A novel tool for organisational learning and its impact on safety culture in a hospital dispensary

Incident reporting as a key mechanism for organisational learning and the establishment of a stronger safety culture are pillars of the current patient safety movement. Studies have suggested that incident reporting in healthcare does not achieve its full potential due to serious barriers to reporting and that sometimes staff may feel alienated by the process. The aim of the work reported in this paper was to prototype a novel approach to organisational learning that allows an organisation to assess and to monitor the status of processes that often give rise to latent failure conditions in the work environment, and to assess whether and through which mechanisms participation in this approach affects local safety culture. The approach was prototyped in a hospital dispensary using Plan-Do-Study-Act (PDSA) cycles, and the effect on safety culture was described qualitatively through semi-structured interviews. The results suggest that the approach has had a positive effect on the safety culture within the dispensary, and that staff perceive the approach to be useful and usable

The Value Driven Pharmacist: Basics of Access, Cost, and Quality 2nd Edition

https://digitalcommons.butler.edu/butlerbooks/1017/thumbnail.jp

Prison health in NHS Greater Glasgow & Clyde : A health needs assessment 2012

Scotland has one of the highest rates of imprisonment in Western Europe and the prison population is rising [1]. In the last decade the average daily prison population in Scotland increased by 27% [1]. The burden of physical and mental illness in the prison population is high; disproportionately so when compared to the general population [2]. This has variably been attributed to socioeconomic disadvantage and lifestyle and behavioural factors such as substance misuse, smoking and poor nutrition which are common in the prison population [2,3]. Prisoners suffer from multiple deprivation [2,3]. Many are a product of the care system, have experienced physical, emotional or sexual abuse and have difficulties forming and maintaining relationships. Levels of educational attainment are low and unemployment high. Homelessness is common. Prior to incarceration prisoners rarely engage with health care services in the community; during imprisonment demand for health care services is high [3,6,7]. Traditionally health care services in Scottish prisons were provided by the Scottish Prisons Service (SPS). On 1st November 2011 responsibility for the provision of health care to prisoners was transferred from SPS to the National Health Service (NHS). The aim of the transfer was to ensure that prisoners received the same standard of care and range of services as offered to the general population according to need. The guiding principle is that of ‘equivalence’ of care. The aim of this Health Needs Assessment (HNA) was to provide a systematic baseline assessment of the health and health care needs of prisoners in NHS Greater Glasgow and Clyde (NHSGGC) and to identify gaps in the current service provision to inform service future planning and development. It focuses on the two operational publicly owned prisons within NHSGGC: HMP Barlinnie and HMP Greenock. A third prison, HMP Low Moss, falls under the remit of NHSGGC but it was under renovation at the time of this HNA. Information about the prison population was drawn from published literature and reports provided by staff from the Justice and Communities Directorate of the Scottish Government. Information about the prisons from HMP Inspectorate reports, direct observation and interviews with members of staff in each prison. To fully understand the level and nature of existing services a service mapping was undertaken jointly with nominated staff from the prison health teams using direct observation and extensive staff and prisoner interviews and focus groups. Overall the findings are in line with other national and international studies on prison health. Despite characteristic differences between the prisons within NHSGGC there was a high level of consensus amongst both prisoners and staff groups about health needs and priorities. The report acknowledges the thoughtful contribution of prison staff and the positive approach to improving health services that they expressed. This has impacted on the formation of recommendations that both validate existing approaches and identify opportunities and 10 priorities for health gain. In addition to more fundamental changes they identify opportunities for quick wins that do not require significant financial outlay

To investigate the feasibility of predicting, identifying and mitigating latent system failures in a UK NHS paediatric hospital

The aim of this study was to investigate the feasibility of identifying latent system failures in a paediatric National Health Service hospital in the England (NHS). Medicine related errors affect up to 9% of all patients in NHS hospitals. The theoretical basis included error causation theory, the functioning of short-term memory and how the brain manages multiple stimuli. The literature review covered error causation and prevention research, undertaken in healthcare settings and other high-risk industries. The study environment was the dispensary of Birmingham Children’s Hospital (BCH) and a busy ward. The study instrument was non-participant, direct observation of routine dispensing and medicines administration tasks. The first phase identified latent risks in a specific readily observable task set in a specialist paediatric hospital pharmacy department. Having identified a major latent risk, interruption, the investigation then established the significance that interruptions had on operatives. The second phase investigated the efficiency and effectiveness of the current Incident and error reporting system (IR1s) in supporting learning from incidents and changing practice. The first phase identified “interruptions” as a latent error and demonstrated, for what appears to have been the first time in healthcare research, the impact these have on operatives. The second phase confirmed that a gap existed in healthcare error reduction strategies. From the outcomes of the first two phases a completely new strategy, to predict latent system errors and then to reduce them was devised. The strategy was then implemented in another area of the hospital, with different staff, on a high-risk task, IV medicine administration and was shown to reduce medicine errors

Practical Strategies for Pharmacist Integration with Primary Care: A Workbook.

This workbook is a practical set of tips and resources to assist pharmacists in providing clinical pharmacy services to primary care providers and their patients. The content was written based on experiences in Vermont in 2014, however the topics should generalize to pharmacists in other areas

A theoretical exploration of hospital clinical pharmacists' perceptions, experiences and behavioural determinants in relation to provision of optimal and suboptimal pharmaceutical care.

Pharmaceutical care describes a range of patient-focused activities delivered by pharmacists. The activities aim to optimise medicines use for patients and to reduce harm from adverse events with medicines. This study was conducted in an NHS Scotland organisation, where the clinical pharmacy service has an established quality management system. It was evident that some gaps existed in the quality assurance parameters for clinical pharmacy services and pharmaceutical care, with there being no clearly defined route to report adverse events or near misses that arose from within the service. In quality management terms this meant it was difficult to determine whether optimal pharmaceutical care was being delivered, or to establish how accurate clinical pharmacists were in their pharmaceutical care activities. Additionally, this meant it was difficult to evidence areas for quality improvement. This study aimed to explore the perceptions, experiences and behavioural determinants of the hospital clinical pharmacists in relation to optimal and suboptimal pharmaceutical care within an NHS organisation in Scotland using a theoretical framework. The research used the concept of suboptimal pharmaceutical care to describe the gap between pharmaceutical care as intended and pharmaceutical care as delivered. This research used qualitative study design and a phenomenological approach, and was conducted in two phases with the first phase influencing the design of the second phase. In Phase 1, focus group methodology was used to determine perceptions of hospital clinical pharmacists to optimal and suboptimal pharmaceutical care. Study participants (n=20) were hospital clinical pharmacists recruited from hospitals across the NHS Scotland health board. A topic guide focused the discussions on the activities related to medicines reconciliation and Kardex/medicines review. Data generated from focus groups was in the form of written statements and audio-recorded narrative to describe participants' perceptions of barriers and enablers to providing optimal pharmaceutical care. The Theoretical Domains Framework (TDF), an integrative theoretical framework that describes behavioural determinants, was used to analyse the findings. Phase 2 used in-depth interviews to explore participants' (n=10) experiences of optimal and suboptimal pharmaceutical care. A semi-structured interview schedule was developed using TDF, to facilitate identification of behavioural determinants to the provision of optimal and suboptimal pharmaceutical care. Within Phase 1, participants perceived that there were barriers to the delivery of optimal pharmaceutical care, citing as contributory elements time factors, lack of policy and procedure, conflicting priorities (including uncertainty over efficiency versus thoroughness), poor underpinning knowledge of medicines by doctors, and inadequate skills in completing and documenting activities. In Phase 2, key determinants were elicited, including knowledge (of trainees), time, policy, procedure or guidance on suboptimal pharmaceutical care, and personal and professional barriers and enablers, including professional embarrassment and hierarchy. The study has allowed an exploration of an underacknowledged topic in clinical pharmacy practice and identified behaviours, including role uncertainty and embarrassment, that may contribute to lack of reporting on suboptimal pharmaceutical care. Recommendations have been made using behavioural change technique interventions and include educational interventions, skills training, modelling, enablement, persuasion, incentivisation, coercion, restriction and environmental restructuring. Implementation of these interventions and evaluation of their effectiveness will enable the organisation to have more robust quality assurance parameters within the clinical pharmacy service, and to ensure continued conformance with the quality management system. Across the wider clinical pharmacy community, lessons may be learned about perceptions and experiences relating to suboptimal pharmaceutical care, and consideration made to capturing the learning opportunities that can arise when considering suboptimal pharmaceutical care in practice

Market entry in the German pharmaceutical market : a framework for business intelligence measures

Pharmaceutical companies today are under great pressure to successfully launch new specialty drugs, high-tech products for small patient populations with cost intensive R&D and complex mechanisms of effect. At the same time, increasing privacy regulation limits the availability of data for market research in the medical markets, forcing pharmaceutical companies to find ways of creating transparency. Researchers can draw from a large, yet disperse body of literature investigating the factors that favour early adoption of a drug. The thesis introduces Roger’s Diffusion of Innovation framework to organize literature on factors that speed up new product adoption among physicians. The framework is expanded to suit the pharmaceutical markets, especially to differentiate between fixed variables and such that are subject to change during an adoption process. Afterwards different approaches to quantitative diffusion modelling are introduced with an exemplary paper each. The different levels of modelling, from macro-level (national sales) down to micro-level (individual behaviour) are explained. Subsequently, the limitations through German privacy regulation as well as through market specific features on data availability for pharmaceutical market research are presented. A comparison between quantitative diffusion models on different levels with the current privacy regulation shows which analysis approaches might still be feasible. Based on the prior analysis, a quantitative model for drug adoption in the German pharmaceutical market is developed, using Multiple Regression Analysis as the statistical tool. It is found that under some conditions, a very simple two-variable model using the salesforce visits’ and their assessment of a doctor’s adoption behaviour can explain more than 40% of the variance in sales between hospitals. Limited availability of independent data causes the model to be largely influenced through the sales force’s agenda in reporting. Although this data is naturally biased, it seems unlikely that data availability from independent sources will improve in the future. Pharmaceutical companies will need to further utilize their sales force to collaborate with physicians and adapt their incentive systems to live up to the new requirements.nhhma

Sustainability and Spread of Community-based Initiatives: A case study of Community Cares, a Children’s Hospital’s 16 year effort to serve its community

The sustainability and spread of innovations is often elusive, presenting continuous challenges to clinicians and healthcare leaders. Somewhere between 33 - 70% of all innovations are reportedly not sustained, and even fewer are spread beyond the original team, or to other units within an organization. In plain language, sustainability is defined as locking in progress, while continually building upon that foundation, while spread is the exchange of knowledge and experience to others beyond the original implementing team. The literature supports the concept that sustainability is both multi-dimensional and multi-factorial and has several characteristics and pre-conditions. Tax-exempt, not-for-profit organizations in the USA must provide measurable community benefits to the populations they seek to serve. Many of these community benefits take the form of locating necessary services closer to or directly within the communities being served in order to enhance access. A case study of a 16 year effort to provide a medical home-oriented primary care model to underserved children in Houston, Texas Children’s Pediatrics’ Community Cares, is presented as illustrative of such a community benefit. Many of the characteristics and preconditions essential to a model for sustainability and spread are highlighted and the Community Cares case study is discussed from the standpoint of this framework