Weak signals in healthcare: The case study of the Mid-Staffordshire NHS Foundation Trust

Most organisational disasters have warning signals prior to the event occurring, which are increasingly appearing in accident reports. In the case of the Mid-Staffordshire Disaster, the disaster was not as a result of component failure or human error but rather an organisation that drifted into failure with precursory warning signals being ignored. It has been estimated that between 400 and 1200 patients died as a result of poor care between 2004 and 2009. The aim of this study was to identify the precursory signals and their rationalizations that occurred during this event. Qualitative document analysis was used to analyse the independent and public inquiry reports. Signals were present on numerous system levels. At a person level, there were cases of staff trying to make management aware of the problems, as well as the campaign “Cure the NHS” started by bereaved relatives. At an organisational level, examples of missed signals included the decrease in the trust’s star rating due to failure to meet targets, the NHS care regulator voicing concern regarding the unusually high death rates and auditors’ reports highlighting concerns regarding risk management. At an external level, examples included negative peer reviews from various external organizations

Postgraduate research students: you are the future of the Academy

This paper explores the changing role of the university developed and changed over time, and how this is likely to change further in the next 25 years. By drawing on scenarios for the future of the HE sector in the UK in 2035, the article argues that postgraduate research students will be the key factor that sustains the future of the Academy as universities focus more and more attention on the teaching of ever increasing numbers of undergraduate students. The paper highlights the danger of a divide occurring between the idea of the university and the notion of the Academy in the future, and the essential role that research students will play in ensuring this divide remains bridged. The article argues that it is imperative for universities to expand their postgraduate research degree provision if the Academy is to continue in the future as the foundation to knowledge creation

The validity and clinical utility of the Massachusetts Youth Screening Instrument – version 2 (MAYSI-2) in the UK

Background The Massachusetts Youth Screening Instrument - version 2 (MAYSI-2) is designed to assist in identifying the mental health needs of young people admitted to secure establishments. To date, very few studies have assessed the MAYSI-2 outside the USA. Aims This study aimed to assess the validity and clinical utility of the MAYSI-2 in England. Methods Boys newly admitted into one large young offenders' institution, were consecutively interviewed individually and completed the MAYSI-2, the Youth Self Report (YSR), which capture similar syndrome scales - and the Kiddie Schedule for Affective Disorders and Schizophrenia (K-SADS), which allows for making psychiatric diagnoses. Results Two hundred and six boys, of average age 16.5-years, completed all assessments. According to the K-SADS, co-morbidity of psychiatric disorders was high (80% of the sample). The MAYSI-2 showed good convergent validity but poorer discriminant validity with the YSR. The MAYSI-2 and YSR corresponded with both conceptually and non-conceptually relevant diagnostic domains. Conclusions The poor ability of the MAYSI-2 and YSR to discriminate and specify disorders is likely to reflect the high rates of co-morbidity. The fact that 90% of the participants reached the caution cut-off for any scale on the MAYSI-2, while suggesting its limited use as a screening tool for this sample, is probably best reflective of the high levels of psychopathology of incarcerated young people in England and Wales since particular efforts to divert as many as possible from custody. A more holistic and comprehensive approach to assessing health needs on admission into custody may be necessary for such a population. Copyright © 2014 John Wiley & Sons, Ltd