Key priority areas for patient safety improvement strategy in Libya: a protocol for a modified Delphi study

Introduction Patient safety is a global public health problem. Estimates and size of the problem of patient safety in low-income and developing countries are scarce. A systems approach is needed for ensuring that patients are protected from harm while receiving care. The primary objective of this study will be to use a consensus-based approach to identify the key priority areas for patient safety improvement in Libya as a developing country. Design A modified Delphi study. Methods and analysis A three-phase modified Delphi study will be conducted using an anonymous web-based questionnaires. 15 international experts in the field of patient safety will be recruited to prioritise areas of patient safety that are vital to developing countries such as Libya. The participants will be given the opportunity to rank a list of elements on five criteria. The participants will also be asked to list five barriers that they believe hinder the implementation of patient safety systems. Descriptive statistics will be used to evaluate consensus agreement, including percentage agreement and coefficient of variation. Kendall’s coefficient of concordance will be used to evaluate consensus across all participants. Ethics and dissemination Ethical approval has been granted from Imperial College Research Ethics Committee (ICREC: 16IC3598). The findings of the study will be published in a PhD thesis. A manuscript will also be prepared for publication in a high-impact peer-reviewed journal describing the Delphi process and the findings of the study

Identifying technology related barriers & enablers to streamlining delivery of BP@home in NCL

Report objectives: This report summarises the key findings of a place-based evaluation to identify barriers and enablers to the streamlined use of digital tools to support successful implementation of BP@home in North Central London (NCL). Specifically, we characterised the IT landscape in NCL, investigated the views and experiences of HCPs regarding the use of place-based IT solutions and processes, and synthesised a list of evidence-based recommendations for the consideration of NCL leadership team. Methods: We used a mixed methods research approach and six phases of investigation to address these aims, including desktop research, personal interviews and focus groups, action research, data analysis, synthesis and reporting. Results: The evaluation showed that there was a lack of standardisation across IT systems, internal processes and templates in PCNs in NCL, leading to challenges in implementing and using digital tools to support P@home. These challenges were not unique to NCL. AccurX and the locally created NCL template are the most widely used IT tools to support the program in NCL. Other digital platforms being tested in NCL include Suvera, each with unique strengths and weaknesses. Other digital tools, such as Omron Connect, could be considered to support management of hypertension and other chronic conditions. HCPs faced challenges with patient engagement, data quality, IT system integration and resource allocation, but generally felt that the current approach works. Basic requirements for the use and adoption of IT tools and systems include adequate resources, stakeholder engagement, user-friendly interfaces, and interoperability between different ystems. We proposed 16 actionable insights and recommendations that could be implemented to help improve the delivery of BP@home in NCL. These include standardising IT systems, improving patient engagement, providing adequate training and support, and promoting the benefits of remote monitoring. Conclusion: On balance, we recommend that NCL continues to deliver BP@home using the current standard IT offer that facilitates asynchronous engagement with patients (i.e., AccurX). Embedding a quality improvement approach to identify mechanisms to continually improve the BP@home offer in NCL is recommended. Clinical leadership could also review the evaluation findings of alternative tools currently being tested locally (e.g., pilot using Suvera across one PCN) to drive evidence-based commissioning decision as the BP@home initiative becomes even more embedded in routine general practice

Views of patients about sickle cell disease management in primary care: a questionnaire-based pilot study.

OBJECTIVES: To determine how patients with sickle cell disease (SCD) perceive the quality of care that they receive from their primary healthcare providers. DESIGN: A questionnaire-based pilot study was used to elicit the views of patients about the quality of care they have been receiving from their primary healthcare providers and what they thought was the role of primary care in SCD management. SETTING: Sickle Cell Society and Sickle Cell and Thalassaemia Centre, in the London Borough of Brent. PARTICIPANTS: One hundred questionnaires were distributed to potential participants with SCD between November 2010 and July 2011 of which 40 participants responded. MAIN OUTCOME MEASURES: Analysis of 40 patient questionnaires collected over a nine-month period. RESULTS: Most patients are generally not satisfied with the quality of care that they are receiving from their primary healthcare providers for SCD. Most do not make use of general practitioner (GP) services for management of their SCD. Collecting prescriptions was the reason most cited for visiting the GP. CONCLUSION: GPs could help improve the day-to-day management of patients with SCD. This could be facilitated by local quality improvement schemes in areas with high disease prevalence. The results of the survey have been used to help develop a GP education intervention and a local enhanced service to support primary healthcare clinicians with SCDs ongoing management

Patients' views on improving sickle cell disease management in primary care: focus group discussion.

OBJECTIVES: To assess sickle cell disease (SCD) patient and carer perspectives on the primary care services related to SCD that they receive from their general practitioner (GP). DESIGN: A focus group discussion was used to elicit the views of patients about the quality of care they receive from their primary health-care providers and what they thought was the role of primary care in SCD management. The focus group discussion was video recorded. The recording was then examined by the project team and recurring themes were identified. A comparison was made with notes made by two scribes also present at the discussion. SETTING: Sickle Cell Society in Brent, UK. PARTICIPANTS: Ten participants with SCD or caring for someone with SCD from Northwest London, UK. MAIN OUTCOME MEASURES: Patients perceptions about the primary care services they received, and a list of key themes and suggestions. RESULTS: Patients and carers often bypassed GPs for acute problems but felt that GPs had an important role to play around repeat prescriptions and general health care. These service users believed SCD is often ignored and deemed unimportant by GPs. CONCLUSION: Participants wanted the health service to support primary health-care providers to improve their knowledge and understanding of SCD. Key themes and suggestions from this focus group have been used to help develop an educational intervention for general practice services that will be used to improve SCD management in primary care

How primary care can contribute to good mental health in adults.

The need for support for good mental health is enormous. General support for good mental health is needed for 100% of the population, and at all stages of life, from early childhood to end of life. Focused support is needed for the 17.6% of adults who have a mental disorder at any time, including those who also have a mental health problem amongst the 30% who report having a long-term condition of some kind. All sectors of society and all parts of the NHS need to play their part. Primary care cannot do this on its own. This paper describes how primary care practitioners can help stimulate such a grand alliance for health, by operating at four different levels - as individual practitioners, as organisations, as geographic clusters of organisations and as policy-makers

Evaluating case studies of community-oriented integrated care.

This paper summarises a ten-year conversation within London Journal of Primary Care about the nature of community-oriented integrated care (COIC) and how to develop and evaluate it. COIC means integration of efforts for combined disease-treatment and health-enhancement at local, community level. COIC is similar to the World Health Organisation concept of a Community-Based Coordinating Hub - both require a local geographic area where different organisations align their activities for whole system integration and develop local communities for health. COIC is a necessary part of an integrated system for health and care because it enables multiple insights into 'wicked problems', and multiple services to integrate their activities for people with complex conditions, at the same time helping everyone to collaborate for the health of the local population. The conversation concludes seven aspects of COIC that warrant further attention

Improving patient safety in developing countries - moving towards an integrated approach

Patient safety is as major public health issue. It has also been recognised as an area for improvement. The purpose of this article is to discuss the need for developing an integrated approach to patient safety improvement in developing countries. Relevant literature to identify the common themes and patterns associated with patient safety improvement was conducted through a search of the online databases (MEDLINE, EMBASE, PUBMED and Google Scholar) for the years 2000 to 2017. Lessons and interventions from developed countries have been taken into consideration to identify the themes needed for patient safety improvement in developing countries. This review provides an integrated approach based on best practice which can be used to guide the development of a national strategy for improving patient safety. Policy makers need to focus on developing a holistic and comprehensive approach to patient safety improvement that takes into account the themes discussed in this article

Status of patient safety culture in Arab countries: a systematic review

Objectives To explore the status of patient safety culture in Arab countries based on the findings of the Hospital Survey on Patient Safety Culture (HSPSC). Design Systematic review. Methods We performed electronic searches of the MEDLINE, EMBASE, CINAHL, ProQuest and PsychINFO, Google Scholar and PubMed databases, with manual searches of bibliographies of included articles and key journals. We included studies that were conducted in the Arab countries that were focused on patient safety culture. 2 reviewers independently verified that the studies met the inclusion criteria and critically assessed the quality of the studies. Results 18 studies met our inclusion criteria. The review identified that non-punitive response to error is seen as a serious issue which needs to be improved. Healthcare professionals in the Arab countries tend to think that a ‘culture of blame’ still exists that prevents them from reporting incidents. We found an overall similarity between the reported composite score for dimension of teamwork within units in all of the reviewed studies. Teamwork within units was found to be better than teamwork across hospital units. All of the reviewed studies reported that organisational learning and continuous improvement was satisfactory as the average score of this dimension for all studies was 73.2%. Moreover, the review found that communication openness seems to be a concerning issue for healthcare professionals in the Arab countries. Conclusions There is a need to promote patient safety culture as a strategy for improving the patient safety in the Arab world. Improving patient safety culture should include all stakeholders, like policymakers, healthcare providers and those responsible for medical education. This review was limited only to English language publications. The varied settings in which the HSPSC was used may have influenced the areas of strengths and weaknesses as healthcare workers' perception of safety culture may differ

Improving patient safety in Libya: insights from the British health system perspective

Purpose: The overall aim of patient safety is to make health care safe for both patients and health professionals. The purpose of this paper is to explore the UK’s patient safety improvement programmes over the past 15 years and whether lessons can be learnt to improve patient safety in Libya. Design/methodology/approach: Publications focused on patient safety in the UK were searched in academic databases. A content analysis was conducted on the selected publications. Findings: In Britain, several initiatives have been undertaken over the past fifteen years to improve patient safety and the British health system. Many stakeholders are involved including regulatory and professional bodies, educational providers and non-governmental organisations. Lessons can be learnt from the British journey in improving patient safety in Libya Research limitations/implications: Practical implications: Developing a national patient safety strategy for the country which reflects the context and needs is paramount. Above all, patient safety strategy in Libya should reference internationally approved guidelines, evidence and policy as well as learning from the unique British experience. Social implications: Originality/value: This review is first to examine patient safety improvement strategies that were adopted in Britain to help developing countries develop local strategies based on lessons learnt from Britain’s unique experience

Towards a strategic alignment of public health and primary care practices at local levels - the case of severe and enduring mental illness

The rapidly increasing number of people who have long-term conditions requires a system of coordinated support for self-care throughout the NHS. A system to support self-care needs to be aligned to systems that support shared-care and community development, making it easier for the multidisciplinary teams who provide care to also help patients and populations to help themselves. Public health practitioners need to work closely with clinicians to achieve this. The best place to coordinate this partnership is a community-based coordinating hub, or local health community – a geographic area of about 50,000 population where different contributions to self-care can be aligned. A shared vision for both health and disease management is needed to ensure consistent messaging by all. A three tier system of shared care can help to combine vertical and horizontal integration. This paper uses severe and enduring mental illness as an exemplar to anticipate the design of such a system