Improving the analysis and use of patient complaints in the English National Health Service

The English National Health Service (NHS) receives over 200,000 patient complaints annually. Complaints provide rich narratives of poor and unsafe care, and are often submitted with the aim of preventing harm from occurring to others. Inquiries into safety failures have demonstrated that complaints signal problems where internal systems fail. Yet, their insights remain underutilised due to their complex unstructured nature, a disregard for their informational value, and a complaints process designed for case-by-case redress. This work develops evidence-based and theory-informed approaches towards improving the analysis and use of complaints in the English NHS. Using process modelling and realist review methods, this thesis generates theory on how and under what conditions healthcare settings can achieve both case-by-case redress and system-wide analysis of complaints. Findings identify the need for a robust coding taxonomy to detect systemic problems with healthcare delivery, and support the prioritisation of deeper qualitative analysis and investigation. The inter-rater reliability of the existing NHS complaints reporting scheme ‘KO41a’ is tested across four NHS Trusts, and compared to the psychometrically robust and theory-informed Healthcare Complaints Analysis Tool (HCAT). Results highlight the limited discriminative value of KO41a, and indicate HCAT as a reliable alternative in most investigated settings. Drawing from social science approaches to safety, the final study conducts data linkage and narrative analysis of complaints and staff incident reports, and demonstrates the contributions of using complainants’ interpretation and sense-making of adverse events to test, challenge, and complement staff representations of the causes and severity of harm. Collectively, the work in this thesis demonstrates why patient and staff perspectives need to be combined for a more holistic understanding of patient safety, and provides a pragmatic, evidence-based pathway towards integrating complaints into the historically staff-driven quality monitoring and improvement systems.Open Acces

Implementing advance care planning in routine nursing home care : the development of the theory-based ACP+ program

Background While various initiatives have been taken to improve advance care planning in nursing homes, it is difficult to find enough details about interventions to allow comparison, replication and translation into practice. Objectives We report on the development and description of the ACP+ program, a multi-component theory-based program that aims to implement advance care planning into routine nursing home care. We aimed to 1) specify how intervention components can be delivered; 2) evaluate the feasibility and acceptability of the program; 3) describe the final program in a standardized manner. Design To develop and model the intervention, we applied multiple study methods including a literature review, expert discussions and individual and group interviews with nursing home staff and management. We recruited participants through convenience sampling. Setting and participants Management and staff (n = 17) from five nursing homes in Flanders (Belgium), a multidisciplinary expert group and a palliative care nurse-trainer. Methods The work was carried out by means of 1) operationalization of key intervention components identified as part of a previously developed theory on how advance care planning is expected to lead to its desired outcomes in nursing homes into specific activities and materials, through expert discussions and review of existing advance care planning programs; 2) evaluation of feasibility and acceptability of the program through interviews with nursing home management and staff and expert revisions; and 3) standardized description of the final program according to the TIDieR checklist. During step 2, we used thematic analysis. Results The original program with nine key components was expanded to include ten intervention components, 22 activities and 17 materials to support delivery into routine nursing home care. The final ACP+ program includes ongoing training and coaching, management engagement, different roles and responsibilities in organizing advance care planning, conversations, documentation and information transfer, integration of advance care planning into multidisciplinary meetings, auditing, and tailoring to the specific setting. These components are to be implemented stepwise throughout an intervention period. The program involves the entire nursing home workforce. The support of an external trainer decreases as nursing home staff become more autonomous in organizing advance care planning. Conclusions The multicomponent ACP+ program involves residents, family, and the different groups of people working in the nursing home. It is deemed feasible and acceptable by nursing home staff and management. The findings presented in this paper, alongside results of the subsequent randomized controlled cluster trial, can facilitate comparison, replicability and translation of the intervention into practice

La classe inversée et des podcasts pour favoriser un apprentissage individualisé dans le cadre d’un cours scientifique à population hétéroclite

Comprend des références bibliographiquesCet article traite de la mise en place du dispositif des classes inversées et de la création d’outils pédagogiques (podcasts, plateforme virtuelle, questionnaires) dans le cadre d’un module s’inscrivant dans un cours scientifique, délivré à l’Université libre de Bruxelles, suivi par des étudiants de facultés différentes et d’années différentes. Ce système de la classe inversée fut innovant tant pour les étudiants que pour les enseignants, qui découvraient cette approche pédagogique. Cette expérience fut enrichissante. Elle a permis de solutionner des problèmes rencontrés par les enseignants lors d’un enseignement traditionnel. D’autre part, elle illustre l’intérêt des étudiants à suivre d’autres cours organisés selon ce modèle. En effet, l’évaluation du dispositif a mis en avant des résultats encourageants et prometteurs

De beschildering van De Krijtberg in Amsterdam

The interior of the Church of St. Franciscus Xaverius or De Krijtberg at Amsterdam (built in 1880-1883 by Alfred Tepe) has remained intact completely. This neo-gothic church was restored in 1979-1990. The polychromy, to which this article is dedicated, still waits for restoration. In 1886 the provisional painting of the sanctuary and of both side-chapels took place. In 1889 the rest of the church was painted in a provisional way. In 1892-\u2793 the definitive painting of sanctuary and side-chapels was carried out after the design of Friedrich Wilhelm (1837-1919). At the same time Mengelberg made the apostle beam with triumphal cross in the sanctuary, Heinrich Geuer (1841-1904) made two windows for the sanctuary and the workshop Nicolas provided the left side-chapel with glass. Mengelberg saw to it that the unity of style was maintained, the figures of saints in the sanctuary and in both chapels were painted by Martin Schenk (1833-1910) after drawings by Mengelberg. Shadows in the folds of the garments to give these figures some sculptural quality. However, they stand in painted gothic niches, which do not suggest depth at all. The paintings respect the flatness of the wall according to the prescriptions in the manuals of the neo-gothics. Below the niches paintings of draperies were carried out. The painting of 1892-\u2793 brought about a colour- and light-contrast between the sanctuary and the side chapels and the rest of the church. In the nave a pale grey colour predominated the same red and blue while the new painting according to a description from 1906 showed a warm glow of red, blue and gold. In 1927-\u2728 the definitive polychroming of the transept and the nave took place. This painting was carried out by the firm of Hans Mengelberg at Utrecht. Hans Mengelberg (1885-1945) was the youngest son of the previously mentioned Friedrich Wilhelm. He also was commissioned to clean and to restore the old polychromy. At that occasion the half round columns against the pillars and walls were painted over in a simple style. The polychromy of Hans Mengelberg does not harmonize with the colours and patterns in the side-chapels and sanctuary in every way. The new paintings show larger planes, less gold, less details and more colour. The choice of the colours however does show same similarity with the stained-glass windows of Willem Mengelberg (1897-1969) in the sanctuary and in the side-aisled (1929 and 1933). The colours, which have been applied in the windows and the paintings in 1927-1933 do not harmonize at all with the interior of the church

De beschildering van De Krijtberg in Amsterdam

The interior of the Church of St. Franciscus Xaverius or De Krijtberg at Amsterdam (built in 1880-1883 by Alfred Tepe) has remained intact completely. This neo-gothic church was restored in 1979-1990. The polychromy, to which this article is dedicated, still waits for restoration. In 1886 the provisional painting of the sanctuary and of both side-chapels took place. In 1889 the rest of the church was painted in a provisional way. In 1892-'93 the definitive painting of sanctuary and side-chapels was carried out after the design of Friedrich Wilhelm (1837-1919). At the same time Mengelberg made the apostle beam with triumphal cross in the sanctuary, Heinrich Geuer (1841-1904) made two windows for the sanctuary and the workshop Nicolas provided the left side-chapel with glass. Mengelberg saw to it that the unity of style was maintained, the figures of saints in the sanctuary and in both chapels were painted by Martin Schenk (1833-1910) after drawings by Mengelberg. Shadows in the folds of the garments to give these figures some sculptural quality. However, they stand in painted gothic niches, which do not suggest depth at all. The paintings respect the flatness of the wall according to the prescriptions in the manuals of the neo-gothics. Below the niches paintings of draperies were carried out. The painting of 1892-'93 brought about a colour- and light-contrast between the sanctuary and the side chapels and the rest of the church. In the nave a pale grey colour predominated the same red and blue while the new painting according to a description from 1906 showed a warm glow of red, blue and gold. In 1927-'28 the definitive polychroming of the transept and the nave took place. This painting was carried out by the firm of Hans Mengelberg at Utrecht. Hans Mengelberg (1885-1945) was the youngest son of the previously mentioned Friedrich Wilhelm. He also was commissioned to clean and to restore the old polychromy. At that occasion the half round columns against the pillars and walls were painted over in a simple style. The polychromy of Hans Mengelberg does not harmonize with the colours and patterns in the side-chapels and sanctuary in every way. The new paintings show larger planes, less gold, less details and more colour. The choice of the colours however does show same similarity with the stained-glass windows of Willem Mengelberg (1897-1969) in the sanctuary and in the side-aisled (1929 and 1933). The colours, which have been applied in the windows and the paintings in 1927-1933 do not harmonize at all with the interior of the church