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E-technology is increasingly used in oncology to obtain self-reported symptom assessment information from patients, although its potential to provide a clinical monitoring tool in palliative care is relatively unexplored in the UK. This study aimed to evaluate the support provided to lung cancer patients post palliative radiotherapy using a computerized assessment tool and to determine the clinical acceptability of the tool in a palliative care setting. However, of the 17 clinicians identified as managing patients who met the initial eligibility criteria for the study, only one clinician gave approval for their patient to be contacted regarding participation, therefore the benefits of this novel technology could not be assessed. Thirteen key clinicians from the centres involved in the study were subsequently interviewed. They acknowledged potential benefits of incorporating computerized patient assessment from both a patient and practice perspective, but emphasized the importance of clinical intuition over standardized assessment. Although clinicians were positive about palliative care patients participating in research, they felt that this population of patients were normally too old, with too rapidly deteriorating a condition to participate in a study using e-technology. In order to encourage acceptance of e-technology within palliative care, emphasis is needed on actively promoting the contribution of technologies with the potential to improve patient outcomes and the patient experience.

This paper reports an empirical study that investigated associations between the quality of care received by older people in residential settings and features of the care homes in which they live. Data were gathered from the first announced inspection reports (2002-2003) of all 258 care homes for older people in one county of England (Surrey). The number of inspected standards failed in each home was used as the main indicator of quality of care. Independent variables (for each home) were: size, type, specialist registration, on-site nursing, ownership, year registered, location, maximum fee, vacancies, resident dependency, whether the home took publicly funded residents, care staff qualifications and managerial quality. Quality of care was modelled using a Poisson count maximum likelihood method based on 245 (91%) of the inspected homes for which relevant data were available. The results showed that quality of care (as defined by failures on national standards) was statistically associated with features of care homes and their residents. A higher probability of failing a standard was significantly associated with being a home that: was a for-profit small business (adjusted risk ratio (RR) = 1.17); was registered before 2000 (adj. RR = 1.22), accommodated publicly funded residents (adj. RR = 1.12); was registered to provide nursing care (adj. RR = 1.12). Fewer failures were associated with homes that were corporate for-profit (adj. RR = 0.82); held a specialist registration (adj. RR = 0.91); charged higher maximum fees (adj. RR = 0.98 per 100 pound sterling unit). A secondary analysis revealed a stronger model: higher scores on managerial standards correlated with fewer failures on other standards (r = 0.65, P < 0.001). The results of this study may help inform future policy. They are discussed in the context of alternative approaches to measuring quality of residential care, and in terms of their generalisability.

Staff at primary healthcare centers are used to adverse events and errors. Despite the demand for safety improvement and the existing evidence on the epidemiology of outpatient medical errors, most research has only been conducted in hospital settings. Many patients are put at risk and some are harmed as a result of adverse events in primary care. Adequate communication and technical skills should be utilized by primary care providers (PCPs) for improvement of patient safety. The patient safety measures should include assessment of the safety attitudes of PCPs.

Aim: to understand how nurses and midwives manage informal complaints at ward level.Background: the provision of high quality, compassionate clinical nursing and midwifery is a global priority. Complaints management systems have been established within the National Health Service (NHS) in the United Kingdom (UK) to improve patient experience yet little is known about effective responses to informal complaints in clinical practice by nurses and midwives.Design: collaborative action research.Methods: four phases of data collection and analysis relating to primarily one NHS trust during 2011-2014 including: scoping of complaints data, interviews with five service users and six key stakeholders and eight reflective discussion groups with six midwives over a period of nine months, two sessions of communications training with separate groups of midwives and one focus group with four nurses in the collaborating trust.Results: three key themes emerged from these data: multiple and domino complaints; ward staff need support; and unclear complaints systems.Conclusions: current research does not capture the complexities of complaints and the nursing and midwifery response to informal complaints.Relevance to clinical practice: robust systems are required to support clinical staff to improve their response to informal complaints and thereby improve the patient experience.Key words: health care complaints; midwifery care complaints; nursing care complaints; patient complaints; action research 2 Summary boxWhat does this paper contribute to the wider global clinical community? Little is known about how ward nurses and midwives respond to informal complaints in spite of a growing body of literature in relation to health care complaints. Robust systems to train and support ward nurses and midwives in responding effectively to informal complaints are required. This paper discusses the findings from a UK study, which explored nurses' and midwives' responses to service user informal complaints. The study was prompted by rising numbers of formal complaints within the NHS and a desire to improve patient experience of health services. It focused on informal complaints management at ward level in the UK and adds to developing robust systems to support clinical staff to improve their responses to informal complaints and thereby improve the patient experience.The findings in this paper should be considered in the light of the Francis Inquiry (DH 2013) and the significant and highly publicised care failings at the Mid Staffordshire Foundation Trust outlined in the Francis reports (Francis 2010(Francis , 2013 which is discussed later. BACKGROUNDWhile the background to this study is shaped by events in the UK A number of reviews and reports have followed in the wake of the Francis reports (Francis, 2010(Francis, , 2013 consider the roles of higher management and frontline staff in complaints management and identify how complainants would be best supported through the complaints process. Their findings suggested that service...