Planning and implementing safety management systems

This thesis describes a study of the content and applicability of BS8800:1996 Guide to occupational health and safety management systems. The research is presented chronologically, with literature review and content analysis of SMS related guides and standards interwoven with two elements of qualitative empirical work. The first of these was carried out shortly after publication of BS8800 in 1996, a 'before-the-event' investigation of how organisations were intending to approach SMS implementation. The challenges faced by these organisations are reviewed against standard management theory, suggesting that the initial motivation for SMS implementation governs the approach organisations will adopt to guidance such as BS8800. The second phase of empirical work was undertaken in the context of OHSAS 18001, an auditable protocol based on BS8800, which allows organisations to certify their safety management systems. A discussion of the evolution of certifiable safety management system is presented, highlighting the similarities and differences between this, BS8800, SMS and wider management system standards. A case study then reviews the experiences of a catering company that implemented 18001, motivated by the opportunity for certification as a business benefit. The empirical work is used to comment on the guidance provided by BS8800, within its evolved role as guidance organisations may use for implementation of a SMS to be certified according to the specifications of OHSAS 18001. It is suggested that optimal implementation is facilitated by initial status review, continual improvement and the use of annexes, where there are used to make changes to the existing safety management system. This thesis concludes with a discussion of these elements, highlighting pertinent areas within BS8800 where revision or amendment may be appropriate

Patient Reported Experience of Kidney Care in the UK 2019

We are pleased to present the 2019 Kidney Patient Reported Experience Measure report (Kidney PREM). Following the initial pilot in 2016, involving over 8,000 people living with kidney disease, participation has continued to grow and the measure is now collected right across the UK and the number of responses has doubled with over 16,000 patients giving their views on their care experience.This unique source of data has been recognised and used throughout the renal community as the international drive for person-centred outcome data across the healthcare system gains momentum. The UK Kidney community is proud to be a part of this international work towards better understanding and improving patient experience.More importantly, our vision of the Kidney PREM is that it is used as a driver for change at a local level. We know the top-level scores are not the full story and that improvement, particularly around the three lower scoring themes - shared decision making, transport and needling - is complicated. There are no easy answers, however, there are some centres who are getting it right and we would like to better understand why this is and what they are doing that could be shared. The working group behind delivering the Kidney PREM continues to work hard to gain a better understanding of the many questions that the Kidney PREM throws up - What is it about a centre that causes it to have the biggest impact on patient experience compared to the other variables collected? Does the Kidney PREM result in an improvement in patient experience? If so, can this improvement be translated to different settings? We do not want the Kidney PREM to stand still. Through research projects, consultation and our own quality improvement, we hope the data and community response to the Kidney PREM will continue to evolve so that it remains meaningful, embedded across the system, and improves the experience and outcomes of people living with Kidney disease, as well as those who care for them in the UK. Thank you for being a part of it.Final Published versio

Patient Reported Experience of Kidney Care in the UK 2020

Headline findings in 2020 • Encouragingly, despite the global pandemic, patients continue to rate their Overall Experience of the service provided by their renal centre highly. • Patient reported experience of Support and Sharing Decisions About Your Care fell in 2020. • Patient scores for Support fell amongst Chronic Kidney Disease (CKD), peritoneal dialysis, home haemodialysis and transplant patients compared to 2019. • Patient experience of Sharing Decisions About Your Care was lowest in those receiving in-centre or in-satellite haemodialysis. • Patient reported experience of Transport improved for in-centre and in-satellite haemodialysis patients in 2020. • The experience of patients living with CKD but not receiving renal replacement therapy notably decreased in 2020 compared to 2019, particularly for Overall Experience, Support and How the Team Treats You

Nutritional and Non-nutritional Strategies in Bodybuilding: Impact on Kidney Function

© 2022 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/)Bodybuilders routinely engage in many dietary and other practices purported to be harmful to kidney health. The development of acute kidney injury, focal segmental glomerular sclerosis (FSGS) and nephrocalcinosis may be particular risks. There is little evidence that high-protein diets and moderate creatine supplementation pose risks to individuals with normal kidney function though long-term high protein intake in those with underlying impairment of kidney function is inadvisable. The links between anabolic androgenic steroid use and FSGS are stronger, and there are undoubted dangers of nephrocalcinosis in those taking high doses of vitamins A, D and E. Dehydrating practices, including diuretic misuse, and NSAID use also carry potential risks. It is difficult to predict the effects of multiple practices carried out in concert. Investigations into subclinical kidney damage associated with these practices have rarely been undertaken. Future research is warranted to identify the clinical and subclinical harm associated with individual practices and combinations to enable appropriate and timely advicePeer reviewedFinal Published versio

Improving patient experience of kidney care, one comment at a time: A mixed methods analysis of Kidney PREM 2020 patient comments

Peer reviewedFinal Published versio

Patient Reported Experience of Kidney Care in the UK 2021

Headline findings • 12,416 people with kidney disease, from all 68 treating centres in the UK, took part in Kidney PREM this year, largely online. • Overall experience of kidney care continues to be rated highly, with many patients who provided a written comment thanking staff for their commitment and efforts. • For four in five participants, overall experience of kidney care stayed the same or was better during the last year of COVID-19. People with a transplant and those with CKD are more likely than those receiving dialysis to report a worse experience of kidney care over the last year. • Privacy and Dignity, Patient Information and Access to the Renal Team continue to be high scoring and are the most consistent regardless of treatment. • Experience of Communication between members of the renal unit team and people with kidney disease was scored far higher than communication between members of the renal team and GPs. • Patient reported experience of Sharing Decisions About Your Care is particularly low scoring, with greater variability in experience between centres and across treatment types. More than half of those on haemodialysis have not been invited to take part in tasks of haemodialysis care, or do not know if they have. • Broadly half of those receiving in-centre or in-satellite haemodialysis say that staff always Needle their fistula or graft with as little pain as possible; this remains a low scoring area with considerable range between centres. • People receiving peritoneal dialysis and home haemodialysis report improved experience of Support from the renal unit team with treatment this year, compared to those receiving in-centre haemodialysis. Support in general continues to be a low scoring theme, notably lower than in 2019. • Experience of Advice on Fluid Intake scores higher than Advice on Diet, and both are rated higher by those receiving dialysis than people with CKD or in receipt of a transplant. • People receiving peritoneal dialysis report improved experience of Tests, with results being returned more quickly; this has worsened for those with a transplant and remains relatively low for people receiving in-centre haemodialysis. Half of respondents do not always understand their test results. • Patient reported experience of Transport continues to be scored better compared to scores in 2019. As in previous years, Transport is one of the lowest scoring aspects of kidney care experience. • People with CKD report relatively poorer experiences than people on kidney replacement therapy; the median (middle) score awarded for overall experience decreased to 6.0 from 7.0 in 2020 and remains there this year

THE EXPERIENCE OF CHRONIC KIDNEY DISEASE PATIENTS: THE RESULTS OF THE 2017 UK RENAL REGISTRY / KIDNEY CARE UK CHRONIC KIDNEY DISEASE PATIENT REPORTED EXPERIENCE MEASURE

© 2018 The Author(s). This an open access work distributed under the terms of the Creative Commons Attribution Licence (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.PURPOSE: The UK Renal Registry (UKRR) and Kidney Care UK’s (KCUK) Chronic Kidney Disease Patient Reported Experience Measure (CKDPREM) was developed by patients, academics and clinicians in 2016. The CKDPREM was designed to provide clinical directors with information about their services from the user perspective, inform quality improvement initiatives and contribute to research. Following a pilot of over 8,000 patients in 2016, and subsequent validation, the UKRR surveyed renal units in 2017 using the revised CKDPREM; this abstract reports the results. METHODS: CKDPREM consists of 50 items across 13 domains covering patient experience of their renal unit, kidney disease and treatment. There are six demographic questions including age, sex, ethnicity and modality. The CKDPREM was distributed to all renal units in England and Wales in July 2017, with accompanying survey guidance and support provided to invite outpatient, pre-dialysis, dialysis and transplant renal patients to complete the CKDPREM online or in hard copy format. The survey was provided online in Welsh, Gujarati and Urdu as well as in English. Patients participated anonymously, returning hard copy CKDPREMs to their unit in return boxes or directly to the UKRR by post. Experience was scored on a scale of 1 (negative) to 7 (positive), and the mean score for all questions was estimated for each respondent. Analysis was conducted at individual unit and aggregate centre level (aggregate being the main hospital and all of its satellite units). Unit and centre means were estimated across respondents for that unit or centre. Patient characteristics were evaluated by comparing mean scores, and via regression models.RESULTS11,027 analysable responses to the CKDPREM were received from 56 centres incorporating 231 units in total. Demographically, respondents represented the patient population as a whole, although there were relatively low numbers of respondents in the pre-dialysis (15%) and transplant (14%) groups. Patient experience was high (6.3 out of 7) but with significant variation between centres. The largest variation was seen in Fluid and Diet (20%), Sharing Decisions (21%), Needling (29%, a new domain) and Transport (52%). More consistent experience was reported by patients for Access to the Team (11%), Privacy and Dignity (13%), and Scheduling and Planning (10%), however the mean difference between the best and worst centre remains greater than 10%. Patient characteristics contributed little to variation; only differences smaller than 10% (.7) of the scale range were seen (men and women, age, type or location of treatment, and ethnicity). Variation was instead explained by differences between centres, with ranges of mean scores from .73 (Scheduling and Planning) to 3.7 (Transport). CONCLUSIONS: Participation in the CKDPREM increased in 2017 compared to 2016, suggesting that post-validation changes made to the 2016 version of the CKDPREM have worked well. The outcome of the 2017 CKDPREM offers significant insight into renal patient experience. Importantly, the biggest factor driving variation in patient experience is the treating centre, and not patient characteristics. Sharing Decisions and Transport are consistently identified as areas with large variation (in both 2016 and 2017) and Scheduling and Planning with the lowest variation. UKRR and KCUK will continue to run the CKDPREM on an annual basis from late spring 2018 and also be making a short form version available.Peer reviewedFinal Accepted Versio

Measuring patients' experience with renal services in the UK: development and validation of the Kidney PREM

© The Author(s) 2022. Published by Oxford University Press on behalf of the ERA. This is an Open Access article distributed under the terms of the Creative Commons Attribution-Non Commercial License (https://creativecommons.org/licenses/by-nc/4.0/).Background Patient experience is a recognised aspect of quality of care for people with chronic kidney disease (CKD), but current patient-reported experience measures (PREMs) only focus on dialysis care. We developed and validated the Kidney PREM to assess patients’ experience with renal services in secondary care for any CKD stage or treatment (transplant, haemodialysis, peritoneal dialysis). Methods We developed the Kidney PREM in two phases, informed by a multidisciplinary expert group to ensure face validity. We organised three national data collections (2016 to 2018) to investigate item response profiles and to conduct exploratory and confirmatory analyses to assess internal consistency. We also explored content validity in cognitive interviews and evaluated test-retest reliability. Finally, we developed the Kidney PREM Short Form for more frequent measurement of patient experience to inform local service improvements. Results We analysed 32,959 responses across data collections, the 2018 collection covering all 71 UK renal centres. The Kidney PREM final version consisted of 38 items grouped in 13 themes, all pertaining to one underlying dimension reflecting the construct of ‘patient experience’ with high internal consistency (Cronbach’s α, .94). The Kidney PREM Short Form consisted of 15 items across the same 13 themes. Conclusions The Kidney PREM supports collection of reliable information on patient experience that people with CKD consider relevant, regardless of CKD stage or treatment modality. Kidney PREM data has the potential to guide local and national initiatives to improve patients’ experience with renal services in the UK and other countries.Peer reviewedFinal Published versio

Implementing Survivorship Care Plans for Colon Cancer Survivors

To evaluate the feasibility, usability, and satisfaction of a survivorship care plan (SCP) and identify the optimum time for its delivery during the first 12 months after diagnosis

The identification and management of depression in UK Kidney Care: Results from the Mood Maps Study

BACKGROUND: Depression is common in people with chronic kidney disease, yet little is known about how depression is identified and managed as part of routine kidney care. OBJECTIVES: The primary objective was to survey all UK adult kidney centres to understand how depression is identified and managed. A secondary objective was to broadly describe the variability in psychosocial care. DESIGN: Online survey. METHODS: The survey comprised of three sections: (1) general kidney care, (2) psychological provision and (3) social work provision. RESULTS: 48/68 (71%) of centres responded to the general survey with 20 and 13 responses from psychological and social work module respectively. Only 31.4% reported having both in centre psychological and social work practitioners. Three centres reported no access to psychosocial provision. Of the 25 centres who reported on pathways, 36.0% reported having internal pathways for the identification and management of depression. Within services with psychological provision, screening for depression varied across modality/group (e.g., 7.1% in mild/moderate chronic kidney disease vs. 62.5% in kidney donors). Cognitive Behavioural Therapy and Acceptance and Commitment Therapy were the most common interventions offered. Most psychosocial services were aware of the National Institute for Health and Care Excellence guidelines for managing depression in long-term conditions (n = 18, 94.7%) yet few fully utilised (n = 6, 33.3%). Limited workforce capacity was evident. CONCLUSIONS: There is considerable variability in approaches taken to identify and treat depression across UK kidney services, with few services having specific pathways designed to detect and manage depression. Workforce capacity remains a significant issue