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

Medical Staff Services Quality to Patients Satisfaction Based on SERVQUAL Dimensions

Hospital service quality was a degree of discrepancy between patients\u27 perceptions and their expectations about hospitals services. Service quality which was provided by medical staff emphasizes the actual hospital service process. In the hospital, patients\u27 satisfaction could be widely used to determine hospital service quality. The purpose of this study was to analyze the influence of medical staff services quality on patients satisfaction based on SERVQUAL dimensions. This study used an analytic observational design with cross-sectional approach. There were 314 respondents taken from inpatients hospital admission using simple random sampling. Based on regression analysis results, five dimensions of health services quality affect patients\u27 level of satisfaction and obtained the equation of Y = 0.026 + 0.226X1 + 0.332X2 + 0.1X3 + 0.075X4 + 0.235X5, this explained that patients\u27 satisfaction was affected by all dimensions of health service quality (RATER) simultaneously. However, different values will be obtained if all dimensions were measured separately, range from 10% to 33.2%. It could be concluded that patients\u27 satisfaction were influenced by the quality of medical staff services through its five components: reliability, assurance, tangible, empathy and responsiveness

Improving access to health services – Challenges in Lean application

Purpose: Healthcare organisations face significant productivity pressures and are undergoing major service transformation. This paper serves to disseminate findings from a Lean healthcare project using a NHS Single Point of Access environment as the case study. It demonstrates the relevance and extent that Lean can be applied to this type of healthcare service setting. Design/methodology/approach: Action research was applied and Lean tools used to establish current state processes, identify wastes and develop service improvement opportunities based upon defined customer values. Findings: The quality of referral information was found to be the root cause of a number of process wastes and causes of failure for the service. Understanding the relationship and the nature of interaction between the service‟s customer/supplier led to more effective and sustainable service improvement opportunities and the co-creation of value. It was also recognised that not all the Lean principles could be applied to this type of healthcare setting. Practical implications: The study is useful to organisations using Lean to undertake service improvement activities. The paper outlines how extending the value stream beyond the organisation to include suppliers can lead to improved co-production and generation of service value. Originality/value: The study contributes to service productivity research by demonstrating the relevance and limitations of Lean application in a new healthcare service setting. The case study demonstrates the practical challenges of implementing Lean in reciprocal service design models and adds validity to existing contextual models

Developing an Intervention Toolbox for the Common Health Problems in the Workplace

Development of the Health ↔ Work Toolbox is described. The toolbox aims to reduce the workplace impact of common health problems (musculoskeletal, mental health, and stress complaints) by focusing on tackling work-relevant symptoms. Based on biopsychosocial principles this toolbox supplements current approaches by occupying the zone between primary prevention and healthcare. It provides a set of evidence-informed principles and processes (knowledge + tools) for tackling work-relevant common health problems. The toolbox comprises a proactive element aimed at empowering line managers to create good jobs, and a ‘just in time’ responsive element for supporting individuals struggling with a work-relevant health problem. The key intention is helping people with common health problems to maintain work participation. The extensive conceptual and practical development process, including a comprehensive evidence review, produced a functional prototype toolbox that is evidence based and flexible in its use. End-user feedback was mostly positive. Moving the prototype to a fully-fledged internet resource requires specialist design expertise. The Health ↔ Work Toolbox appears to have potential to contribute to the goal of augmenting existing primary prevention strategies and healthcare delivery by providing a more comprehensive workplace approach to constraining sickness absence

Mental Health Service in Ghana: a Review of the Case

Mental health care in Ghana has been fraught with several challenges leading to stagnant growth in mental health service delivery and in some cases a severe depreciation in the nature of care. The Government of Ghana pays little or no attention to mental health care in the country, a situation that has led to poor service delivery in the three major psychiatric hospitals in Ghana. The implementation of the Ghana Mental Act of 2012 has also been faced with major challenges with no significant progress being made. This studytherefore sought to review and document the development of mental health care services in Ghana. Specifically, the study examined the various legislations on mental health that have been enacted in Ghana since 1900; investigated the implementation of the current Mental Health Act of Ghana; found out whether the Ghanaian government has prioritise mental health services in the country and assessed the challenges and problems that confronted mental health services in Ghana since 1900.The study concludes that, since 1888 efforts have been made by various governments to legislate the provision of mental services in Ghana. However, these legislations have not always protected the rights and interest of the mentally ill

Evidence based or person centered? An ontological debate

Evidence based medicine (EBM) is under critical debate, and person centered healthcare (PCH) has been proposed as an improvement. But is PCH offered as a supplement or as a replacement of EBM? Prima facie PCH only concerns the practice of medicine, while the contended features of EBM also include methods and medical model. I here argue that there are good philosophical reasons to see PCH as a radical alternative to the existing medical paradigm of EBM, since the two seem committed to conflicting ontologies. This paper aims to make explicit some of the most fundamental assumptions that motivate EBM and PCH, respectively, in order to show that the choice between them ultimately comes down to ontological preference. While EBM has a solid foundation in positivism, or what I here call Humeanism, PCH is more consistent with causal dispositionalism. I conclude that if there is a paradigmatic revolution on the way in medicine, it is first of all one of ontology

Northumbria Police custody health needs assessment

A health needs assessment of detainees in poilce custody in Northumbri

Evaluating the quality of society and public services

A person’s quality of life is not only shaped by individual choices and behaviour: the surrounding environment and the public services on offer have a big influence on how people perceive the society they live in and on their evaluation of their own quality of life. Institutions influence the quality of society through collective actions that individuals cannot undertake themselves: for example maintaining schools, hospitals and roads. Public policies are also responsible for ensuring that water and air are not polluted, and for reducing tensions between different social groups. If public policies are effective and these services are provided to a high standard, the quality of society will improve, with a positive impact on the overall quality of life of citizens. This is why European policymakers and citizens share a common concern regarding the quality of society and public services: the actions of policymakers should contribute to improving the quality of citizens’ lives. To evaluate whether this is in fact happening, one needs to look beyond objective measures of material wealth such as gross domestic product (GDP) and find out how citizens assess the conditions in their society. The second European Quality of Life Survey (EQLS), carried out by the European Foundation for the Improvement of Living and Working Conditions (Eurofound) in 2007, asks European citizens to evaluate multiple aspects of quality of society. The result is a comprehensive picture of the diverse social realities in the 27 EU Member States, in Norway, Croatia, the former Yugoslav Republic of Macedonia and Turkey