Patient complaints as predictors of patient safety incidents

Patients remain an underused resource in efforts to improve quality and safety in healthcare, despite evidence that they can provide valuable insights into the care they receive. This study aimed to establish whether high-level patient safety incidents (HLIs) were predictable from preceding complaints, enabling complaints to be used to prevent HLIs. For this study complaints received from November 2011 through June 2012 and HLI incident reports from April through September 2012 were examined. Complaints and HLIs were categorised according to location or specialty and the themes they included. Data were analysed to look for correlations between number of complaints and HLIs in a given area. A qualitative analysis was carried out to determine whether any complaints contained information that, if acted upon earlier, could have prevented later HLIs. In the data a total of 52 complaints and 16 HLIs were included. No correlation was established between location of HLIs and complaints. Complaints commonly focused on staff attitude, diagnostic problems and delayed treatment. HLIs most often arose from failure to recognise a patient’s deterioration and escalate appropriately or incorrect patient identification. Most HLIs were not preceded by similar complaints. However, in two instances complaints did signpost future HLIs. Patient complaints can highlight specific risks to patient safety and act as an early warning system. There is a need to devise reliable means of identifying the minority of complaints that do precede serious incidents

3rd Annual Conference of the Leverhulme Centre for Integrative Research on Agriculture and Health (LCIRAH), Developing methods in agriculture and health research, London, 13–14 June 2013

Non-PRIFPRI3; ISI; CRP4; B Promoting healthy food systemsPHND; A4NHCGIAR Research Program on Agriculture for Nutrition and Health (A4NH

Designing and evaluating complex interventions to improve health care

Complex interventions are “built up from a number of components, which may act both independently and interdependently.”1 2 Many health service activities should be considered as complex. Evaluating complex interventions can pose a considerable challenge and requires a substantial investment of time. Unless the trials illuminate processes and mechanisms they often fail to provide useful information. If the result is negative, we are left wondering whether the intervention is inherently ineffective (either because the intervention was inadequately developed or because all similar interventions are ineffective), whether it was inadequately applied or applied in an inappropriate context, or whether the trial used an inappropriate design, comparison groups or outcomes. If there is a positive effect, it can be hard to judge how the results of the trial might be applied to a different context (box 1)

Measurement properties of the Disability Rating Index in patients undergoing hip replacement

Objective. The aim of this study was to establish and validate the measurement properties of the Disability Rating Index (DRI) in a population of adults undergoing hip replacement. Methods. One hundred and twenty-six adults participating in a randomized controlled trial completed the Oxford Hip Score, Harris Hip Score, DRI and EuroQol Group–Five Dimensions (EQ-5D) questionnaires at four time points. The structural validity of the DRI was assessed using principal component analysis. Cronbach’s α was used to determine the internal consistency and scale reliability was also assessed. Correlation between the DRI and the other functional and health-related quality of life scales was used to check criterion validity. DRI responsiveness was estimated and the interpretability of the scale was also assessed by checking for edge effects. Results. Results of analyses showed that the DRI was internally consistent (Cronbach’s α = 0.92), had good association with both function-specific and general health-related quality of life scores and was sensitive to change (smallest detectable change = 2.7). No evidence of edge effects was found. Furthermore, structural assessment of the DRI revealed two novel subscales representing simple tasks and difficult tasks. Conclusions. The DRI is structurally valid, responsive and concurs with functional assessment in adults undergoing hip replacement

Special section: Advancing customer experience and big data impact via academic- practitioner collaboration

Purpose This paper outlines the purpose, planning, development and delivery of the “1st AcademicPractitioner Research with Impact workshop: Customer Experience Management (CEM) and Big Data”, held at Alliance Manchester Business School on 18th and 19th January 2016, at which four subsequent papers were initially developed. Design/methodology/approach The paper sets out a summary of the importance and significance of the four papers developed at the workshop, and how the co-creative dialogue between managerial practitioners presenting key problems and issues that they face and carefully selected teams of academics was facilitated. Findings In order to develop richer and more impactful understanding of current problems challenging customer focused managers, there is a need for more dialogue and engagement between academics and practitioners. Practical implications The paper serves as a guideline for developing future workshops that aim at strengthening the links between academia and the business world. Originality/value This paper highlights the value of academic-practitioner workshops for focusing academic research on areas of importance for practitioners in order to generate impact. The innovative format of the workshop and the resulting impactful papers should serve as a call and motivation for future academic-practitioner workshop development

Rethinking relationship marketing as consumer led and technology driven: propositions for research and practice

The study of Relationship Marketing (RM) has led to improved understanding and management of customer relationships. However, it has suffered recent criticism for firm-centricity, and for failing to address the impact of the technological revolution and resulting customer empowerment in firm-customer relationships. This paper addresses these limitations by reconceptualizing RM as consumer led, with firm interactions enabling consumers to create their own unique experiences and value through the increasing accessibility of innovative technologies. This, in turn, benefits the firm through reciprocated value and beneficial relationship outcomes. We critically review extant knowledge and derive five propositions about firm-customer relationships. These propositions form the basis of managerial implications and a research agenda to better understand the impact of technologies and customer experience on RM

Postpartum glucose follow-up and lifestyle management after gestational diabetes mellitus:general practitioner and patient perspectives

BACKGROUND: Incidence of type 2 diabetes is high after gestational diabetes mellitus (GDM). We aimed to evaluate the adherence to follow-up six-weeks postpartum visits in secondary care after GDM and glucose monitoring in primary care longer than 12-14 months after delivery and the years thereafter. In addition, we examined the women's lifestyle after delivery. METHODS: A cross-sectional follow-up survey among women with a history of GDM and their general practitioners (GP). Rates of attendance at the six-weeks postpartum visit and glucose testing were obtained from hospital records, over the period 2011-2012. Rates of annual follow-up postpartum glucose testing were assessed by a survey among their GP's. Lifestyle of the women on diet and exercise was assessed by questionnaire in 2015. RESULTS: In total 197 women were eligible for the study. Of these, 156 (79%) attended the six-weeks postpartum visit at the diabetes outpatient clinic and in 145 (93%) of these women glucose testing was performed. In total 77 (39%) women responded to the invitation to participate in this study and filled in the lifestyle questionnaire. About one third of the women met the recommendations for sufficient physical activity. A majority of them did not fulfil the Dutch guidelines on healthy diet - fruit intake 35.1%, vegetables intake 7.8%. Of the 74 invited GP's, 61 responded (82%), only 12 (20%) reported that they had performed a follow-up glucose testing within >12-14 months postpartum. Of these women, five were tested only in the first year of follow-up, five also in the second year, and two were tested for three consecutive years. CONCLUSIONS: Despite the high attendance rate of six-weeks postpartum visit and glucose testing, we observed low rates of longer-term follow-up regarding postpartum glucose testing. Moreover, we found a suboptimal adherence to healthy lifestyle for women with a history of GDM

Detection of Type 1 Prion Protein in Variant Creutzfeldt-Jakob Disease

Molecular typing of the abnormal form of the prion protein (PrP(Sc)) has come to be regarded as a powerful tool in the investigation of the prion diseases. All evidence thus far presented indicates a single PrP(Sc) molecular type in variant Creutzfeldt-Jakob disease (termed type 2B), presumably resulting from infection with a single strain of the agent (bovine spongiform encephalopathy). Here we show for the first time that the PrP(Sc) that accumulates in the brain in variant Creutzfeldt-Jakob disease also contains a minority type 1 component. This minority type 1 PrP(Sc) was found in all 21 cases of variant Creutzfeldt-Jakob disease tested, irrespective of brain region examined, and was also present in the variant Creutzfeldt-Jakob disease tonsil. The quantitative balance between PrP(Sc) types was maintained when variant Creutzfeldt-Jakob disease was transmitted to wild-type mice and was also found in bovine spongiform encephalopathy cattle brain, indicating that the agent rather than the host specifies their relative representation. These results indicate that PrP(Sc) molecular typing is based on quantitative rather than qualitative phenomena and point to a complex relationship between prion protein biochemistry, disease phenotype and agent strain