Longitudinal patient safety education as a means to promote organizational learning in different resource settings

Letter to the Editor

Junior doctors’ views on reporting concerns about patient safety: a qualitative study

Background Enabling healthcare staff to report concerns is critical for improving patient safety. Junior doctors are one of the groups least likely to engage in incident reporting. This matters both for the present and for the future, as many will eventually be in leadership positions. Little is known about junior doctors’ attitudes towards formally reporting concerns. Aims To explore the attitudes and barriers to junior doctors formally reporting concerns about patient safety to the organisations in which they are training Methods A qualitative study comprising three focus groups with ten junior doctors at an Acute Teaching Hospital Trust in the Midlands, UK, conducted in 2013. Focus group discussions were transcribed verbatim and analysed using a thematic approach, facilitated by NVivo 10. Results Participants were supportive of the idea of playing a role in helping healthcare organisations become more aware of risks to patient safety, but identified that existing incident reporting systems could frustrate efforts to report concerns. They described barriers to reporting including a lack of rolemodelling and senior leadership, a culture within medicine that was not conducive to reporting concerns, and a lack of feedback providing evidence that formal reporting was worthwhile. They reported a tendency to rely on informal ways of dealing with concerns as an alternative to engaging with formal reporting systems. Conclusions If healthcare organisations are to be able to gather and learn from intelligence about risks to patient safety from junior doctors, this will require attention to the features of reporting systems, as well as the implications of hierarchies and the wider cultural context in which junior doctors work

Evaluation of an Education Quality Dashboard (EQD) in a UK Teaching Hospital

To ensure a safe and effective learning environment, healthcare organisations are required to demonstrate compliance with quality standards for education. Currently there is a lack of tools for systematically assessing training environments. This qualitative study evaluated the use of an Education Quality Dashboard (EQD) to monitor education and training quality for junior doctors in a large UK NHS teaching hospital. Metrics for the EQD were selected based on GMC standards for training, local policies and in discussion with education stakeholders. The EQD was piloted in 7 clinical management groups (CMGs) and then implemented on an ongoing basis. Education Quality Leads (EQLs) in 6 of the 7 CMGs were appointed and given responsibility for collecting and reviewing the dashboard data. In September and October 2016 semi-structured telephone interviews were conducted with 14 stakeholders involved in producing and using the EQD. Data was analysed thematically using a combination of deductive and inductive coding, with the aid of NVivo 10. The findings of the study highlighted the way the EQD was used in practice and the value and impact of the EQD. The EQD has helped to collate education quality data, highlighted important variations in practice and education quality between departments, raised awareness of educational issues and helped to drive some improvements in education. The qualitative findings also provided insight into the challenges of using a dashboard in assessing the quality of the education environment, and into how this approach could be optimised for future use

Healthcare workers' views on mandatory SARS-CoV-2 vaccination in the UK: A cross-sectional, mixed-methods analysis from the UK-REACH study.

Several countries now have mandatory SARS-CoV-2 vaccination for healthcare workers (HCWs) or the general population. HCWs' views on this are largely unknown. Using data from the nationwide UK-REACH study we aimed to understand UK HCW's views on improving SARS-CoV-2 vaccination coverage, including mandatory vaccination.Between 21st April and 26th June 2021, we administered an online questionnaire via email to 17 891 UK HCWs recruited as part of a longitudinal cohort from across the UK who had previously responded to a baseline questionnaire (primarily recruited through email) as part of the United Kingdom Research study into Ethnicity And COVID-19 outcomes in Healthcare workers (UK-REACH) nationwide prospective cohort study. We categorised responses to a free-text question "What should society do if people do not get vaccinated against COVID-19?" using qualitative content analysis. We collapsed categories into a binary variable: favours mandatory vaccination or not, using logistic regression to calculate its demographic predictors, and its occupational, health, and attitudinal predictors adjusted for demographics.Of 5633 questionnaire respondents, 3235 answered the free text question. Median age of free text responders was 47 years (IQR 36-56) and 2705 (74.3%) were female. 18% (n = 578) favoured mandatory vaccination (201 [6%] participants for HCWs and others working with vulnerable populations; 377 [12%] for the general population), but the most frequent suggestion was education (32%, n = 1047). Older HCWs (OR 1.84; 95% CI 1.44-2.34 [≥55 years vs 16 years to <40 years]), HCWs vaccinated against influenza (OR 1.49; 95% CI 1.11-2.01 [2 vaccines vs none]), and with more positive vaccination attitudes generally (OR 1.10; 95% CI 1.06-1.15) were more likely to favour mandatory vaccination, whereas female HCWs (OR= 0.79, 95% CI 0.63-0.96, vs male HCWs) and Black HCWs (OR=0.46, 95% CI 0.25-0.85, vs white HCWs) were less likely to.Only one in six of the HCWs in this large, diverse, UK-wide sample favoured mandatory vaccination. Building trust, educating, and supporting HCWs who are hesitant about vaccination may be more acceptable, effective, and equitable.</p