Curriculum renewal for interprofessional education in health

In this preface we comment on four matters that we think bode well for the future of interprofessional education in Australia. First, there is a growing articulation, nationally and globally, as to the importance of interprofessional education and its contribution to the development of interprofessional and collaborative health practices. These practices are increasingly recognised as central to delivering effective, efficient, safe and sustainable health services. Second, there is a rapidly growing interest and institutional engagement with interprofessional education as part of pre-registration health professional education. This has changed substantially in recent years. Whilst beyond the scope of our current studies, the need for similar developments in continuing professional development (CPD) for health professionals was a consistent topic in our stakeholder consultations. Third, we observe what might be termed a threshold effect occurring in the area of interprofessional education. Projects that address matters relating to IPE are now far more numerous, visible and discussed in terms of their aggregate outcomes. The impact of this momentum is visible across the higher education sector. Finally, we believe that effective collaboration is a critical mediating process through which the rich resources of disciplinary knowledge and capability are joined to add value to existing health service provision. We trust the conceptual and practical contributions and resources presented and discussed in this report contribute to these developments.Office of Learning and Teaching Australi

A safer place for patients: learning to improve patient safety

1 Every day over one million people are treated successfully by National Health Service (NHS) acute, ambulance and mental health trusts. However, healthcare relies on a range of complex interactions of people, skills, technologies and drugs, and sometimes things do go wrong. For most countries, patient safety is now the key issue in healthcare quality and risk management. The Department of Health (the Department) estimates that one in ten patients admitted to NHS hospitals will be unintentionally harmed, a rate similar to other developed countries. Around 50 per cent of these patient safety incidentsa could have been avoided, if only lessons from previous incidents had been learned. 2 There are numerous stakeholders with a role in keeping patients safe in the NHS, many of whom require trusts to report details of patient safety incidents and near misses to them (Figure 2). However, a number of previous National Audit Office reports have highlighted concerns that the NHS has limited information on the extent and impact of clinical and non-clinical incidents and trusts need to learn from these incidents and share good practice across the NHS more effectively (Appendix 1). 3 In 2000, the Chief Medical Officer’s report An organisation with a memory 1 , identified that the key barriers to reducing the number of patient safety incidents were an organisational culture that inhibited reporting and the lack of a cohesive national system for identifying and sharing lessons learnt. 4 In response, the Department published Building a safer NHS for patients3 detailing plans and a timetable for promoting patient safety. The goal was to encourage improvements in reporting and learning through the development of a new mandatory national reporting scheme for patient safety incidents and near misses. Central to the plan was establishing the National Patient Safety Agency to improve patient safety by reducing the risk of harm through error. The National Patient Safety Agency was expected to: collect and analyse information; assimilate other safety-related information from a variety of existing reporting systems; learn lessons and produce solutions. 5 We therefore examined whether the NHS has been successful in improving the patient safety culture, encouraging reporting and learning from patient safety incidents. Key parts of our approach were a census of 267 NHS acute, ambulance and mental health trusts in Autumn 2004, followed by a re-survey in August 2005 and an omnibus survey of patients (Appendix 2). We also reviewed practices in other industries (Appendix 3) and international healthcare systems (Appendix 4), and the National Patient Safety Agency’s progress in developing its National Reporting and Learning System (Appendix 5) and other related activities (Appendix 6). 6 An organisation with a memory1 was an important milestone in the NHS’s patient safety agenda and marked the drive to improve reporting and learning. At the local level the vast majority of trusts have developed a predominantly open and fair reporting culture but with pockets of blame and scope to improve their strategies for sharing good practice. Indeed in our re-survey we found that local performance had continued to improve with more trusts reporting having an open and fair reporting culture, more trusts with open reporting systems and improvements in perceptions of the levels of under-reporting. At the national level, progress on developing the national reporting system for learning has been slower than set out in the Department’s strategy of 2001 3 and there is a need to improve evaluation and sharing of lessons and solutions by all organisations with a stake in patient safety. There is also no clear system for monitoring that lessons are learned at the local level. Specifically: a The safety culture within trusts is improving, driven largely by the Department’s clinical governance initiative 4 and the development of more effective risk management systems in response to incentives under initiatives such as the NHS Litigation Authority’s Clinical Negligence Scheme for Trusts (Appendix 7). However, trusts are still predominantly reactive in their response to patient safety issues and parts of some organisations still operate a blame culture. b All trusts have established effective reporting systems at the local level, although under-reporting remains a problem within some groups of staff, types of incidents and near misses. The National Patient Safety Agency did not develop and roll out the National Reporting and Learning System by December 2002 as originally envisaged. All trusts were linked to the system by 31 December 2004. By August 2005, at least 35 trusts still had not submitted any data to the National Reporting and Learning System. c Most trusts pointed to specific improvements derived from lessons learnt from their local incident reporting systems, but these are still not widely promulgated, either within or between trusts. The National Patient Safety Agency has provided only limited feedback to trusts of evidence-based solutions or actions derived from the national reporting system. It published its first feedback report from the Patient Safety Observatory in July 2005

Consultancy to progress hospital in the home care provision: Final report, CHERE Project Report No 13

In July 1998, the Commonwealth Department of Health and Family Services commissioned the Centre for Health Economics Research and Evaluation (CHERE) to identify and document Hospital in the Home (HITH) care models nationally and internationally. The purpose of this consultancy was to examine the appropriateness of this form of care for acutely ill patients and to make recommendations about how to increase the utilisation and cost effectiveness of services. Hospital in the Home is emerging internationally and within Australia as a viable alternative form of provision of acute care. The benefits of HITH have generally been seen in terms of its capacity to provide a cost-effective and acceptable alternative to hospital inpatient care, which reduces pressure on hospital beds. However, so far there has only been limited evaluation to lend support to these claims. Over the past decade a wide range of hospital in the home programs have been introduced across the Australian health care system. These programs have often emerged in response to local factors and have a range of different purposes, funding and organisational arrangements, and varying levels of success. In some states hospital in the home has been formalised into a program, whereas in other parts of Australia the introduction of HITH has been left to local decision makers. Thus, the experience of HITH has been extremely variable. It is appropriate at this stage to draw together information about what services are available, how acceptable these services are and what they have achieved. This information is important for determining the future directions of HITH in Australia, as well as providing a valuable resource for service providers and policy makers.Hospital in the home, Australia

New ways of working in acute inpatient care: a case for change

This position paper focuses on the current tensions and challenges of aligning inpatient care with innovations in mental health services. It argues that a cultural shift is required within inpatient services. Obstacles to change including traditional perceptions of the role and responsibilities of the psychiatrist are discussed. The paper urges all staff working in acute care to reflect on the service that they provide, and to consider how the adoption of new ways of working might revolutionise the organisational culture. This cultural shift offers inpatient staff the opportunity to fully utilise their expertise. New ways of working may be perceived as a threat to existing roles and responsibilities or as an exciting opportunity for professional development with increased job satisfaction. Above all, the move to new ways of working, which is gathering pace throughout the UK, could offer service users1 a quality of care that meets their needs and expectations

Reducing hospital associated infection : a role for social marketing

Purpose: Although hand hygiene is seen as the most important method to prevent the transmission of hospital associated infection in the UK, hand hygiene compliance rates appear to remain poor. This research aims to assess the degree to which social marketing methodology can be adopted by a particular organization to promote hand hygiene compliance. Design/Methodology/Approach: The research design is based on a conceptual framework developed from analysis of social marketing literature. Data collection involved taped interviews given by nursing staff working within a specific Hospital Directorate in Manchester, England. Supplementary data was obtained from archival records of the hand hygiene compliance rates. Findings: Findings highlighted gaps in the Directorate’s approach to the promotion of hand hygiene compared to what could be using social marketing methodology. Respondents highlighted how the Directorate failed to fully optimise resources required to endorse hand hygiene practice and this resulted in poorer compliance. Originality/Value: From the experiences and events documented, the study suggests how the emergent phenomena could be utilized by the Directorate to apply a social marketing approach which could positively influence hand hygiene compliance

Patients’ Perspectives on Engaging in Their Healthcare while Hospitalized

Aims and objectives To examine patients’ experiences and preferences for engaging in their healthcare while hospitalised. Background Promoting patient engagement or involvement in healthcare has become an important component of contemporary, consumer‐oriented approaches to quality care. Previous research on patient engagement highlights that preferences for engagement are not assessed while hospitalised, leading to patient role confusion and frustration. Methods Semistructured interviews were conducted with patients from January–March 2017 to examine their experiences and preferences for engaging in their care while hospitalised on medical‐surgical units in the United States. Inductive thematic analysis was used to uncover the themes from the interview transcriptions. The reporting of research findings followed the COREQ checklist. Results Seventeen patients, eight male and nine female, aged between 19–83 years old were interviewed. Patients had a difficult time articulating how they participated in their care while hospitalised, with the majority stating there were few decisions to be made. Many patients felt that decisions were made prior to or during hospitalisation for them. Patients described their engagement through the following themes: sharing the subjective, involvement of family, information‐gathering, constraints, “I let them take care of me,” and variability. Conclusions Engagement is a dual responsibility of both nurses and patients. Patients’ experiences highlight that engagement preferences and experiences are not universal between patients, speaking to the importance of assessing patient preferences for engagement in health care upon hospital admission. Relevance to clinical practice The articulation of what patients actually experience in the hospital setting contributes to improve nursing practice by offering insight into what is important to the patient and how best to engage with them in their care. The constraints that patients reported facing related to their healthcare engagement should be used to inform the delivery of future engagement interventions in the acute care setting

An evaluation of a nurse led unit: an action research study

This study is an exemplar of working in a participatory way with members of the public and health and social care practitioners as co-researchers. A Nurse Consultant Older People working in a nurse-led bed, intermediate care facility in a community hospital acted as joint project lead with an academic researcher. From the outset, members of the public were part of a team of 16 individuals who agreed an evaluation focus and were involved in all stages of the research process from design through to dissemination. An extensive evaluation reflecting all these stakeholders’ preferences was undertaken. Methods included research and audit including: patient and carer satisfaction questionnaire surveys, individual interviews with patients, carers and staff, staff surveys, graffiti board, suggestion box, first impressions questionnaire, patient tracking and a bed census. A key aim of the study has been capacity building of the research team members which has also been evaluated. In terms of impact, the co-researchers have developed research skills and knowledge, grown in confidence, developed in ways that have impacted elsewhere in their lives, developed posters, presented at conferences and gained a better understanding of the NHS. The evaluation itself has provided useful information on the processes and outcomes of intermediate care on the ward which was used to further improve the service