Knowledge @lert for Tuesday 18th November

November 18, 2014 Daily News

Improving hospital care: are learning organizations the answer?
Sophie Soklaridis
Journal of Health Organization and Management, Volume 28, Issue 6, Page 830-838, November 2014.
Purpose – Hospital leaders are being challenged to become more consumer-oriented, more interprofessional in their approach to care and more focused on outcome measures and continuous quality improvement. The concept of the learning organization could provide the conceptual framework necessary for understanding and addressing these various challenges in a systematic way. The paper aims to discuss these issues. Design/methodology/approach – A scan of the literature reveals that this concept has been applied to hospitals and other health care institutions, but it is not known to what extent this concept has been linked to hospitals and with what outcomes. To bridge this gap, the question of whether learning organizations are the answer to improving hospital care needs to be considered. Hospitals are knowledge-intensive organizations in that there is a need for constant updating of the best available evidence and the latest medical techniques. It is widely acknowledged that learning may become the only sustainable competitive advantage for organizations, including hospitals. Findings – With the increased demand for accountability for quality care, fiscal responsibility and positive patient outcomes, exploring hospitals as learning organizations is timely and highly relevant to senior hospital administrators responsible for integrating best practices, interprofessional care and quality improvement as a primary means of achieving these outcomes. Originality/value – To date, there is a dearth of research on hospitals as learning organizations as it relates to improving hospital care.

Evaluation of aviation-based safety team training in a hospital in The Netherlands

Dirk F. de Korne et al
Journal of Health Organization and Management, Volume 28, Issue 6, Page 731-753, November 2014.
Purpose – The purpose of this paper is to evaluate the implementation of a broad-scale team resource management (TRM) program on safety culture in a Dutch eye hospital, detailing the program’s content and procedures. Aviation-based TRM training is recognized as a useful approach to increase patient safety, but little is known about how it affects safety culture. Design/methodology/approach – Pre- and post-assessments of the hospitals’ safety culture was based on interviews with ophthalmologists, anesthesiologists, residents, nurses, and support staff. Interim observations were made at training sessions and in daily hospital practice. Findings – The program consisted of safety audits of processes and (team) activities, interactive classroom training sessions by aviation experts, a flight simulator session, and video recording of team activities with subsequent feedback. Medical professionals considered aviation experts inspiring role models and respected their non-hierarchical external perspective and focus on medical-technical issues. The post-assessment showed that ophthalmologists and other hospital staff had become increasingly aware of safety issues. The multidisciplinary approach promoted social (team) orientation that replaced the former functionally-oriented culture. The number of reported near-incidents greatly increased; the number of wrong-side surgeries stabilized to a minimum after an initial substantial reduction. Research limitations/implications – The study was observational and the hospital’s variety of efforts to improve safety culture prevented us from establishing a causal relation between improvement and any one specific intervention. Originality/value – Aviation-based TRM training can be a useful to stimulate safety culture in hospitals. Safety and quality improvements are not single treatment interventions but complex socio-technical interventions. A multidisciplinary system approach and focus on “team” instead of “profession” seems both necessary and difficult in hospital care.

Implementing the Friends and Family Test – Nursing Times

McIntyre, Lyn;Davies, Karen;Fox, Carolyn;Taft, June Nursing Times [London] 05 Nov 2014 : pp.12-14

This article discusses the background to the Friends and Family Test, highlighting the commitment to improve the patient experience. It also demonstrates how patient feedback was used to improve services in Aintree University Hospital Foundation Trust.

Are adequate fluid challenges prescribed for severe sepsis?

Michael Courtney et al
International Journal of Health Care Quality Assurance, Volume 27, Issue 8, Page 719-728, October 2014.
Purpose – Managing severe sepsis early has several benefits. Correct early management includes delivering an appropriate fluid challenge. The purpose of this paper is to assess whether junior doctors prescribe adequate fluid challenges to severely septic patients. Design/methodology/approach – A questionnaire outlining three scenarios, each involving a patient with severe sepsis, but with varying weights (50/75/100 kg), was distributed to junior doctors, working in two UK hospitals, managing surgical patients. Participants were asked the fluid volume challenge that they would prescribe for each patient. Responses were compared with the Surviving Sepsis Campaign’s recommended volume during the study (20 ml/kg). Findings – Totally, 77 questionnaires were completed. There were 15/231 (6.5 per cent) correct responses. The median volume chosen in each scenario was 500 ml, equating to 5-10 ml/kg. There was no significant difference between doctor grades (FY1 and SHO) in any scenario. With most junior doctors (FY1), there was no difference in responses according to weight; for SHOs the only significant difference was between the 75 and 100 kg scenarios. Practical implications – Junior doctors are not following guidelines when prescribing fluid challenges to severely septic patients, giving too little and not adjusting volume according to body weight. This implies that high-prevalence, high-mortality conditions are not being treated appropriately by those most likely to treat these patients. More teaching, training and reassessment is required to improve care. Originality/value – This, the first case-based survey the authors could find, highlights an issue requiring significant improvement. The implications are likely to be relevant to clinicians in all UK hospitals.

Improving operating room productivity via parallel anesthesia processing

Michael J. Brown et al
International Journal of Health Care Quality Assurance, Volume 27, Issue 8, Page 697-706, October 2014.
Purpose – Parallel processing of regional anesthesia may improve operating room (OR) efficiency in patients undergoes upper extremity surgical procedures. The purpose of this paper is to evaluate whether performing regional anesthesia outside the OR in parallel increases total cases per day, improve efficiency and productivity. Design/methodology/approach – Data from all adult patients who underwent regional anesthesia as their primary anesthetic for upper extremity surgery over a one-year period were used to develop a simulation model. The model evaluated pure operating modes of regional anesthesia performed within and outside the OR in a parallel manner. The scenarios were used to evaluate how many surgeries could be completed in a standard work day (555 minutes) and assuming a standard three cases per day, what was the predicted end-of-day time overtime. Findings – Modeling results show that parallel processing of regional anesthesia increases the average cases per day for all surgeons included in the study. The average increase was 0.42 surgeries per day. Where it was assumed that three cases per day would be performed by all surgeons, the days going to overtime was reduced by 43 percent with parallel block. The overtime with parallel anesthesia was also projected to be 40 minutes less per day per surgeon. Research limitations/implications – Key limitations include the assumption that all cases used regional anesthesia in the comparisons. Many days may have both regional and general anesthesia. Also, as a case study, single-center research may limit generalizability. Practical implications – Perioperative care providers should consider parallel administration of regional anesthesia where there is a desire to increase daily upper extremity surgical case capacity. Where there are sufficient resources to do parallel anesthesia processing, efficiency and productivity can be significantly improved. Originality/value – Simulation modeling can be an effective tool to show practice change effects at a system-wide level.

Professional medical leadership: a relational training model

Graham Dickson et al
Leadership in Health Services, Volume 27, Issue 4, Page 343-354, September 2014.
Purpose – This paper aims to describe the educational philosophy and practice underpinning the Royal Australasian College of Medical Administrators (RACMA) program and how it is aligned with the needs of the Australian and New Zealand health care systems. Preparing future doctors as medical leaders requires keeping pace with developments in medical education and increased sophistication on the part of teaching and supervising faculty. Design/methodology/approach – This paper is a descriptive case study. The data are complemented by workforce data and excerpts from the RACMA Management and Leadership Curriculum. Findings – The RACMA has developed a program informed by current best practices in medical education. The educational underpinnings and instructional practices of the RACMA emphasize leadership as a collaborative social process and the importance of relational leadership in successful modern day practice. The ongoing development of the program has a focus on setting of clear learning objectives, regular and continuous feedback to trainees and reflective practice facilitated by the close relationship between trainees and their preceptor. Research limitations/implications – Although a site-specific case study, the application of relational models of teaching can be applied in other settings. Practical implications – The application of relational models of teaching can be applied in other settings. Social implications – This paper fulfils a social need to describe successful competency models used for medical leadership development. Originality/value – This paper fulfils an identified need to define competency models used as a foundation for medical leadership development.

Leadership styles used by senior medical leaders

Graham Dickson et al
Leadership in Health Services, Volume 27, Issue 4, Page 283-298, September 2014.
Purpose – The purpose of this study was to determine the predominant leadership styles used by medical leaders and factors influencing leadership style use. Clinician leadership is important in healthcare delivery and service development. The use of different leadership styles in different contexts can influence individual and organisational effectiveness. Design/methodology/approach – A mixed methods approach was used, combining a questionnaire distributed electronically to 224 medical leaders in acute hospital trusts with in-depth “critical incident” interviews with six medical leaders. Questionnaire responses were analysed quantitatively to determine, first, the overall frequency of use of six predefined leadership styles and, second, individual leadership style based on a consultative/decision-making paradigm. Interviews were analysed thematically using both a confirmatory approach with predefined leadership styles as themes, and also an inductive grounded theory approach exploring influencing factors. Findings – Leaders used a range of styles, the predominant styles being democratic, affiliative and authoritative. Although leaders varied in their decision-making authority and consultative tendency, virtually all leaders showed evidence of active leadership. Organisational culture, context, individual propensity and “style history” emerged during the inductive analysis as important factors in determining use of leadership styles by medical leaders. Practical implications – The outcomes of this evaluation are useful for leadership development at the level of the individual, organisation and wider National Health Service (NHS). Originality/value – This study adds to the very limited evidence base on patterns of leadership style use in medical leadership and reports a novel conceptual framework of factors influencing leadership style use by medical leaders.

Embedding physician leadership development within health organizations

Graham Dickson et al
Leadership in Health Services, Volume 27, Issue 4, Page 330-342, September 2014.
Purpose – The purpose of this conceptual paper is to provide strategies on how to embed physician leadership development efforts within health organizations. Design/methodology/approach – Findings from our previous research, which include an extensive literature review and analysis of 53 interviews with representatives from healthcare organizations across the globe, are integrated within the context of the Influencer© framework to provide a useful and grounded tool for physician leadership development strategies. Findings – Physician leadership development strategies are identified for each of the six domains within the Influencer© framework. Practical implications – A number of physician leadership development strategies are provided. They can be used in combination or used independently. Originality/value – Integrating the knowledge gained from practices in health organizations and from the literature within the Influencer© framework is a unique approach and strengthens the usefulness of the identified physician leadership development strategies.

Developing junior doctors as leaders of service improvement

Graham Dickson et al
Leadership in Health Services, Volume 27, Issue 4, Page 316-329, September 2014.
Purpose – This paper aims to provide an overview of the design and initial outcomes of a leadership and service improvement program for junior medical staff. Design/methodology/approach – This paper describes the rationale, initial set-up, structure, program outcomes and future directions of the Medical Service Improvement Program for junior doctors. This program is a recent initiative of the Western Australian public healthcare system. Findings – The Medical Service Improvement Program illustrates a successful approach to developing junior doctors to lead improvements in health service delivery. The program has resulted in tangible personal outcomes for participants, in addition to important organisational outcomes. Practical implications – This paper provides an evidence-based structured approach to developing the leadership abilities of junior medical staff. It provides practical information on the design of the leadership program that aligns the participant learning outcomes to postgraduate medical competencies. The program has demonstrated clear service outcomes, confirming that junior medical staff is both capable and committed to leading service improvement and reform. Originality/value – This paper provides clear evidence for the benefits of providing dedicated non-clinical time for junior medical staff to lead quality and improvement initiatives. This case study will assist hospital administrators, postgraduate education units and those involved in designing and administering clinical leadership development programs.

Supporting Safe Transition For Internationally Educated Health Professionals (IEHPs) Working In The NHS In London – London Postgraduate Medical and Dental Education

This framework aims to provide an overview of the challenges and opportunities which face IEHPs and their educators. The framework is centred around five domains: communicative and cultural capability, clinical capability, professional culture, developing resilience and teaching & learning. It includes links to case studies, podcasts of IEHPs discussing their experiences, and access to online resources for both educators and IEHPs.

Exploring CQC’s well-led domain: How can boards ensure a positive organisational culture? – The King’s Fund 

The five areas that boards should focus on to ensure their organisation is well-led are:

  • inspiring vision – developing a compelling vision and narrative
  • governance – ensuring clear accountabilities and effective processes to measure performance and address concerns
  • leadership, culture and values – developing open and transparent cultures focused on improving quality
  • staff and patient engagement – focusing on engaging all staff and valuing patients’ views and experience
  • learning and innovation – focusing on continuous learning, innovation and improvement.

This paper sets out what boards can do in these five areas and draws on examples of good practice in leadership and culture in health care. It has been written as a practical guide for board members in strengthening leadership and culture.

Going home alone: report and campaign

The Royal Voluntary Service (RVS), with support from the King’s Fund, has published Going Home Alone.  The report suggests that in the last five years almost 200,000 people aged over 75 returned home from hospital without the support they needed to look after themselves and thousands of re admissions could be prevented if they received more help at discharge.  The report advocates that the establishment of Home from Hospital schemes which may benefit people by providing support and practical help and thus reduce the need for hospital readmission.  The report marks the launch of a campaign Let’s End Going Home Alone which sees the RVS work in partnership with communities, local authorities and NHS Trusts to provide more volunteers in hospitals and support vulnerable older people in their homes following discharge from hospital.

Evidence update: Psoriasis

NICE has published a new evidence update Psoriasis (Evidence Update 68).  This is a summary of selected new evidence relevant to NICE clinical guideline 153 ‘The assessment and management of psoriasis’ (2012).  Evidence updates are intended to increase awareness of new evidence they do not replace current NICE guidance and do not provide formal practice recommendations.

Innovation and efficiency

The Department of Health has published the transcript of Health Secretary Jeremy Hunt’s speech to the King’s Fund which was delivered on 13 November 2014. The speech outlines the four pillars of the government’s plan for the NHS and how it intends to make a reality of the NHS England five year forward view.

Bulletins

Knowledge @lert for Wednesday 12th November

Knowledge @lert for Wednesday 19th November