A Medicines Optimisation Service

"The service was developed as a result of a pilot in one practice who used innovation funding to employ a pharmacist to improve their management of medicines. The idea came from the GPs who felt they were always rushed when looking at discharge medicines and this task would be more efficiently and effectively undertaken by a pharmacist. "

A Medicines Optimisation Service
Wyre Forest Clinical Commissioning Group
NICE Shared Learning example
May 2015

Read more here.

Improving evidence-based management of irritable bowel syndrome across Somerset

"By identifying cost savings from reducing referrals to secondary care for patients of 16-45 years old with no red flag symptoms and likely IBS, and limiting investigations to those with a likely inflammatory pathology, we were able to fund faecal calprotectin testing for general practice and a specialist dietetic-led gastroenterology clinic"

Improving evidence-based management of irritable bowel syndrome across Somerset
Somerset Gastroenterology Flexible Healthcare Team
NICE Shared Learning example
June 2015

Read more here.

A Right Care Collaboration 2015/19: Forward View

"During 2015/16, NHS Right Care will scale up its activities and will seek to develop partnerships across the major NHS bodies to develop a variations and value programme." 

A Right Care Collaboration 2015/19: Forward View
NHS Right Care
June 2015

Read more here.

Medicine optimisation can cut the costs of long term conditions

"Medicines optimisation can cut waste, emergency admissions and the cost of long term conditions. But a review of rheumatoid arthritis care reveals how far it has to go"

Medicine optimisation can cut the costs of long term conditions
M Shelley
Health Service Journal Supplement
June 2015

Read more here.

Improving medical handover at the weekend

"we found that a structured, well organised weekend handover meeting together with an effective electronic handover system improves the quality of medical weekend handover."

Improving medical handover at the weekend: a quality improvement project
E Michael, C Patel
BMJ Quality Improvement Reports 2015;4: doi:10.1136/bmjquality.u207153.w2899

Read more here.

Optimising the Pre-Operative Investigative Work Up for Elective Surgical Patients

"Design and implementation of a “Pre-Admission Handbook”, for use by junior doctors and nurse practitioners in the pre-operative setting, reduced the rate of over investigation to 12% in a subsequent, prospective audit cycle of 50 patients, and has improved patient care by standardising the pre-admissions process for elective surgery"

Optimising the Pre-Operative Investigative Work Up for Elective Surgical Patients
N Hack-Adams, N King, M Ahuja, SM Higgs
BMJ Quality Improvement Reports 2015;4: doi:10.1136/bmjquality.u206272.w2608

Read more here.

How-to Guide: Prevent Adverse Drug Events

"This How-to Guide describes key evidence-based care components to prevent adverse drug events (ADEs) by implementing medication reconciliation at all transitions in care (at admission, transfer, and discharge), describes how to implement these interventions, and recommends measures to gauge improvement." 

How-to Guide: Prevent Adverse Drug Events (Medication Reconciliation)
Institute for Healthcare Improvement
2011

Read more here.

How-to Guide: Prevent Catheter-Associated Urinary Tract Infection

"This How-to Guide describes key evidence-based care components for preventing catheter-associated urinary tract infections, describes how to implement these interventions, and recommends measures to gauge improvement."

How-to Guide: Prevent Catheter-Associated Urinary Tract Infection
Institute for Healthcare Improvement
2011

Read more here.

How-to Guide: Deploy Rapid Response Teams

"This How-to Guide describes key evidence-based care components for Rapid Response Teams, describes how to implement these interventions, and recommends measures to gauge improvement."

How-to Guide: Deploy Rapid Response Teams
Institute for Healthcare Improvement
2008

Read more here.

High performing hospitals: a qualitative systematic

"The objective of this study was to undertake a systematic review of qualitative literature to identify methods used to identify high performing hospitals, the factors associated with high performers, and practical strategies for improvement."

High performing hospitals: a qualitative systematic review of associated factors and practical strategies for improvement
N Taylor, R Clay-Williams, E Hogden, J Braithwaite, O Groene
BMC Health Services Research 2015, 15:244  doi:10.1186/s12913-015-0879-z

Read more here.

Waiting time reduction in intravitreal clinics by optimization of appointment scheduling

"This study was designed guided by the Model for Improvement framework to reduce waiting times and visit duration in the intravitreal therapy clinic, while improving patient and staff experience. In our aim to provide good quality, patient-centred care and constantly improve, we optimised the appointment profile and patient flow."

Waiting time reduction in intravitreal clinics by optimization of appointment scheduling: balancing demand and supply
M Ugarte
BMJ Quality Improvement Reports 2015;4: doi:10.1136/bmjquality.u208924.w3618

Read more here.

Triggers for palliative care: Improving access

"This report explores the evidence around access to palliative care for people with terminal illnesses other than cancer."

Triggers for palliative care:  Improving access to care for people with diseases other than cancer
Marie Curie
June 2015

Read more here.

Sexual health commissioning in local government

"This resource describes how public health in a number of councils has started to build on the opportunities of a local government setting to improve sexual health and wellbeing. The case studies were chosen because they show a range of ways in which public health in councils is approaching the commissioning of sexual health services."

Sexual health commissioning in local government: building strong relationships, meeting local needs
Local Government Association
June 2015

Read more here.

Transforming general practice

"Financial incentives are most likely to stimulate transformational change if they are large scale and high profile – with finances and reputations at stake if they fail"

Transforming general practice: what are the levers for change?
R Rosen
Nuffield Trust

June 2015

Read more here.

Ending the Crisis in NHS Leadership: a Plan for Renewal

"If leadership is to be strengthened and successful, then the task must be made more manageable, more attractive and more sustainable"

Ending the Crisis in NHS Leadership: a Plan for Renewal
HSJ Future of NHS Leadership
June 2015

Read more here.

Improving Patient Safety Culture through Teamwork and Communication

"This new HPOE guide outlines the TeamSTEPPS framework, describes teamwork tools and includes examples and case studies illustrating how hospitals and care systems are using TeamSTEPPS to improve patient safety and quality."

Improving Patient Safety Culture through Teamwork and Communication: TeamSTEPPS®
Health Research & Educational Trust
June 2015

Read more here.

Pharmacist-led repeat prescription management

"Walsall Clinical Commissioning Group (CCG) implemented a pharmacist-led repeat prescription management service (RPMS). The service was aimed at reducing medicines wastage, minimising possible harm from medicines and improving the quality of repeat prescribing."

Pharmacist-led repeat prescription management: ensuring appropriate prescribing and reducing wastage
Walsall Clinical Commissioning Group
QIPP Case Study
November 2014

Read more here.

Transforming our health care system: Ten priorities for commissioners

"We have identified ten priorities for action. A striking feature of all the priorities is the degree to which they call for change within primary care and the way in which primary care relates to the rest of the system. "

Transforming our health care system: Ten priorities for commissioners
C Naylor et al.
The King's Fund
April 2015

Read more here.

Integration: Local government and health leaders prefer a whole system approach

"Local government and health leaders believe whole system integration models are a better option than pathways for specific conditions"

Integration: Local government and health leaders prefer a whole system approach
R Dalton
Health Service Journal Supplement
June 2015

Read more here.

Specialised commissioning: Are we getting best value from £14.5bn?

"Specialised commissioning costs the NHS billions each year. HSJ gathered experts to tackle some difficult questions, not least over the balance between central and local involvement."

Specialised commissioning: Are we getting best value from £14.5bn?
A Moore
Health Service Journal Supplement
June 2015

Read more here.

Local Estates Strategies: A Framework for Commissioners

"Achieving the efficiencies required by the Five Year Forward View will mean all parts of the health service will need to work with greater agility and greater co-operation. Good quality strategic estates planning is vital to making the most of these changes and will allow the NHS to:

• fully rationalise its estate,
• maximise use of facilities,
• deliver value for money, and
• enhance patients’ experiences."

Local Estates Strategies: A Framework for Commissioners
Property Branch in Commercial Division
Department of Health
June 2015

Read more here.

Back to basics: checklists in aviation and healthcare

"Overreliance on checklists as a safety net can lead to omission of other safety practices that may better support safety through reliability and resilience. Checklists are excellent ‘aides memoire’ and directives to correct procedures, but they are not a panacea"

Back to basics: checklists in aviation and healthcare
R Clay-Williams, L Colligan
BMJ Quality and Safety 2015;24:428-431 doi:10.1136/bmjqs-2015-003957

Read more here.

The association of hospital prevention processes and patient risk factors with the risk of Clostridium difficile infection

"In the largest study to date, selected hospital prevention strategies were not associated with a statistically significant reduction in patients’ risk of C. difficile infection."

The association of hospital prevention processes and patient risk factors with the risk of Clostridium difficile infection: a population-based cohort study
N Daneman, A Guttmann, X Wang, X Ma1, D Gibson, TA Stukel
BMJ Quality and Safety 2015;24:435-443 doi:10.1136/bmjqs-2014-003863

Read more here.

Monitoring of physical health parameters on a child and adolescent mental health unit receiving antipsychotic therapy

"In the adolescent unit, we identified a significant lack of physical health monitoring in this high risk age group. A single paged prompt sheet has been shown to significantly improve physical health monitoring in the majority of parameters."

Monitoring of physical health parameters for inpatients on a child and adolescent mental health unit receiving regular antipsychotic therapy
N Pasha, S Saeed, K Drewek
BMJ Quality Improvement Reports 2015;4: doi:10.1136/bmjquality.u202645.w3700

Read more here.

Perioperative dexamethasone administration in tonsillectomy patients

"Dexamethasone provides a low cost and relatively safe method to reduce post-operative complications in tonsillectomy patients. Despite this evidence, failure to administer dexamethasone still results in unplanned admissions, causing unnecessary costs to the National Heath Service"

Perioperative dexamethasone administration in tonsillectomy patients: A three-cycle audit showing improvement using printed theatre lists
S Bola, A Bartlett, R Williams
BMJ Quality Improvement Reports 2015;4: doi:10.1136/bmjquality.u208428.w3339

Read more here.

Outcome-based payment schemes: government’s use of payment by results

"This report highlights lessons on the selection and implementation of PbR in the UK public sector. Its intended main audience is commissioners and senior decision-makers within departments, as well as officials at the centre of government with an interest in public service delivery models."

Outcome-based payment schemes: government’s use of payment by results
National Audit Office
June 2015

Read more here.

Hospital board oversight of quality and safety

"This paper offers critical reflection on the relationship between hospital board oversight and patient safety. In doing so it highlights new perspectives and suggestions for developing this area of study."

Hospital board oversight of quality and safety: a stakeholder analysis exploring the role of trust and intelligence
R Millar, T Freeman, R Mannion
BMC Health Services Research 2015, 15:196  doi:10.1186/s12913-015-0771-x

Read more here.

Improving Care for Chronic Conditions

"The goal of this project is to document the current range of chronic care management services, identify best practices, and elicit industry trends. We also attempt to identify factors in the plans’ operating environment that limit their ability to optimize chronic care programs."

Improving Care for Chronic Conditions: Current Practices and Future Trends in Health Plan Programs
S Mattke, T Mengistu, L Klautzer, EM Sloss, RH Brook
RAND Corporation
2015

Read more here.

The NIHR Invention for Innovation (i4i) programme: progress review

"The NIHR Invention for Innovation (i4i) programme supports the development of innovative medical technologies for patient benefit...The evaluation aimed to identify outputs and impacts to date, and to examine the factors influencing performance and progress. "

The NIHR Invention for Innovation (i4i) programme: A review of progress and contributions to innovation in healthcare technologies
S Marjanovic, J Krapels, S Sousa, S Castle-Clarke, V Horvath, J Chataway
RAND Corporation
June 2015

Read more here.

Wrong-Site Surgery, Retained Surgical Items, and Surgical Fires

"Current estimates for wrong-site surgery and retained surgical items are 1 event per 100 000 and 1 event per 10 000 procedures, respectively, but the precision is uncertain, and the per-procedure prevalence of surgical fires is not known. "

Wrong-Site Surgery, Retained Surgical Items, and Surgical Fires: A Systematic Review of Surgical Never Events 
S Hempe et al.
JAMA Surgery June 10, 2015. doi:10.1001/jamasurg.2015.0301

Read more here.

General Practice in England

"This briefing paper provides general background for Members and their staff on NHS primary medical services provided by general practitioners (GPs) in England. It gives an overview of commissioning arrangements as well as information on changes to GP contracts and funding arrangements."

General Practice in England
Commons Briefing papers CBP-7194
E Blow, T Powell
May 2015

Read more here.

Emerging practice in outcome-based commissioning for social care

"This paper is a progress report exploring the lessons learnt from a variety of approaches taken by councils to “outcome-based commissioning” in adult social care (sometimes called 'payment by results').  It considers some of the opportunities and risks that arise from taking this approach."

Emerging practice in outcome-based commissioning for social care
J Bolton
Institute of Public Care, Oxford Brookes University
April 2015

Read more here.

Epilepsy emergency rescue training

"The intervention has a significant positive impact on patient safety, prescribing costs, and was anecdotally evidenced by reduction of paramedic call outs and ED admissions."

Epilepsy emergency rescue training
R Shankar, C Jory, J Ashton, B McLean, M Walker
BMJ Quality Improvement Reports 2015;4: doi:10.1136/bmjquality.u208167.w3566

Read more here.

Five Year Forward View - The Success Regime

"The ‘Success Regime’ is aimed at providing increased support and direction to the most challenged systems in order to secure improvement in 3 main areas:

• short-term improvement against agreed quality, performance or financial metrics
• medium and longer-term transformation, including the application of new care models where applicable
• developing leadership capacity and capability across the health system"

Five Year Forward View - The Success Regime: A whole systems intervention
Monitor, NHS
June 2015

Read more here.

Sexual health commissioning in local government

"This resource describes how public health in a number of councils has started to build on the
opportunities of a local government setting to improve sexual health and wellbeing.
The case studies were chosen because they show a range of ways in which public health in
councils is approaching the commissioning of sexual health services. They include councils
spread across England, covering both rural and urban environments and with varying levels of
deprivation and affluence."

Sexual health commissioning in local government: building strong relationships, meeting local needs
Local Government Association, MEDFASH
June 2015

Read more here.

Making Sense and Making Use of Patient Experience Data

"The report raises important questions. Is the collection, analysis and reporting of data on patient experience being done by people with the right skills and knowledge to do this work? Are these activities merged with responsibilities for reporting on activity and clinical quality, or are they carried out separately?"

Making Sense and Making Use of Patient Experience Data
Membership Engagement Services’, InHealth Associates
June 2015

Read more here.

Review of Operational Productivity in NHS providers

"This interim report outlines the work that has been carried out by Lord Carter of Coles to review the productivity of NHS hospitals, working with a group of 22 NHS providers.."

Review of Operational Productivity in NHS providers
An independent report for the Department of Health by Lord Carter of Coles
Interim Report
June 2015

Read more here.

Feasibility and impact of implementing a private care system’s diabetes quality improvement intervention in the safety net

"This study adds substantially to our understanding of whether and how QI strategies proven effective in better-resourced care settings can be translated into under-resourced clinics. Such translation and implementation could potentially yield important benefits to clinics serving low-income populations by helping them keep up with the care delivery innovations that other settings develop."

Feasibility and impact of implementing a private care system’s diabetes quality improvement intervention in the safety net: a cluster-randomized trial
R Gold et al.
Implementation Science 2015, 10:83  doi:10.1186/s13012-015-0259-4

Read more here.

Knowledge exchange in health-care commissioning

"The aim of this research from 2011 to 2014 was to study knowledge exchange between these external providers and health-care commissioners to learn about knowledge acquisition and transformation, the role of external providers and the benefits of contracts between external providers and health-care commissioners."

Knowledge exchange in health-care commissioning: case studies of the use of commercial, not-for-profit and public sector agencies, 2011-14
L Wye, E Brangan, A Cameron, J Gabbay, J Klein, C Pope
Health Services and Delivery Research  2015;3(19)

Read more here.

Options for integrated commissioning

"A single national outcomes framework for integrated care should be agreed to ensure there is joint accountability between the NHS and local government."

Options for integrated commissioning: Beyond Barker
R Humphries, L Wenze
The King's Fund
June 2015

Read more here.

Talent management: Developing leadership not just leaders

"Talent management is a set of integrated organisational workforce processes designed to attract, develop, motivate and retain productive, engaged employees. The goal of talent management is to create a high-performance, sustainable organisation that meets its strategic and operational goals and objectives."

Talent management: Developing leadership not just leaders
Sarah Massie
The King's Fund
June 2015

Read more here.

Improving handover from intensive care to ward medical teams with simple changes to paperwork

"This quality improvement project serves to demonstrate that carefully targeted, simple changes to practice in identified critical areas can produce dramatic as well as legally and ethically required results in a very short space of time."

Improving handover from intensive care to ward medical teams with simple changes to paperwork
J Messing
BMJ Quality Improvement Reports 2015;4: doi:10.1136/bmjquality.u206467.w2913

Read more here.

Cutting delays in reversing anticoagulation after intracerebral haemorrhage

"We have substantially reduced delays in delivering PCC (Prothrombin complex concentrate) to VKA-ICH (vitamin K antagonists) patients at our centre and our simple changes could be easily implemented at centres facing similar barriers."

Cutting delays in reversing anticoagulation after intracerebral haemorrhage: three key changes at a UK comprehensive stroke centre
A Parry-Jones
BMJ Quality Improvement Reports 2015;4: doi:10.1136/bmjquality.u208763.w3521

Read more here.

Smoking Cessation Interventions in the Cardiology Ward

"NRT was available for inpatients, but was rarely utilised by junior doctors. With the achievement of NCSCT certification by all the senior house officers, the recording of smoking status in the electronic patient record and the flagging up of patients yet to be queried about their smoking status, NRT prescription significantly increased from 25% to 100%"

Smoking Cessation Interventions in the Cardiology Ward

MP Cassar
BMJ Quality Improvement Reports 2015;4: doi:10.1136/bmjquality.u206437.w2654

Read more here.

Reducing hospital acquired pressure ulcers in intensive care

"The measures or changes to practice used to reduce hospital acquired pressure ulcers in the intensive care department achieved their goal and incidences of hospital acquired pressure ulcers decreased."

Reducing hospital acquired pressure ulcers in intensive care
E Cullen Gill
BMJ Quality Improvement Reports 2015;4: doi:10.1136/bmjquality.u205599.w3015

Read more here.

How can we improve the recognition, reporting and resolution of medical device-related incidents in hospitals?

"The results of this qualitative study has the potential to provide some initial steps to the design and development of a hospital medical device surveillance system that would help to improve the patient safety and health care delivery."

How can we improve the recognition, reporting and resolution of medical device-related incidents in hospitals? A qualitative study of physicians and registered nurses
J Polisena, A Gagliardi, T Clifford
BMC Health Services Research 2015, 15:220  doi:10.1186/s12913-015-0886-0

Read more here.

Mental health crisis care review

Two reports have been published following a review of mental health crisis services. The reports consider aspects of quality, safety and effectiveness, as well as patient experience.

Mental health crisis review – experiences of black and minority ethnic communities
Jeraj, Samir, Shoham, Tara and Islam-Barrett, Farah
Race Equality Foundation
June 2015

Access the report here.

Right here, right now: Mental health crisis care review
Care Quality Commission
June 2015

Access the report here.

Using clinical supervision to improve the quality and safety of patient care

"The evidence linking clinical supervision to the quality and safety of patient care reveals that supervision is most effective when its educational and supportive functions are separated from its managerial and evaluative functions."

Using clinical supervision to improve the quality and safety of patient care: a response to Berwick and Francis
J Tomlinson
BMC Medical Education 2015, 15:103  doi:10.1186/s12909-015-0324-3

Read more here.

Safer Wards: reducing violence on older people's mental health wards

"Through the Safer Wards project we aimed to reduce the number of incidents of physical violence on older people’s mental health wards."

Safer Wards: reducing violence on older people's mental health wards
J Brown et al.
BMJ Quality Improvement Reports 2015;4: doi:10.1136/bmjquality.u207447.w2977

Read more here.

Quality improvement in resident education

"This resident physician-led quality improvement project was conducted with aims to improve the health of youth prescribed atypical antipsychotic medications by increasing physician monitoring for metabolic side effects, while simultaneously educating trainees in quality improvement methodology."

Quality improvement in resident education: a pilot project to mitigate metabolic side effects from atypical antipsychotic medications in youth
J Jeffrey
BMJ Quality Improvement Reports 2015;4: doi:10.1136/bmjquality.u208804.w3544

Read more here.

Type 1 diabetes pregnancy toolkit

"The research showed that there was very little easy to understand information available aimed solely at women with type 1 diabetes... Furthermore, advice for women with type 1 diabetes advice was often mixed with advice for women with type 2 diabetes.

We identified a clear patient need for a simple, downloadable, information resource about all aspects of pregnancy with type 1 diabetes that identified pre-conception goals."

Type 1 diabetes pregnancy toolkit
JDRF
NICE Shared Learning example
May 2015

Read more here.

Improving GP services: commissioners and patient choice

"This report presents the findings of our review of how GP services are working for patients, with a specific focus on the role of choice and competition...Here, we focus on the role of patient choice in driving improvements in the quality of GP services"

Improving GP services: commissioners and patient choice
Monitor
June 2015

Read more here.

Screening for Cancer: Advice for High-Value Care

"Higher-intensity strategies are not necessarily higher value. High-value strategies provide a degree of benefits that clearly justifies the harms and costs incurred; low-value screening provides limited or no benefits to justify the harms and costs. When cancer screening leads to benefits, an optimal intensity of screening maximizes value. Some aspects of screening practices, especially overuse and underuse, are low value."

Screening for Cancer: Advice for High-Value Care From the American College of Physicians
TJ Wilt, RP Harris, A Qaseem
Annals of Internal Medicine. 2015;162(10):718-725. doi:10.7326/M14-2326

Read more here.

Health and social care priorities for the Government

" it is essential that we move to a more empowering, bottom-up approach while at the same time holding health care leaders to account for the care their organisations deliver to patients and service users."

Health and social care priorities for the Government: 2015–2020
Nuffield Trust
June 2015

Read more here.

Can staff and patient perspectives on hospital safety predict harm-free care?

"The findings suggest that although the views of patients and staff predict some overlapping variance in patient safety outcomes, both also offer a unique perspective on patient safety, contributing independently to the prediction of safety outcomes."

Can staff and patient perspectives on hospital safety predict harm-free care? An analysis of staff and patient survey data and routinely collected outcomes
R Lawton, JK O'Hara, L Sheard, C Reynolds, K Cocks, G Armitage, J Wright
BMJ Quality and Safety 2015;24:369-376 doi:10.1136/bmjqs-2014-003691

Read more here.

An algorithm for predicting doctors’ risks of formal patient complaints

"The PRONE score appears to be a valid method for assessing individual doctors’ risks of attracting recurrent complaints. Regulators could harness such information to target quality improvement interventions, and prevent substandard care and patient dissatisfaction."

The PRONE score: an algorithm for predicting doctors’ risks of formal patient complaints using routinely collected administrative data
MJ Spittal, MM Bismark, DM Studdert
BMJ Quality and Safety 2015;24:360-368 doi:10.1136/bmjqs-2014-003834

Read more here.