Why won’t workforce policy makers tackle gender inequality in healthcare?

Blog post in The BMJ Opinio

Water You Waiting For? Balancing Private Rights and Public Necessity in the South Atlantic Wetlands

A healthy and robust network of wetlands protects coastal communities from storm damage caused by hurricanes. Unfortunately, development pressures threaten wetlands along the South Atlantic coast, the region most susceptible to an increased risk of climate change induced hurricanes. If these wetlands are not protected from destruction, coastal communities will be left without a buffer against flooding, storm damage, and sea level rise. In addition to putting the public at large in physical danger, significant environmental justice concerns accompany the failure to protect coastal wetlands. In order to protect these ever-diminishing resources, federal and state law makers have enacted regulatory regimes that combat wetland degradation. However, these regimes are severely flawed, as they: (1) are difficult for private property owners to navigate; (2) lack inter-governmental coordination; and (3) give rise to litigable conflicts between private property owners and state and federal regulators. The 2013 Supreme Court decision Koontz v. St. John’s River Water Mgmt. Dist., which extends the essential nexus and rough proportionality requirements of Nollan v. California Coastal Commission and Dolan v. City of Tigard to monetary exactions, threatens to further undermine the efficacy of these regulatory regimes by inducing a regulatory chilling effect, Thus, this note argues that courts should extend the application of the public necessity defense to regulatory takings cases, thereby absolving the government of takings liability, where the state can show that the destruction of coastal wetlands will expose vulnerable communities to harm from hurricanes and sea level rise

Users' trust in information resources in the Web environment: a status report

This study has three aims; to provide an overview of the ways in which trust is either assessed or asserted in relation to the use and provision of resources in the Web environment for research and learning; to assess what solutions might be worth further investigation and whether establishing ways to assert trust in academic information resources could assist the development of information literacy; to help increase understanding of how perceptions of trust influence the behaviour of information users

The onus on us? Stage one in developing an i-Trust model for our users.

This article describes a Joint Information Systems Committee (JISC)-funded project, conducted by a cross-disciplinary team, examining trust in information resources in the web environment employing a literature review and online Delphi study with follow-up community consultation. The project aimed to try to explain how users assess or assert trust in their use of resources in the web environment; to examine how perceptions of trust influence the behavior of information users; and to consider whether ways of asserting trust in information resources could assist the development of information literacy. A trust model was developed from the analysis of the literature and discussed in the consultation. Elements comprising the i-Trust model include external factors, internal factors and user's cognitive state. This article gives a brief overview of the JISC funded project which has now produced the i-Trust model (Pickard et. al. 2010) and focuses on issues of particular relevance for information providers and practitioners

A thematic analysis of the prevention of future deaths reports in healthcare from HM coroners in England and Wales 2016–2019

Background The Coroners and Justice Act allows coroners in England or Wales to issue reports after inquest, if they believe that action should be taken to prevent a future death. Coroners are under a statutory duty to issue a Prevention of Future Death (PFD) report to persons or organisations that they believe have the power to act. Cumulatively, these reports may contain useful intelligence for patient safety. The aim of this study was to examine the feasibility of extracting data from these reports and to evaluate if learning was possible from any common themes. Methods Reports were extracted from 2016 to 2019 for deaths in hospitals, care homes and the community in England and Wales. These were subjected to descriptive statistics and thematic analysis of coroner’s concerns. Application of data mining techniques was not possible due to data quality. Results 710 reports were examined, with 3469 concerns being raised (mean 4.88, range 1–33). 36 reports expressed concern about having to issue repeat PFDs to the same organisation for the same or similar concerns. Thematic analysis reliability was high ( κ 0.89 unweighted) with five emerging primary themes: deficit in skill or knowledge, missed, delayed or uncoordinated care, communication and cultural issues, systems issues and lack of resources. A codebook of 53 subthemes were identified. Conclusions PFD reports offer valuable insight. Aggregation and continued analysis of these reports could offer more informed patient safety, workforce development and organisational policy. Improved data quality would allow for possible automation of analysis and faster feedback into practice

Implementation and perceived impact of the SWAN model of end-of-life and bereavement care: a realist evaluation

Objectives To evaluate the End-of-Life and Bereavement Care model (SWAN) from conception to current use. Design A realist evaluation was conducted to understand what works for whom and in what circumstances. The programme theory, derived from a scoping review, comprised: person and family centred care, institutional approaches and infrastructure. Data were collected across three stages (May 2021 to December 2021): semi-structured, online interviews and analysis of routinely collected local and national data. Setting Stage 1: Greater Manchester area of England where the SWAN model was developed and implemented. Stage 2: Midlands. Stage 3: National data. Participants Twenty-three participants were interviewed: Trust SWAN leads, end-of-life care nurses, board members, bereavement services, faith leadership, quality improvement, medicine, nursing, patient transport, mortuary, police and coroners. Results Results from all three stages were integrated within themes, linked to the mechanisms, context and outcomes for the SWAN model. The mechanisms are: SWAN is a values-based model, promoting person/family-centred care and emphasising personhood after death. Key features are: memory-making, normalisation of death and ‘one chance’ to get things right. SWAN is an enablement and empowerment model for all involved. The branding is recognisable and raises the profile of end-of-life and bereavement care. The contextual factors for successful implementation and sustainability include leadership, organisational support, teamwork and integrated working, education and engagement and investment in resources and facilities. The outcomes are perceived to be: a consistent approach to end-of-life and bereavement care; a person/family-centred approach to care; empowered and creative staff; an organisational culture that prioritises end-of-life and bereavement care. Conclusion The SWAN model is agile and has transferred to different settings and circumstances. This realist evaluation revealed the mechanisms of the SWAN model, the contextual factors supporting implementation and perceived outcomes for patients, families, staff and the organisation

State authenticity

State authenticity is the sense that one is currently in alignment with one’s true or real self. We discuss state authenticity as seen by independent raters, describe its phenomenology, outline its triggers, consider its well-being and behavioral implications, and sketch out a cross-disciplinary research agenda

Barriers to delivering advanced cancer nursing: a workload analysis of specialist nurse practice linked to the English National Lung Cancer Audit

Purpose: Health services across the world utilise advanced practice in cancer care. In the UK, lung cancer nurse specialists (LCNS) are recognised as key components of quality care in national guidelines, yet access to LCNS contact is unequal and some responsibilities are reportedly left undone. We assess whether any variation in working practices of LCNS is attributable to factors of the lung cancer service at the hospital trust. Method: Nationwide workload analysis of LCNS working practices in England, linked at trust level to patient data from the National Lung Cancer Audit. Chi-squared tests were performed to assess whether patient contact, workload, involvement in multidisciplinary teams (MDT), and provision of key interventions were related to 1) the trust's lung cancer service size, 2) LCNS caseload, 3) anti-cancer treatment facilities and 4) lung cancer patient survival. Results: Unpaid overtime was substantial for over 60% of nurses and not associated with particular service factors assessed; lack of administrative support was associated with large caseloads and chemotherapy facilities. LCNS at trusts with no specialty were more likely to challenge all MDT members (80%) compared with those at surgical (53%) or chemotherapy (58%) trusts. The most frequent specialist nursing intervention to not be routinely offered was proactive case management. Conclusion: Working practices of LCNS vary according to service factors, most frequently associated with trust anti-cancer treatment facilities. High workload pressures and limited ability to provide key interventions should be addressed across all services to ensure patients have access to recommended standards of care

Using knowledge discovery through data mining to gain intelligence from routinely collected incident reporting in an acute English hospital

Purpose: Incident reporting systems are commonly deployed in healthcare but resulting datasets are largely warehoused. This study explores if intelligence from such datasets could be used to improve quality, efficiency, and safety. Design/methodology/approach: Incident reporting data recorded in one NHS acute Trust was mined for insight (n = 133,893 April 2005-July 2016 across 201 fields, 26,912,493 items). An a priori dataset was overlaid consisting of staffing, vital signs, and national safety indicators such as falls. Analysis was primarily nonlinear statistical approaches using Mathematica V11. Findings: The organization developed a deeper understanding of the use of incident reporting systems both in terms of usability and possible reflection of culture. Signals emerged which focused areas of improvement or risk. An example of this is a deeper understanding of the timing and staffing levels associated with falls. Insight into the nature and grading of reporting was also gained. Practical implications: Healthcare incident reporting data is underused and with a small amount of analysis can provide real insight and application to patient safety. Originality/value: This study shows that insight can be gained by mining incident reporting datasets, particularly when integrated with other routinely collected data

Investigating the impact of financial concerns on symptoms of depression in UK healthcare workers: data from the UK-REACH nationwide cohort study

BACKGROUND: Exploration of the association between financial concerns and depression in UK healthcare workers (HCWs) is paramount given the current 'cost of living crisis', ongoing strike action and recruitment/retention problems in the National Health Service. AIMS: To assess the impact of financial concerns on the risk of depression in HCWs, how these concerns have changed over time and what factors might predict financial concerns. METHOD: We used longitudinal survey data from a UK-wide cohort of HCWs to determine whether financial concerns at baseline (December 2020 to March 2021) were associated with depression (measured with the Public Health Questionnaire-2) at follow-up (June to October 2022). We used logistic regression to examine the association between financial concerns and depression, and ordinal logistic regression to establish predictors of developing financial concerns. RESULTS: A total of 3521 HCWs were included. Those concerned about their financial situation at baseline had higher odds of developing depressive symptoms at follow-up. Financial concerns increased in 43.8% of HCWs and decreased in 9%. Those in nursing, midwifery and other nursing roles had over twice the odds of developing financial concerns compared with those in medical roles. CONCLUSIONS: Financial concerns are increasing in prevalence and predict the later development of depressive symptoms in UK HCWs. Those in nursing, midwifery and other allied nursing roles may have been disproportionately affected. Our results are concerning given the potential effects on sickness absence and staff retention. Policy makers should act to alleviate financial concerns to reduce the impact this may have on a discontent workforce plagued by understaffing