Data integrity: an often-ignored aspect of safety systems: executive summary

Data is all-pervasive and is found in all aspects of modern computer systems, and yet many engineers seem reluctant to recognise the importance of data integrity. The conventional view of data, as simply an aspect of software, underestimates the role played by data errors in the behaviour of the system and their potential effect on the integrity of the overall system. In many cases hazard analysis is not applied to data in the same way that it is applied to other system components. Without data integrity requirements, data development and data provision may not attract the degree of rigour that would be required of other system components of a similar integrity. This omission also has implications for safety assessment where the data is often ignored or neglected. This position becomes self reenforcing, as without integrity requirements the importance of data integrity remains hidden. This research provides a wide-ranging overview of the use (and abuse) of data within safety systems, and proposes a range of strategies and techniques to improve the safety of such systems. A literature review and a survey of industrial practice confirmed the conventional view of data, and showed that there is little consistency in the methods used for data development. To tackle these problems this work proposes a novel paradigm, in which data is considered as a separate and distinct system component. This approach not only ensures that data is given the importance that it deserves, but also simplifies the task of providing guidance that is specific to data. Having developed this conceptual framework for data, the work then goes on to develop lifecycle models to assist with data development, and to propose a range of techniques appropriate for the various lifecycle phases. An important aspect of the development of any safety-related system is the production of a safety argument, and this research looks in some detail at the treatment of data, and data development, within this justification. The industrial survey reveals that in data-intensive systems data is often developed quite separately from other elements of the system. It also reveals that data is often produced by an extended data supply chain that may involve a number of disparate organisations. These characteristics of data distinguish it from other system components and greatly complicate the achievement and demonstration of safety. This research proposes methods of modelling complex data supply chains and proposes techniques for tackling the difficult task of safety justification for such systems

Consumer attitudes towards production diseases in intensive production systems

Many members of the public and important stakeholders operating at the upper end of the food chain, may be unfamiliar with how food is produced, including within modern animal production systems. The intensification of production is becoming increasingly common in modern farming. However, intensive systems are particularly susceptible to production diseases, with potentially negative consequences for farm animal welfare (FAW). Previous research has demonstrated that the public are concerned about FAW, yet there has been little research into attitudes towards production diseases, and their approval of interventions to reduce these. This research explores the public’s attitudes towards, and preferences for, FAW interventions in five European countries (Finland, Germany, Poland, Spain and the UK). An online survey was conducted for broilers (n = 789), layers (n = 790) and pigs (n = 751). Data were analysed by means of Kruskal-Wallis ANOVA, exploratory factor analysis and structural equation modelling. The results suggest that the public have concerns regarding intensive production systems, in relation to FAW, naturalness and the use of antibiotics. The most preferred interventions were the most “proactive” interventions, namely improved housing and hygiene measures. The least preferred interventions were medicine-based, which raised humane animal care and food safety concerns amongst respondents. The results highlighted the influence of the identified concerns, perceived risks and benefits on attitudes and subsequent behavioural intention, and the importance of supply chain stakeholders addressing these concerns in the subsequent communications with the public

Developing minimum clinical standards for physiotherapy in South African ICUs: A qualitative study

Rationale, aims, and objectives: Physiotherapists are integral members of the intensive care unit (ICU) team. Clinicians working in ICU are dependent on their own experience when making decisions regarding individual patient management thus resulting in variation in clinical practice. No formalized clinical practice guidelines or standards exist for the educational profile or scope of practice requirements for ICU physiotherapy. This study explored perceptions of physiotherapists on minimum clinical standards that ICU physiotherapists should adhere to for delivering safe, effective physiotherapy services to critically ill patients. Method: Experienced physiotherapists offering a service to South African ICUs were purposively sampled. Three focus group sessions were held in different parts of the country to ensure national participation. Each was audio recorded. The stimulus question posed was “What is the minimum standard of clinical practice needed by physiotherapists to ensure safe and independent practice in South African ICUs?” Three categories were explored, namely, knowledge, skill, and attributes. Themes and subthemes were developed using the codes identified. An inductive approach to data analysis was used to perform conventional content analysis. Results: Twenty-five physiotherapists participated in 1 of 3 focus group sessions. Mean years of ICU experience was 10.8 years (±7.0; range, 3-33). Three themes emerged from the data namely, integrated medical knowledge, multidisciplinary teamwork, and physiotherapy practice. Integrated medical knowledge related to anatomy and physiology, conditions that patients present with in ICU, the ICU environment, pathology and pathophysiology, and pharmacology. Multidisciplinary teamwork encompassed elements related to communication, continuous professional development, cultural sensitivity, documentation, ethics, professionalism, safety in ICU, and technology. Components related to physiotherapy practice included clinical reasoning, handling skills, interventions, and patient care. Conclusions: The information obtained will be used to inform the development of a list of standards to be presented to the wider national physiotherapy and ICU communities for further consensus-building activities

A framework for measuring quality in the emergency department

There is increasing concern that medical care is of variable quality, with variable outcomes, safety, costs and experience for patients. Despite substantial efforts to improve patient safety, some studies suggest little evidence of reductions in adverse events. Furthermore, there is limited agreement about what outcomes are expected and whether increased expenditure results in a real improvement in outcome or experience. In emergency medicine, many countries have developed specific indicators to help drive improvements in patient care. Most of these are time based and there is a lack of consensus regarding which indicators are high priority and what an appropriate framework for measuring quality should look like

A Review of Best Practices for Monitoring and Improving Inpatient Pediatric Patient Experiences.

ContextAchieving high-quality patient-centered care requires assessing patient and family experiences to identify opportunities for improvement. With the Child Hospital Consumer Assessment of Healthcare Providers and Systems Survey, hospitals can assess performance and make national comparisons of inpatient pediatric experiences. However, using patient and family experience data to improve care remains a challenge.ObjectiveWe reviewed the literature on best practices for monitoring performance and undertaking activities aimed at improving pediatric patient and family experiences of inpatient care.Data sourcesWe searched PubMed, Cumulative Index to Nursing and Allied Health Literature, and PsychINFO.Study selectionWe included (1) English-language peer-reviewed articles published from January 2000 to April 2019; (2) articles based in the United States, United Kingdom, or Canada; (3) articles focused on pediatric inpatient care; (4) articles describing pediatric patient and family experiences; and (5) articles including content on activities aimed at improving patient and family experiences. Our review included 25 articles.Data extractionTwo researchers reviewed the full article and abstracted specific information: country, study aims, setting, design, methods, results, Quality Improvement (QI) initiatives performed, internal reporting description, best practices, lessons learned, barriers, facilitators and study implications for clinical practice, patient-experience data collection, and QI activities. We noted themes across samples and care settings.ResultsWe identified 10 themes of best practice. The 4 most common were (1) use evidence-based approaches, (2) maintain an internal system that communicates information and performance on patient and family experiences to staff and hospital leadership, (3) use experience survey data to initiate and/or evaluate QI interventions, and (4) identify optimal times (eg, discharge) and modes (eg, print) for obtaining patient and family feedback. These correspond to adult inpatient best practices.ConclusionsBoth pediatric and adult inpatient best practices rely on common principles of culture change (such as evidence-based clinical practice), collaborative learning, multidisciplinary teamwork, and building and/or supporting a QI infrastructure that requires time, money, collaboration, data tracking, and monitoring. QI best practices in both pediatric and adult inpatient settings commonly rely on identifying drivers of overall ratings of care, rewarding staff for successful implementation, and creating easy-to-use and easy-to-access planning and QI tools for staff

Hard-to-Employ Parents: A Review of Their Characteristics and the Programs Designed to Serve Their Needs

Many low-income parents with personal challenges that make work difficult (sometimes called the "hard to employ") seek help from the Temporary Assistance for Needy Families (TANF) program, but many do not. The most effective TANF programs offer cash assistance along with services that alleviate barriers and help clients find jobs. Other federal-state programs offer help by providing either generic employment services or specialized services that address particular challenges. Hard-to-employ parents probably fare best when they enroll in TANF and receive a holistic set of supports. A redesigned system should marshal all program resources to provide an integrated system that addresses barriers and supports work simultaneously

A value chain analysis of interventions to control production diseases in the intensive pig production sector

Value chain analysis (VCA) calculated the financial effects on food chain actors of interventions to improve animal health and welfare in the intensive pig sector. Two interventions to reduce production diseases were studied. A generic chain diagram of linkages between stakeholders and value-added dimensions was designed. Data on structure and financial performance were collected for the sector. The production parameters and financial effects of the interventions were then described to illustrate impact on the supply chain. The effects of the interventions were also assessed at market level using economic welfare analysis. The sectors in Finland and the UK are small in farm numbers and few companies produced much of the output in a largely vertically-integrated structure. The most beneficial intervention in financial terms to farmers was improved hygiene in pig fattening (around +50% in gross margin). It was calculated to reduce the consumer price for pig meat by up to 5% when applied at large, whereas for improved management measures, it would reduce consumer price by less than 0.5%. However, the latter added value also through food quality attributes. We show that good hygiene and animal care can add value. However, evaluation of the financial and social viability of the interventions is needed to decide what interventions are adopted. The structure of supply chains influences which policy measures could be applied. Of the two interventions, improved pig hygiene had the largest potential to improve efficiency and reduce costs. The studied interventions can also provide new business opportunities to farms, slaughterhouses and food sector companies. More evidence is needed to support public policies and business decision-making in the sector. For this, evidence on consumer attitudes to production diseases is needed. Nevertheless, the study makes an important contribution by showing how improvements in health and welfare benefit the whole chain