety in the NHS. The authors thank colleagues on this programme. The authors are especially grateful to Professor Michael West and Professor Lorna McKee for their very useful feedback on earlier drafts of this manuscript. Discussion: utilization of resources The authors thank the staff at the hospital where this study was conducted for their participation in the project. Thanks to Ichklaq Din and Shoba Dawson for their help in conducting some of the interviews, and to Gerry Armitage for advice on analysis. Write up of this paper was supported by a Wellcome Trust Senior Investigator award (MDW) WT097899. Keywords Quality, Patient care, Safety, Behaviour, Hospitals, Executives Paper type Research paper Introduction Health systems worldwide face challenges in ensuring the delivery of safe, high-quality care (Wachter, 2010); adverse event studies indicate that approximately 5-10 per cent of hospitalised patients in high-income countries experience harm, and about one-third of harmful events are preventable (Vincent et al., 2001; Baker et al., 2004; Thomas et al., 2000; Baines et al., 2013). The need to find ways of addressing these problems more effectively has been given added urgency in the English National Health Service (NHS) by the recent findings of Sir Robert Francis’s inquiries into Mid Staffordshire NHS Foundation Trust (Francis, 2010, 2013). The evidence about how patient safety problems can best be tackled remains contested and conflicting (Shojania and Grimshaw, 2005; Shekelle et al., 2011), but one potentially attractive approach is that of the patient safety campaign. Though no consensual definition of campaigns exists, they are generally characterised by their purposeful attempts to achieve planned effects in their target audiences within a specific time period using organised communication (McQuail, 2010).Discussion: utilization of resources They have been a feature of patient safety improvement efforts since the early 2000s, with the US “100,000 Lives” campaign (Berwick et al., 2006) an early example. Research on patient safety campaigns has typically focused on large-scale, multi-organisation efforts, including the US “Door to Balloon” campaign (Krumholz et al., 2008), the UK “cleanyourhands” campaign (Stone et al., 2012) the German hand hygiene campaign (Reichardt et al., 2013), and the international “Surviving Sepsis” campaign (Levy et al., 2012). Studies of these campaigns have offered important lessons for those seeking to undertake improvements across multiple organisations. For instance, they have identified the need for shared goals among participants, clinician engagement, clinical champions, and the importance of well-designed, theoretically sound interventions (Soo et al., 2009; Benning et al., 2011b; Fuller et al., 2012). Some of the advantages of large-scale campaigns include their ability to create conditions known to be important to achieving change on a large scale, including developing and standardising technical interventions (Pronovost et al., 2009), establishing data collection systems, mobilising peer norms, and competitive pressures across different organisations, sharing learning, and providing the infrastructure for improvement (Dixon-Woods et al., 2011a, b, 2012; Aveling et al., 2012). Yet the campaign approach to patient safety is also one that single healthcare organisations may pursue internally, particularly when, under policy moves such as those currently underway in England (Department of Health, 2010), responsibility for how quality and safety are secured is increasingly devolved to local providers rather than orchestrated at national level. Individual organisations may be highly motivated to take action at local level, especially when confronted with evidence of poor performance or weaknesses in systems (Dixon-Woods et al., 2013a, b). Discussion: utilization of resources Internally run campaigns may be especially tempting when opportunities for joining large-scale campaigns or programmes are not be aligned with priorities of organisations or their timescales for securing improvement. In business settings, internal marketing campaigns have a long history; the literature in this area suggests that such campaigns have a particular role when shifts in staff behaviour must be effected rapidly (Ballantyne, 2000; Hogg et al., 2010). However, the conclusions of the corpus of research on what makes internal marketing campaigns work are divergent, and the transferability of learning from these settings Patient safety campaign 563 JHOM 28,4 564 to healthcare organisations is unclear. Some evidence exists of challenges in single-organisation patient safety campaigns (Niegsch et al., 2013), but it has remained under-studied as approach. There is need to optimise understanding of how single-organisation patient safety campaigns can best be designed and executed. In this paper, we present a qualitative study of one organisation’s patient safety campaign. The campaign, which we anonymise as Building and Expanding Safety Together (BEST), took place at a large NHS foundation teaching hospital trust in England. It sought to improve the organisation’s performance against 12 patient safety goals (list below), focusing on one topic per month over a 15-month period. Our concern in this study was not to determine the campaign’s effectiveness in meeting its goals or to assess its outcomes, but to examine its design and implementation by investigating the views and experiences of those who introduced the campaign and those at the “sharp end” of practice charged with its implementation. With the aim of guiding those who may consider internal patient safety campaigns as an improvement strategy, we sought to characterise the mechanisms by which BEST attempted to achieve change, the extent to which these processes were realised in practice, and the possible unintended consequences of deploying a campaign approach to patient safety. Discussion: utilization of resources BEST campaign topics 2010-2011: . Protecting patients from thromboembolism. . Improving the quality of patient observations. . Identifying and managing the deteriorating patient. . Conducting effective ward rounds. . Improving communication in health records and at handover. . Eliminating delays in investigations for patients who are acutely unwell. . Ensuring best practice for oxygen therapy. . Identifying patients correctly. . Eradicating medication errors. . Optimising the patient journey. . Supervision and training to support patient safety. . Preventing avoidable pressure ulcers. Design and methodology Our approach was an organisational case study (Yin, 2009) where the whole hospital trust was the unit of analysis. The study was conducted approximately mid-way through the BEST campaign run at the trust and involved staff at the “blunt end” (executive/board, which we refer to as the senior team) and the “sharp end” (Woods et al., 2010) (where staff provide care to patients) of the hospital. Data were collected both by an independent external team comprising three researchers and by four interviewers internal to the organisation. Author Martin from the external team conducted semi-structured interviews with the senior team. Authors Minion and Willars from the external team undertook non-participant observation and informal chats with staff on wards and units of two clinical areas (surgery and maternity) of the hospital over the course of one week. During this time, they also conducted semi-structured interviews with sharp-end staff. In order to increase the amount of data available to the study and ensure that a wide range of clinical areas was represented, author Robins plus three other interviewers internal to the organisation (see acknowledgements) conducted semi-structured interviews with staff at the sharp end in three medical wards and one unit using the same prompt guide as the external team. The internal team did not conduct observations. Sampling for interviews at the sharp end was largely opportunistic according to availability of staff, and included senior and junior doctors, nurses and midwives, healthcare assistants, operating theatre personnel, and ward managers. Researchers’ observations and discussions with staff were attentive to cultural and behavioural issues in relation to patient safety and quality of care, but included a specific focus on aspects of the BEST campaign. Discussion: utilization of resources They looked, for instance, at what methods of dissemination were used, explored staff’s awareness and views on the campaign, and sought to understand staff’s perceptions of the impact on the campaign on their practices. Interviews were recorded and fully transcribed; ethnographic observations were captured in fieldnotes. Data analysis of interviews and fieldnotes was based on the constant comparative method (Glaser and Strauss, 1967). The research team initially generated “open codes” based on transcripts and fieldwork notes, which were subsequently grouped into higher-order organising themes relating to the delivery of the BEST campaign. We also used some sensitising concepts (Charmaz, 2006), derived chiefly from the literature on public campaigns. Coding of transcripts was supported by NVIVO 8 software. The analysis was subject to extensive discussion within and between the internal and external research teams, leading to the development of shared interpretations reported in the paper. Approval for the study was obtained from an NHS REC. Signed consent was obtained from staff who took part in an interview, and permission for observational work was obtained verbally. Quotations are numbered to indicate different participants and preserve anonymity. Findings We conducted 19 interviews with members of the executive and board teams (the “blunt end”), 24 interviews with staff on three medical wards and one medical unit, 15 interviews in the surgery directorate, and six interviews within the maternity department (thus 45 at the “sharp end”). We conducted 56 hours of observations, including 54 in clinical areas and two at meetings. We begin by explaining the senior team’s rationale for and design of the campaign, and then describe the response of the sharp end. Rationale and design of the campaign Interviews with senior team members suggested that they had several motives for the campaign. First, the team reported that it took its responsibilities for quality and safety seriously, seeing these duties as central to the organisation’s mission. Second, they identified a need to achieve rapid institutional change following some serious incidents (then known as serious untoward incidents (SUIs)) at the hospital. These events, including one incident involving manifestly poor care, created a sense of shock and appetite for change among the hospital leadership.Discussion: utilization of resources The senior team reported that they felt galvanised to take swift, decisive action, and that the incidents provided a “burning platform” that could command attention and enhance the legitimacy of that action. Patient safety campaign 565 JHOM 28,4 566 Third, the hospital had previously taken part in campaign-style initiatives that the senior team considered to have been useful in providing a mission and focus around which action could cohere. The senior team were especially persuaded of the potential of campaign approaches by their apparent success in driving down healthcare-acquired infections across the organisation: What we’re trying to do is get a message out there which says you’re a part of this organisation [that] is taking the patient experience and the quality of patient care very seriously [59]. We were very keen to get it off the ground quickly part because of the SUIs [y] you didn’t want to lose the impetus of the effect of the SUIs [61]. The infection control [campaign] worked, so there’s actually an appetite for it, because people see it as a load more work but also they can’t argue because the infection control one worked [45]. In order to take advantage of the profile afforded by the serious incidents, and to secure rapid change and high visibility, the campaign was implemented quickly and at a fast tempo, initially planned to be one topic a month for 12 months. The intention was that once the initial boost had been provided by the campaign, higher standards of practices would be embedded and would endure: Because there’s been such a big change, we decided [that] rather than do it little by little, let’s do a big change all at once, to make everybody think this is new, we have to think about it [44]. Discussion: utilization of resources They’re not meant to be one-month projects, I think that’s the key bit about them [y] They’re launched in that month but they’re forever [17]. The campaign involved a new focus each month. Each of the topics was intended to refer to basic standards of care that were equally relevant to all patient groups, and would thus be implemented throughout the hospital in all clinical areas. Reference groups, overseen by a programme board, were established for each of the topics to determine action plans to achieve best practice. These were then implemented through a process we termed “communication and compliance”: the standards were signalled through a variety of communication methods, and then compliance was monitored through a system of spot checks and audits, often involving staff both internal and external to clinical areas (sometimes including members of the senior team) making inspections. The data were collected from different clinical areas at different times, and were not standardised audits. High-quality outcome data were therefore not available. Determining the details of implementation was mostly left up to the individual directorates. The campaign provided guidelines and outlined best practice, and it was assumed that change could be led by local “champions” in the clinical areas who would have the capability and capacity to drive change. All materials were funded from a small campaign budget but the initiative was not supported by additional financial resources. Discussion: utilization of resources Where appropriate to the topic, for example in the area of Modified Early Warning Scores (MEWS) and oxygen prescribing teaching, training, and competency assessments for staff were offered: It was done on the cheap, it was done very quickly. The budgets stayed small for it [y] There’s a bit for publicity with all the posters and everything but BEST has been done on the cheap. And maybe it doesn’t have to be expensive, because you are relying on champions [21]. Our professional development worker makes sure we all go on training and that we do attend training and then obviously that training is put into practice, so yeah I think it’s definitely made an impact [27]. Patient safety campaign Among the senior leadership, the intention was to take action reactively in the event of non-delivery on project aims; areas found to be failing would then be subject to remedial action: I’ve clearly set out what our expectation is about, we’ve provided the training for those staff with the fact that the competence of all of the BEST campaign has these elements in it. What we then do is if somebody fails to adhere to that policy, we go back through that training and competency assessment process again. If they repeatedly do it then we will go through the disciplinary process, and we have. So where we’ve got areas where people have repeatedly failed to follow policy in respect of patient safety, we really use the disciplinary process [54]. Interviews suggested that the campaign was largely successful in creating energy, focus, and enthusiasm among the senior executive and board team, as well as among those directly involved in campaign design: Front line, I think people are signed up and certainly [y] we have a collective group in medicine where the – you know we’ve got a mixture of consultants, matrons, sisters who meet on a weekly basis [y] And we’ve got really good engagement and they’re really keen [17]. Discussion: utilization of resources Though there was no systematic evidence of how the 12 patient safety goals had been met, some improvements were reported over the campaign’s course. Increased use of MEWS for detecting deteriorating patients, improved staff competence in measuring blood pressure, and increased awareness of need for venous thromboembolism assessment were reported by some staff at the sharp end as strengths of the campaign: Yeah, I think when it’s in front of you in black and white you can’t play ignorance or anything like that [39]. It’s to make sure you’ve got good protocols in place that all the trust members are aware of, and that everybody is supposed to adhere to them, it’s about making sure your patients are safe and the priority [66]. Several staff also reported a more generally increased focus and attention to the importance of safety, and some staff reported feeling increased empowerment: It has raised or reminded everybody that things like clinical observations are really … Get a 10 % discount on an order above $ 100 Use the following coupon code : NURSING10