A systems approach to identifying patient safety problems in arterial surgery

In the face of the oft-quoted dictum ‘primum non nocere’, it is now widely recognised that a significant number of patients come to harm whilst in hospital. A large body of evidence demonstrates that half of all harm events are preventable and the operating theatre appears to be the most common site for adverse events to occur. For patients undergoing arterial intervention, technical expertise and risk-factor management are clearly important in achieving excellent outcomes. Recent research in vascular surgery has focussed on volume-outcome relationships and the impact of advancements in endovascular intervention. By contrast, there is a relative lack of research examining the extraordinarily complex system within which patients with arterial disease are treated. This thesis aims to develop a broad understanding of system failures and their relationship with patient safety and outcomes in arterial surgery in the British NHS. In section I (chapter 1 and 2) the systems approach is outlined and discussed and the rationale for adopting this approach in arterial surgery is provided. Section II consists of three exploratory studies: chapter 3 presents a systematic review of the literature examining the impact of system factors on safety in arterial surgery; chapter 4 reports a mixed-methods study exploring surgeons’ perceptions of the causes of adverse events in arterial surgery; and chapter 5 presents a multi-centre study of safety culture in vascular operating departments in England. Section III provides an account of the LEAP study: a multi-centre study of system failures occurring during aortic intervention. The methods and main findings of the LEAP study are presented in chapters 6 and 7. Chapter 8 reports on the determinants of intraoperative system failures and the relationship between intraoperative failure and patient outcome. Chapter 9 summarises the main findings and limitations of this thesis, and discusses recommendations for practice and future research.Open Acces

Instilling reflective practice – The use of an online portfolio in innovative optometric education Accepted as: e‐poster Paper no. 098

At UCLAN we are breaking the mould and have developed a blended learning MSci optometry programme which is the first blended learning course in optometric education in the UK and the first to use a practice-based online portfolio. Optometry has traditionally been taught as a 3‐year undergraduate programme. Upon successful graduation, students are required to complete a year in practice and meet the General Optical Council's (GOC) “ability to” core competencies. However, a recent study by the GOC found that 76% of students felt unprepared for professional practice with insufficient clinical experience and in response, the GOC is currently undertaking an educational strategic review. To ensure the students receive high-quality clinical experience in the workplace, we have developed an online logbook and portfolio. Students log their experiences, learning points and reflections. The portfolio is closely monitored both by the student's mentor in practice and by academic staff. The content and reflections logged by the students then helps to drive the face to face teaching, small group discussions and clinical experiences provided by the university

Diagnostic Fluidity: Working with Uncertainty and Mutability

Diagnostic procedures are emblematic of medical work. Scholars in the field of social studies of medicine identify diverse dimensions of diagnosis that point to controversies, processual qualities and contested evidence. In this anthology, diagnostic fluidity is seen to permeate diagnostic work in a wide range of contexts, from medical interactions in the clinic, domestic settings and other relations of affective work, to organizational structures, and in historical developments. The contributors demonstrate, each in their own way, how different agents ‘do diagnosis’, highlighting the multi-faceted elements of uncertainty and mutability integral to diagnostic work. At the same time, the contributors also show how in ‘doing diagnosis’ enactments of subjectivities, representations of cultural imaginaries, bodily processes, and socio-cultural changes contribute to configuring diagnostic fluidity in significant ways

The adoption of healthcare information systems within public hospitals in Kurdistan region of Iraq

In Iraq, government reports stated that the ‎adoption of Healthcare Information Systems ‎‎(HIS) is still low and below the aspirations of the ‎government despite the investments in the system ‎development. For this reason, there was a need to ‎explore and investigate the actual issues that ‎influence the adoption of HIS, and to examine the ‎effect of different dimensions (i.e. the individual, ‎technological, organizational and environmental) ‎on the adoption of HIS in Iraq. The main objective of the study is to explore the ‎factors that affect the adoption of HIS among ‎healthcare practitioners within Kurdistan Region ‎of Iraq (KRI) public hospitals. Furthermore, ‎another goal was to examine the influence of ‎different dimensions on the healthcare ‎practitioners’ adoption behavior in order to ‎produce the essential knowledge regarding HIS ‎adoption. The study used a mixed method approach. The ‎data collection started with a qualitative study ‎using semi-structured interviews with eight ‎healthcare professionals and then followed by a ‎quantitative study that was conducted among 551 ‎respondents using self-administered ‎questionnaires. The qualitative study resulted in 26 themes that ‎were elicited from the interviews. Moreover, the ‎findings of the quantitative study indicated that ‎the adoption of HIS was significantly influenced ‎by different individual, technological, ‎organizational and the environmental dimensions ‎collectively. The study revealed the actual issues (i.e. the ‎individual, technological, organizational and ‎environmental) facing the adoption of HIS within ‎the study’s new context through the qualitative ‎investigation. Moreover, a comprehensive and ‎holistic model based on the Unified Theory of ‎Acceptance and Use of Technology (UTAUT) ‎was presented. The study presented the essential ‎knowledge and information to the literature, ‎healthcare practitioners and researchers in Iraq ‎regarding the issue of HIS adoptio

Changing professional landscapes : the influence of education on the origin and evolution of radiography advanced practice

Throughout the twentieth century clear professional demarcations have existed between the professions of radiography and radiology in respect of the nature of practitioners' work and responsibilities. Yet, in the last two decades, an extended scope of radiography practice has begun to blur traditional professional boundaries. In particular, the concept of advanced practice in radiography has the potential to improve the quality and quantity of services available for the benefit of patients. This thesis presents thirteen works published between 1998 and 2009, which collectively explore this changing professional landscape. Critical analysis of the contribution of the published works via extensive literature review, book reviews and citation / download analysis, demonstrated their utility and impact. The published works offer a distinctive and original contribution that supports the general development of radiography advanced practice, and in particular the emerging subspecialty of gastrointestinal imaging. Thematic analysis of the published works reveals their contribution to knowledge and understanding of radiography advanced practice in respect to the following themes: the drivers and barriers to implementation; the consequences of advanced practice; dissemination of advanced practice both within the United Kingdom and overseas; the influence of education; the required knowledge base, teaching, learning and assessment. The published works demonstrate that the concept of advanced practice has now been embraced within the UK radiography workforce, with increasing international interest in adopting practices pioneered by radiographers within the United Kingdom. The importance of reliable evidence for the success (or otherwise) of these emerging radiographer roles, coupled with the creation of relevant educational materials to support knowledge and skills development, is not to be underestimated if the contemporary professional landscape, to which this thesis contributes, is to significantly benefit patient care. The published works are displayed in full within Volume 2 of the thesis. Each published work, listed in Table 1 of Volume 2, is accompanied by a one page summary sheet