Learning from failure: lessons from the Checklist project in Wessex – by Dr Kate Lyle and Professor Catherine Pope

Dr Kate Lyle is a Research Fellow based in Health Sciences at the University of Southampton

Professor Catherine Pope is Deputy Director NIHR CLAHRC Wessex

Dr Kate Lyle is a Research Fellow in Health Sciences at the University of Southampton and Professor Catherine Pope (right) is Deputy Director of NIHR CLAHRC Wessex

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As academics, practitioners, and users of healthcare services we are all used to hearing about examples of successful interventions that have improved health services and care.  Indeed one of the core aims of the NIHR CLARHC programme is to improve patient outcomes locally and across the wider NHS. Here in Wessex we have been working hard over the past 5 years to do just that, spreading best practice and evidence based research throughout the NHS.

But what about the things that don’t work? Attempts at service improvement or innovation that went nowhere? Often these are the things we don’t hear about.  Yet, arguably there is as much to learn from our failures, as there is from successful innovations.

Right idea? Wrong time

AKI – seeing the bigger picture through sharing data – By Dr Simon Fraser

One of the great things about being involved with CLAHRC Wessex has been the opportunity to engage with other research teams around the country doing similar work. A group of us have been part of a network of people across England, Scotland and Wales who are interested in acute kidney injury (AKI). A challenge with AKI research is that it can be misleading if you don’t use the same methods and definitions to define the condition.

Overloaded A&Es – Have we got this all wrong? Dr Brad Keogh

Dr Brad Keogh

Accident and Emergency wait times seem to be constantly in the news. Less commonly but equally importantly are headlines that waiting lists for elective operations and procedures are on the rise. Although these topics hit our headlines regularly there is actually very little evidence and understanding behind the reasons for these changes in NHS services, and how the NHS can take positive action to cope with these issues.

From what we understand a lot of the currently held beliefs around the causes for pressure on NHS services come from very basic, non peer-reviewed, and potentially flawed analyses. It does not need too much explaining that making decisions based on these might be a bad idea.

What does it mean to be a nurse? International Nurses Day

To mark International Nurses Day we asked the many researchers who are qualified nurses to answer these three questions:

1. What nursing means to you? And is there a different view of it if you’re originally from another country?
2. How you would encourage other nurses to progress and conduct research?
3. What are the challenges facing the future of nursing that you can see?

Here’s what they said.

Professor of Health Services Research and the lead for CLAHRC research into Fundamental Care in Hospital

Professor Peter Griffiths

I remember being asked in my interview for nursing why I wasn’t applying to be a doctor. There’s no simple answer to ‘what nursing is’ or ‘what it means to me’ but the answer I gave then is probably as close as I’ll ever get.

I’m not that interested in disease but I am interested in people. Nursing is about supporting and helping people, often through their most difficult times. While it’s hard to distinguish this from many other caring professions the key (to me) is that the focus is on the person comes first and the rest follows.

Why might nurses miss people’s ‘danger signs’ at night? – Dr Jo Hope

We know that nurses miss or delay taking patients’ vital signs (such as pulse, temperature and blood pressure) at night. Until now, no one knew why.

The NHS expects hospitals to use ‘Early Warning Scores’ to measure how ill someone is. These are based on the observation of ‘vital signs’ – measurements of things like pulse, temperature, blood pressure and breathing speed. The higher the score, the more often someone’s vital signs should be checked. This is so staff can spot the early danger signs of someone becoming very unwell, in time to help them.

Your local hospital will probably have an ‘early warning protocol’ that says how often people should be checked according to their early warning score. At higher levels observations will need to be done in the middle of the night. Despite this, we know that nurses are much less likely to do the observations that are expected to be done at night.

What are we missing here? (Are at risk older people spotted early enough in hospital?) – Dr Kinda Ibrahim, Research Fellow at Academic Geriatric Medicine

Nearly two thirds (65%) of people admitted to hospital in the UK are aged over 65 years old. Many of them are frail and at high risk of poor healthcare outcomes – like staying longer in hospital, reduced physical abilities, becoming dependant, going to a care home, and even death.

National recommendations suggest that these high-risk older individuals should be routinely identified when they are admitted to hospital to allow healthcare teams to provide appropriate individual care that meets patient’s needs (1).  It is unclear whether and how those people are identified in hospital. Therefore our study looked at the current practice in one hospital with regard to identification of patients at high-risk of poor healthcare outcomes. To do that, we reviewed a random sample of patient’s clinical notes and interviewed staff members who worked at five acute medicine for older people wards (2).

How to hold it together in times of crisis. Nursing calling – Dr Mari Carmen Portillo Associate Professor University of Southampton

Let me tell you a secret… I am proud of being a nurse but when I was 18 I wasn´t that sure. Finally, advised by friends and family I ended up starting the nursing degree at an excellent and powerful University in Spain…  so that was a fair trade for me… Ok… I will do nursing!

Like many other nurse students, at that time I faced several fundamental crises and I even thought of quitting nursing because I had never thought of myself as a nurse and sometimes others’ pain and disgrace gave me the chills.

The importance of the academic citizen in Health Services Research – Dr Gemma McKenna

It was palpable with research geekery excitement while travelling to Nottingham for the 2017 Health Services Research UK Conference. I needed this, I thought, an opportunity for positivity, to talk enthusiastically about how we as researchers can help sustain the future of the NHS and wider health services. The conference didn’t disappoint.

We are all too aware of the popular rhetoric that consumes newsfeeds and social media channels, with headlines like ‘The NHS is in Crisis’ and ‘too many people are pitching up to A&E’. All doom and gloom. The conference was a perfect antidote to this. While there are no panaceas to these ongoing issues, my fellow health services researchers offered positivity and direction against the troubling backdrop of public service austerity and Brexit uncertainty.

OPINION: Tonight’s movie is a set in a dystopian future and stars your local A&E department. Dr Tom Monks

If you surf to a news website right now or flick on the TV news this evening, you might for a moment think that you watching a bad science fiction movie of a dystopian future starring your local A&E department. Sadly, it is real. The news has gone mad about A&E and the waiting time crisis that it faces. This morning the BBC reported that only 82% of patients are meeting the four-hour waiting time target. It doesn’t make pleasant reading.

Location, location, location – The social factors making a difference to kidney health.

Many of us don’t fully understand what our kidneys are for or how they work, but they are important to all of us. A team of us a CLAHRC Wessex have been conducting a big research project to find out more about something called ‘Acute kidney injury’, which is when the kidney suddenly stops working properly. This can make people very ill by causing a build-up of waste products in the blood and upsetting the balance of fluids in the body. As a result, people with acute kidney injury can have longer hospital stays and can experience serious consequences, such as needing dialysis or even dying.