More holes than cheese. What prevents the delivery of effective, high quality and safe health care in England?

Hignett, Sue; Lang, Alexandra; Pickup, Laura; Ives, Christine; Fray, Michael; McKeown, Céline; Tapley, Sarah; Woodward, Matthew; Bowie, Paul

doi:10.1080/00140139.2016.1245446

Cited by 46 publications

(41 citation statements)

References 34 publications

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“…From the organisational change literature in health care, we know that certain common themes recur, particularly around the importance of a receptive context and an understanding of organisational history, of having both senior management and distributed leadership, of the engagement of opinion leaders and clinicians, of 'fit' with existing organisational goals and strategies, and of organisational support and resources. [53][54][55][56] From a human factors perspective, a daunting list of 760 challenges to the delivery of effective, high-quality and safe health care has been identified by Hignett et al 57 The authors group these under eight headings, which, again, are remarkably consistent with other organisational studies:…”

Section: Wider Literature On Quality Improvement Theory Methods and mentioning

confidence: 60%

Understanding how front-line staff use patient experience data for service improvement: an exploratory case study evaluation

Locock

Graham

King

et al. 2020

Health Serv Deliv Res

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Background and aim The NHS collects a large number of data on patient experience, but there are concerns that it does not use this information to improve care. This study explored whether or not and how front-line staff use patient experience data for service improvement. Methods Phase 1 – secondary analysis of existing national survey data, and a new survey of NHS trust patient experience leads. Phase 2 – case studies in six medical wards using ethnographic observations and interviews. A baseline and a follow-up patient experience survey were conducted on each ward, supplemented by in-depth interviews. Following an initial learning community to discuss approaches to learning from and improving patient experience, teams developed and implemented their own interventions. Emerging findings from the ethnographic research were shared formatively. Phase 3 – dissemination, including an online guide for NHS staff. Key findings Phase 1 – an analysis of staff and inpatient survey results for all 153 acute trusts in England was undertaken, and 57 completed surveys were obtained from patient experience leads. The most commonly cited barrier to using patient experience data was a lack of staff time to examine the data (75%), followed by cost (35%), lack of staff interest/support (21%) and too many data (21%). Trusts were grouped in a matrix of high, medium and low performance across several indices to inform case study selection. Phase 2 – in every site, staff undertook quality improvement projects using a range of data sources. The number and scale of these varied, as did the extent to which they drew directly on patient experience data, and the extent of involvement of patients. Before-and-after surveys of patient experience showed little statistically significant change. Making sense of patient experience ‘data’ Staff were engaged in a process of sense-making from a range of formal and informal sources of intelligence. Survey data remain the most commonly recognised and used form of data. ‘Soft’ intelligence, such as patient stories, informal comments and daily ward experiences of staff, patients and family, also fed into staff’s improvement plans, but they and the wider organisation may not recognise these as ‘data’. Staff may lack confidence in using them for improvement. Staff could not always point to a specific source of patient experience ‘data’ that led to a particular project, and sometimes reported acting on what they felt they already knew needed changing. Staff experience as a route to improving patient experience Some sites focused on staff motivation and experience on the assumption that this would improve patient experience through indirect cultural and attitudinal change, and by making staff feel empowered and supported. Staff participants identified several potential interlinked mechanisms: (1) motivated staff provide better care, (2) staff who feel taken seriously are more likely to be motivated, (3) involvement in quality improvement is itself motivating and (4) improving patient experience can directly improve staff experience. ‘Team-based capital’ in NHS settings We propose ‘team-based capital’ in NHS settings as a key mechanism between the contexts in our case studies and observed outcomes. ‘Capital’ is the extent to which staff command varied practical, organisational and social resources that enable them to set agendas, drive process and implement change. These include not just material or economic resources, but also status, time, space, relational networks and influence. Teams involving a range of clinical and non-clinical staff from multiple disciplines and levels of seniority could assemble a greater range of capital; progress was generally greater when the team included individuals from the patient experience office. Phase 3 – an online guide for NHS staff was produced in collaboration with The Point of Care Foundation. Limitations This was an ethnographic study of how and why NHS front-line staff do or do not use patient experience data for quality improvement. It was not designed to demonstrate whether particular types of patient experience data or quality improvement approaches are more effective than others. Future research Developing and testing interventions focused specifically on staff but with patient experience as the outcome, with a health economics component. Studies focusing on the effect of team composition and diversity on the impact and scope of patient-centred quality improvement. Research into using unstructured feedback and soft intelligence. Funding The National Institute for Health Research Health Services and Delivery Research programme.

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Section: Wider Literature On Quality Improvement Theory Methods and mentioning

confidence: 60%

Understanding how front-line staff use patient experience data for service improvement: an exploratory case study evaluation

Locock

Graham

King

et al. 2020

Health Serv Deliv Res

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“…The 2016 Care Quality Commission briefing recognised that applying HFE principles can reduce the risk of adverse events reoccurring, and Health Education England has invested in staff training with HFE taster workshops [13], [14] . Similarly, NHS Education for Scotland (NES) routinely delivers HFE workshops.…”

Section: Human Factors and Ergonomicsmentioning

confidence: 99%

Considering human factors and developing systems-thinking behaviours to ensure patient safety

2018

Clinical Pharmacist

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“…9 One of the initiatives to implement the Concordat was a series of HFE taster workshops by the UK professional body for HFE, the Chartered Institute of Ergonomics & Human Factors (CIEHF). 10 Changes in professional priorities must be reflected in educational curricula, but development with respect to patient safety has been slow. Regulatory bodies have a growing safety focus, but provide little direction for teaching.…”

Section: Introductionmentioning

confidence: 99%

A UK Perspective on Human Factors and Patient Safety Education in Pharmacy Curricula

Vosper

Hignett

2018

American Journal of Pharmaceutical Education

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Objective. To take a systematic approach to exploring patient safety teaching in health care curricula, particularly in relation to how educators ensure students achieve patient safety competencies.Findings. There is a lack of formally articulated patient safety curricula, which means that student learning about safety is largely informal and influenced by the quality and culture of the practice environment. Human Factors and Ergonomics appeared largely absent from curricula. Summary. Despite its absence from health care curricula, Human Factors and Ergonomics approaches offer a vehicle for embedding patient safety teaching. The authors suggest a possible model, with Human Factors and Ergonomics forming the central structure around which the curriculum can be built.

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More holes than cheese. What prevents the delivery of effective, high quality and safe health care in England?

Cited by 46 publications

References 34 publications

Understanding how front-line staff use patient experience data for service improvement: an exploratory case study evaluation

Understanding how front-line staff use patient experience data for service improvement: an exploratory case study evaluation

Considering human factors and developing systems-thinking behaviours to ensure patient safety

A UK Perspective on Human Factors and Patient Safety Education in Pharmacy Curricula

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