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

Frailty – a team approach to learning. Dr Melinda Taylor and Dr Alex Recio-Saucedo

Dr Melinda Taylor, Senior Research Fellow in Organisational Behaviour, NIHR CLAHRC Wessex Data Science Hub

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The first blog in this series described how health professionals in our study found it difficult to define ‘frailty’ but agreed that it was an extremely broad concept with no defined boundaries. This has an impact on training in frailty care. This second blog outlines our participants’ views on frailty care training.

Our study evaluated particular aspects of four initiatives intended to enhance the care provided to people regarded as frail. The diverse nature of the initiatives further demonstrates the complex nature of frailty.

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.

Dementia care at meal times in acute hospitals – Naomi Gallant

Almost a year on from my last post here and I’ve done a lot of work on my developing my research proposal – reading, learning, literature reviewing – but sadly not a lot has changed for people with dementia in acute hospitals. My desire to improve the quality of care, especially at meal times has certainly grown.

‘There’s no better person to help you than you’ – The missing links in care by Sandy Walker

Could this statement be the one that encapsulates the perception that mental health services are frequently unable to help people with mental health issues?

A research participant in a study I’m conducting into support networks of people with long term mental health problems outlined what she saw as some of the problems with her encounters with health professionals in the mental health system.

NATIONAL CONSULTATION ON EMERGENCY CARE AND TREATMENT PLAN: IMPLICATIONS FOR THE TREATMENT ESCALATION PLAN (TEP) PROJECT? Professor Alison Richardson

Having conversations about the best course of action in the event a person’s condition deteriorates is difficult for everyone involved, whether it is the patient themselves, their family or carer and the clinician.

After an initial study on Advance Care Planning (A. Richardson, S. Lund¹), research into the current application of treatment escalation plans across the country, and early engagement with some of the acute trusts in the Wessex region, it was apparent there was a desire to improve this process.

Maths without equations: Dr Tom Monks insights into patient flow from queuing theory

Previously I have written about using a detailed computer model to ask ‘what-if’ an emergency department could be run differently.   Hidden away in complex models like these are important rules of thumb that tell us how to efficiently manage patient flow.

Getting a grip on high risk older inpatients with low grip strength -Dr Kinda Ibrahim and Dr Helen Roberts, Associate Professor in Geriatric Medicine

Our muscles play an important role in our health and grip strength is a good way of measuring how well our muscles are doing. Our grip strength builds through young adulthood to reach its peak in our 30s after which it gradually tails away. It is a reliable and valid way of evaluating someone’s hand strength, which in turns provides an objective measure of the skeletal muscle strength and function in their whole body.

Evidence Brief – 12 hour shifts: Nurse burnout, job satisfaction & intention to leave – by Chiara Dall’ora

Job satisfaction and burnout in the nursing workforce are global concerns. Not only do job satisfaction and burnout impact on the quality and safety of care, but job satisfaction is also a factor in nurses’ decisions to stay or leave their jobs. Shift patterns may be an important aspect influencing wellbeing and satisfaction among nurses. Many hospitals worldwide are moving to 12 hour shifts in an effort to improve efficiency and cope with nursing shortages. But what is the effect of these work patterns on the wellbeing of nurses working on hospital wards? In this digest we report on the results of a study performed in 12 European countries exploring whether 12 hour shifts are associated with burnout, job satisfaction and intention to leave the job.

The Doctor will see you now: Using models to think about self-management – Professor Anne Kennedy

My colleagues and I recently published a paper which describes how we created a model to show how people with diabetes become less dependent on primary care and more able self-managers.

We used maps created by general practice staff to show how their patients progress through the system following diagnosis.

In the current system, once treatment has been decided on, the frequency of appointments decreases and people are expected to self-manage with support from regular review appointments. Seeing the model and talking it through with GPs and others helped us to consider some of the shortfalls in the system.