Utilisation of LEAN Start Up methodology for the identification, development, and pilot of novel services that red cell immunohaematology can provide hospital transfusion laboratories

Introduction Service development is improved by customer input. LEAN Startup streamlines collective idea creation in extreme uncertainty, providing collaboration to match a service to customer wants. Uncertainty brought by pathology networks prompted Red Cell Immunohaematology (RCI) to use LEAN Startup to develop services beyond its traditional testing role with the Bristol Royal Infirmary (BRI). Methods The Value Proposition Canvas (VPC) Customer Profile, Kano model and the Business Model Canvas (BMC) identified themes and attributes for new service provision. The VPC Customer Profile identified the BRIs jobs, pains, and gains. Process mapping gathered data relating to: (i) ISO15189 vertical audit training and completion; (ii) Sample verification, automation, and manual crossmatch processes. Online Miro based events allowed redesign of processes. Results Three themes were identified (i) Quality assurance – Enables a self-sufficient laboratory, provides centralised document control, facilitates compliance; (ii) LEAN Laboratory – Part of daily practice, (iii) Training – Demonstrates effectiveness of a cross-organisational platform for competency. The VPC Value Map and BMC resulted with the Laboratory Solution Development Platform to support hospital partner service provision. The Build-Measure-Learn cycle resulted in three options: (1) The hospital partner bespoke service; (2) The hospital and RCI full partnership bespoke service (3) RCI led generic template service. Option 2 targeted two job themes: (i) Vertical audit training and completion to meet ISO15189 accreditation requirement. New training material was created. A new audit process allowed planning, process observation and report generation; (ii) Improve process flow. The laboratory layout was sub-optimal. A new layout reduced process waste, improved patient safety and blood readiness. Conclusion LEAN Startup principles and related business tools allowed identification, development, and pilot of a service beyond RCIs traditional testing role. Benefits were related to: A better understanding of the current market; An improved relationship between RCI and hospital; Empowerment of the HTL; improved patient safety and treatment times

Patient Safety: Preventing Patient Harm and Building Capacity for Patient Safety

Patient safety is a global public health concern. It is a health care discipline with ever evolving advancement and complexity resulting in consequential rise in patient harm. Since the pandemic, patient safety has been threatened even more by laying bare the inadequacies of health systems. Many unsafe care practices, risks, and errors contribute to patient harm and overall economic burden. These include medical, diagnostic, and radiation errors, healthcare associated infections, unsafe surgical procedures and transfusion practices, sepsis, venous thromboembolism, and falls. Although patient safety has become an integral part of the healthcare delivery model and resources have been dedicated towards it, much still needs to be achieved. An attitude of inclusivity for all care teams and anyone in contact with the patient, including the patients themselves, would enhance patient safety. Incorporating this attitude from educational infancy will allow for better identification of medical errors and inculcate critical analysis of process improvement. Implementing the ‘Just Culture’ by health care organizations can build the infrastructure to eliminate avoidable harm. To reduce avoidable harm and improve safety, a constant flow of information and knowledge should be available to mitigate the risks. Lastly, proper communication and effective leadership can play an imperative role to engage stakeholders and reduce harm

Extending learning opportunities: a framework for self-evaluation in study support

The Extending Learning Opportunities (ELO) framework for selfevaluation in study support is a tool to use when quality assuring learning opportunities for children and young people outside of normal lesson time. This framework is a revised edition of the ELO (2009) DCSF publication. It provides a framework for all schools, and school consortiums including Complementary Supplementary Schools, Children’s Centres, Playing for Success (PfS) centres, Higher Education Institutions (HEIs) and organisations such as libraries, museums, galleries, theatres, including youth and community/volunteer projects that offer a structured learning programmes to young people, to extend and enhance their provision and so to improve their outcomes. It is based on self–evaluation and sets out criteria against which schools, HEIs and other organisations, can review their extended provision, the planning and practices which support it and the overall ethos which supports learning. The criteria, which take the form of Key Indicators, are at three levels: Emerged, Established and Advanced

Improving the analysis and use of patient complaints in the English National Health Service

The English National Health Service (NHS) receives over 200,000 patient complaints annually. Complaints provide rich narratives of poor and unsafe care, and are often submitted with the aim of preventing harm from occurring to others. Inquiries into safety failures have demonstrated that complaints signal problems where internal systems fail. Yet, their insights remain underutilised due to their complex unstructured nature, a disregard for their informational value, and a complaints process designed for case-by-case redress. This work develops evidence-based and theory-informed approaches towards improving the analysis and use of complaints in the English NHS. Using process modelling and realist review methods, this thesis generates theory on how and under what conditions healthcare settings can achieve both case-by-case redress and system-wide analysis of complaints. Findings identify the need for a robust coding taxonomy to detect systemic problems with healthcare delivery, and support the prioritisation of deeper qualitative analysis and investigation. The inter-rater reliability of the existing NHS complaints reporting scheme ‘KO41a’ is tested across four NHS Trusts, and compared to the psychometrically robust and theory-informed Healthcare Complaints Analysis Tool (HCAT). Results highlight the limited discriminative value of KO41a, and indicate HCAT as a reliable alternative in most investigated settings. Drawing from social science approaches to safety, the final study conducts data linkage and narrative analysis of complaints and staff incident reports, and demonstrates the contributions of using complainants’ interpretation and sense-making of adverse events to test, challenge, and complement staff representations of the causes and severity of harm. Collectively, the work in this thesis demonstrates why patient and staff perspectives need to be combined for a more holistic understanding of patient safety, and provides a pragmatic, evidence-based pathway towards integrating complaints into the historically staff-driven quality monitoring and improvement systems.Open Acces

Diverse Approaches to Developing and Implementing Competency-based ICT Training for Teachers: A Case Study

In this highly connected and rapidly changing world, there is no doubt that teachers play a key role in successfully integrating ICT into education. Realizing the importance of teachers’ capacity to do this, governments, teacher education institutions, the private sector, and NGOs alike provide training opportunities – ranging from the skills needed to use a particular software, to integrating educational technologies, to innovating teaching to promote 21st century skills. However, more often than not, teachers’ actual use of ICT in the classroom is reported as incremental, merely reinforcing traditional teacher-centred approaches by using slides and drill-and-practice exercises. Teachers’ use of ICT to actually innovate teaching is an exception rather than the norm. From the policy perspective, facilitating ICT-pedagogy integration in school education takes more than sporadic professional development, requiring more systematic policy-level changes to create an enabling environment. Research also shows that an essential condition to foster innovative teaching and learning is a close alignment between what the policy envisions and what actually happens in the classrooms. Inadequate monitoring of teachers’ development and their integration practices of ICT have also been raised as reoccurring concerns. With the formal adoption of the 2030 Agenda for Sustainable Development at the United Nations General Assembly in September 2015, Member States are asked to abide by the Education 2030 Framework for Action that underscores the central role of teachers in achieving the new set of education goals. In line with this Framework, all governments are enjoined to ensure that by 2030, all learners are taught by qualified, professionally trained, motivated, committed, and wellsupported teachers who use relevant pedagogical approaches. Accordingly, one of the major focus areas for the governments is equipping teachers with the competencies through quality teacher training and continuous professional development, alongside favourable working conditions and appropriate support. In response to this, UNESCO Bangkok has implemented the ‘Supporting Competency-Based Teacher Training Reforms to Facilitate ICT-Pedagogy Integration’ project. Supported by Korean Funds-inTrust, this project encourages governments to enact systematic policy-level changes. They include reforming teacher training and professional development programmes into competency-based ones, whereby teacher development is systematically guided, assessed, monitored and tracked at policy and institutional levels. As part of the project, UNESCO Bangkok gathered four exemplary cases which took diverse approaches to developing and implementing competency-based ICT training and development for teachers. This publication is to take stock of different frameworks, models, processes, and reference materials that are used in developing and implementing national ICT competency standards for teachers and to provide step-by-step references for countries or organisations that wish to develop and implement competency-based teacher training and development. We hope that this collection of case studies, with varying approaches, will provide policy-makers with sufficient background and models to develop and implement ICT competency standards for teachers within their respective contextsUNESCO, Korean Funds-in-Trus

Contemporary Topics in Patient Safety

As healthcare systems continue to evolve, it is clear that providing safe, high-quality care to patients is an extremely complex process. Ranging from multi-disciplinary teams to bedside care, virtually every aspect of the patient-care experience provides us with an opportunity for doing things better, from improving efficiency, safety, and overall outcomes to reducing costs and promoting team synergy. This book, the fifth in our patient safety series collection, consists of chapters that help explore key concepts related to both the safety and quality of care. In a departure from the vignette-driven format of our earlier books, this installment gravitates toward discussing frameworks, theoretical considerations, team-centric approaches, and a variety of other concepts that are critical to both our understanding and the implementation of safer and better-performing health systems. We also feel that the knowledge presented herein increasingly applies across the world, especially as global health systems evolve and mature over time. It is our goal to improve the recognition of potential opportunities that will highlight various aspects of the delivery of healthcare and thus contribute to better patient experiences, with safety at the forefront. Topics covered in this volume, as well as the previous volumes, highlight the critical importance of identifying and addressing opportunities for improvement, not as one-time events, but rather as continuous, hardwired institutional processes

Testing accelerated experience-based co-design : a qualitative study of using a national archive of patient experience narrative interviews to promote rapid patient-centred service improvement

BACKGROUND: Measuring, understanding and improving patients’ experiences is of central importance to health care systems, but there is debate about the best methods for gathering and understanding patient experiences and how to then use them to improve care. Experience-based co-design (EBCD) has been evaluated as a successful approach to quality improvement in health care, drawing on video narrative interviews with local patients and involving them as equal partners in co-designing quality improvements. However, the time and cost involved have been reported as a barrier to adoption. The Health Experiences Research Group at the University of Oxford collects and analyses video and audio-recorded interviews with people about their experiences of illness. It now has a national archive of around 3000 interviews, covering around 75 different conditions or topics. Selected extracts from these interviews are disseminated for a lay audience on www.healthtalkonline.org. In this study, we set out to investigate whether or not this archive of interviews could replace the need for discovery interviews with local patients. OBJECTIVES: To use a national video and audio archive of patient experience narratives to develop, test and evaluate a rapid patient-centred service improvement approach (‘accelerated experience-based co-design’ or AEBCD). By using national rather than local patient interviews, we aimed to halve the overall cycle from 12 to 6 months, allowing for EBCD to be conducted in two clinical pathways rather than one. We observed how this affected the process and outcomes of the intervention. DESIGN: The intervention was an adapted form of EBCD, a participatory action research approach in which patients and staff work together to identify and implement quality improvements. The intervention retained all six components of EBCD, but used national trigger films, shortened the time frame and employed local service improvement facilitators. An ethnographic process evaluation was conducted, including observations, interviews, questionnaires, cost and documentary analysis including previous EBCD evaluation reports. SETTING: Intensive care and lung cancer services in two English NHS hospital trusts (Royal Berkshire and Royal Brompton and Harefield). PARTICIPANTS: Ninety-six clinical staff (primarily nursing and medical) and 63 patients and family members. INTERVENTION: For this accelerated intervention, the trigger film was derived from pre-existing national patient experience interviews. Local facilitators conducted staff discovery interviews. Thereafter, the process followed the usual EBCD pattern: the film was shown to local patients in a workshop meeting, and staff had a separate meeting to discuss the results of their feedback. Staff and patients then came together in a further workshop to view the film, agree priorities for improvement and set up co-design working groups to take these priorities forward. RESULTS: The accelerated approach proved readily acceptable to staff and patients; using films of national rather than local narratives did not adversely affect local NHS staff engagement, and may in some cases have made the process less threatening or challenging. Local patients felt that the national films generally reflected important themes, although a minority felt that they were more negative than their own personal experience. However, they served their purpose as a ‘trigger’ to discussion, and the resulting 48 co-design activities across the four pathways were similar in nature to those in EBCD but achieved at reduced cost. AEBCD was nearly half the cost of EBCD. However, where a trigger film already exists, pathways can be implemented for as little as 40% of the cost of traditional EBCD. It was not necessary to do additional work locally to supplement the national interviews. The intervention carried a ‘cost’ in terms of heavy workload and intensive activity for the local facilitators, but also brought benefits in terms of staff development/capacity-building. Furthermore, as in previous EBCDs, the approach was subsequently adopted in other clinical pathways in the trusts. CONCLUSIONS: Accelerated experience-based co-design delivered an accelerated version of EBCD, generating a comparable set of improvement activities. The national film acted as an effective trigger to the co-design process. Based on the results of the evaluation, AEBCD offers a rigorous and effective patient-centred quality improvement approach. We aim to develop further trigger films from the archived material as resources permit, and to investigate different ways of conducting the analysis (e.g. involving patients in doing the analysis)

Electronic recording and reporting for tuberculosis care and control

"This guide on electronic recording and reporting is the result of a major collaborative effort involving 9 agencies and institutions and 21 individuals. This document was funded by the United States Agency for International Development under the USAID Tuberculosis CARE I, Cooperative Agreement No. AID-OAA-A-10-000020. Development of the guide was led by the World Health Organization (WHO) in close cooperation with the KNCV Tuberculosis Foundation (KNCV) and Management Sciences for Health (MSH). Hazim Timimi in the WHO Stop TB Department\ue2\u20ac\u2122s TB monitoring and evaluation team coordinated the production of the document, under the guidance of Katherine Floyd and Philippe Glaziou." --p. v"Adopting electronic recording and reporting is not simply about choosing a piece of software: it is also about changing how people work. This is not a simple undertaking. This document introduces the key questions to be considered and illustrates what the questions, options and recommendations mean in practice by drawing on examples of recent experience from a variety of countries. It is an essential resource for all those planning to introduce electronic recording and reporting systems for TB care and control, or to enhance existing systems."--p. [4] of cover.1. Identifying general requirements -- 2. Identifying detailed requirements -- 3. Selecting a solution -- 4. Implementing an electronic recording and reporting system -- Annex 1. Development of this document.Also available online.Includes bibliographical references