Coproduction of healthcare service

"In our efforts to improve healthcare service, we have often inadvertently approached the work as though healthcare was a ‘good’ produced by healthcare professionals. Recognising that healthcare service is a ‘service’ coproduced by patients and health professionals invites four clusters of opportunity for action."

Coproduction of healthcare service
M Batalden, P Batalden, P Margolis, M Seid, G Armstrong, L Opipari-Arrigan, H Hartung
BMJ Qual Saf 2016;25:509-517 doi:10.1136/bmjqs-2015-004315

Read more here.

Are reductions in emergency department length of stay associated with improvements in quality of care?

"We sought to determine whether patients seen in hospitals who had reduced overall emergency department (ED) length of stay (LOS) in the 2 years following the introduction of the Ontario Emergency Room Wait Time Strategy were more likely to experience improvements in other measures of ED quality of care for three important conditions."

Are reductions in emergency department length of stay associated with improvements in quality of care? A difference-in-differences analysis
MJ Vermeulen et al.
BMJ Qual Saf 2016;25:489-498 doi:10.1136/bmjqs-2015-004189

Read more here.

How safe is primary care?

"Improving patient safety is at the forefront of policy and practice. While considerable progress has been made in understanding the frequency, causes and consequences of error in hospitals, less is known about the safety of primary care."

How safe is primary care? A systematic review
S Singh Panesar et al.
BMJ Qual Saf 2016;25:544-553 doi:10.1136/bmjqs-2015-004178

Read more here.

Outpatient services and primary care: scoping review, substudies and international comparisons

"There is little conclusive evidence on the cost-effectiveness of the provision of more care in the community. In developing new models of care for the NHS, it should not be assumed that community-based care will be cheaper than conventional hospital-based care. Possible reasons care in the community may be more expensive include supply-induced demand and addressing unmet need through new forms of care and through loss of efficiency gained from concentrating services in hospitals."

Outpatient services and primary care: scoping review, substudies and international comparisons 
E Winpenny, C Miani, E Pitchforth, S Ball, E Nolte, S King, et al.
Health Services Delivery Research 2016;4(15)

Read more here.

Stopping Over-Medication of People with Learning Disabilities

"The goal is to improve the quality of life of people with a learning disability by reducing the potential harm of inappropriate psychotropic drugs that may be used wholly inappropriately, as a “chemical restraint” to control challenging behaviour, in place of other more appropriate treatment options. It is time for action, it is time for you to lead a medication review of all people with a learning disability, with a view to implementing a planned supervised dose reduction and stopping of inappropriate psychotropic drugs"

Stopping Over-Medication of People with Learning Disabilities (toolkit): Reducing inappropriate psychotropic drugs in people with a learning disability in general practice and hospitals in 2016
NHS England
June 2016

Access the toolkit here.

Commissioning for Value Focus Packs

"These focus packs provide more detailed information on those highest spending programmes previously covered by the earlier Commissioning for Value packs. The areas covered are: cancer; the CVD family of conditions including renal, stroke and diabetes; maternity and early years; mental health and dementia; musculoskeletal and trauma; neurology; and respiratory. The packs include a wider range of outcome measures and information on the most common procedures and diagnoses for the condition in question. They help CCGs begin work on phase two of the RightCare approach ‘What to Change’ by using indicative data to identify improvement opportunities."

There are two Commissioning for Value focus packs available for each CCG:

• Cancer, Mental health and dementia, MSK and trauma – May 2016
• CVD, Neurological, Respiratory, Maternity – April 2016

Find out more and access the packs here.

Dementia and housing: An assessment tool for local commissioning

"Commissioned by Public Health England ... this self-assessment tool focuses on local commissioning processes and decision-making. The main principle being applied in this tool is that all available assets and resources need to be combined, both to create the conditions that reduce the risk of developing dementia, and to develop a framework of support to help those with dementia, their families and carers, to have as good a quality of life as possible."

Dementia and housing: An assessment tool for local commissioning
Housing Learning & Improvement Network
May 2016

Read more here.

Sustaining Improvement. IHI White Paper

"This white paper presents a framework that health care organizations can use to sustain improvements in the safety, effectiveness, and efficiency of patient care. The key to sustaining improvement is to focus on the daily work of frontline managers, supported by a high-performance management system that prescribes standard tasks and responsibilities for managers at all levels of the organization."

Sustaining Improvement. IHI White Paper

R Scoville, K Little, J Rakover, K Luther, K Mate 

Cambridge, Massachusetts: Institute for Healthcare Improvement

2016

Read more here (requires registration).  

Methods for Reducing Sepsis Mortality in Emergency Departments and Inpatient Units

"In 2011, North Shore-LIJ Health System (now Northwell Health) launched a strategic partnership with the Institute for Healthcare Improvement to accelerate the pace of sepsis improvement, focusing initially on sepsis recognition and treatment in emergency departments (EDs). The health system reduced overall sepsis mortality by approximately 50 percent in a six-year period (2008-2013; sustained through 2014) "

Methods for Reducing Sepsis Mortality in Emergency Departments and Inpatient Units
ME Doerfler  et al.
Joint Commission Journal on Quality and Patient Safety. 2015 May;41(5):205-211.

Read more here (registration required).

Impact of the DoH Commissioning for Quality and Innovation incentive on the success of venous thromboembolism risk assessment

"We achieved 95% RA [Risk Assessment] compliance which has favourably impacted on our daily practice and improved the quality of the clinical care."
The impact of the DoH Commissioning for Quality and Innovation incentive on the success of venous thromboembolism risk assessment in hospitalised patients. 
A Shlebak, P Sandhu, V Ali, G Jones, C Baker
Journal of the Royal Society of Medicine Open June 2016 vol. 7 no. 6 2054270416632702

Read more here.

Using lean methodology to improve efficiency of electronic order set maintenance in the hospital

"Applying Lean production principles to the order set review process resulted in significant improvement in processing time and increased quality of orders. As use of order sets and other forms of clinical decision support increase, regular evidence and process updates become more critical."

Using lean methodology to improve efficiency of electronic order set maintenance in the hospital
L Idemoto, B Williams, C Blackmore
BMJ Quality Improvement Reports 2016;5: doi:10.1136/bmjquality.u211725.w4724

Read more here.

Implementation of a Shoulder Soft Tissue Injury Triage Service Improves Time to Surgery

"Our new service resulted in surgical repair of traumatic rotator cuff tears 29 days faster than the traditional system with an extra 38% of patients having surgery within 90 days of injury - a benchmark thought to improve outcome. Future work will aim to improve this percentage further and include long term patient follow up of outcome measures after surgery."

Implementation of a Shoulder Soft Tissue Injury Triage Service in a UK NHS Teaching Hospital Improves Time to Surgery for Acute Rotator Cuff Tears.
M Bateman, G Davies-Jones, A Tambe, DI Clark
BMJ Quality Improvement Reports 2016;5: doi:10.1136/bmjquality.u211254.w4531

Read more here.

Succeeding in Sustained Reduction in the use of Restraint using the Improvement Model

"As part of the Scottish Patient Safety Programme – Mental Health one of the main drivers was the reduction of harm to patients caused by restraint. The aim of this project was to reduce the number of restraints on our Acute Admissions ward."

Succeeding in Sustained Reduction in the use of Restraint using the Improvement Model
A Bell, N Gallacher
BMJ Quality Improvement Reports 2016;5: doi:10.1136/bmjquality.u211050.w4430

Read more here.

Improving maternal confidence in neonatal care through a checklist intervention

"These results suggest that introduction of a simple checklist can be successfully utilised to improve confidence of mothers in being able to care for their newborn child. Further investigation is indicated, but this intervention has the potential for routine application in postnatal care."

Improving maternal confidence in neonatal care through a checklist intervention
D Radenkovic et al.
BMJ Quality Improvement Reports 2016;5: doi:10.1136/bmjquality.u210655.w4292

Read more here.

Improving the management of iron deficiency in ambulatory heart failure patients

"In an attempt to improve patient and physician satisfaction we piloted an ambulatory outpatient service to deliver iv iron. We demonstrated that this service was feasible and more efficient as less time was required waiting for a bed or spent in hospital and was less costly."

Improving the management of iron deficiency in ambulatory heart failure patients
C Hayward, H Patel, C Allen, A Vazir
BMJ Quality Improvement Reports 2016;5: doi:10.1136/bmjquality.u209822.w4076

Read more here.

Improving physical health for people taking antipsychotic medication

"The combination of interventions has created an improvement in monitoring and changes appear to be sustained throughout the project." 

Improving physical health for people taking antipsychotic medication in the Community Learning Disabilities Service
I Hall, A Shah
BMJ Quality Improvement Report 2016;5: doi:10.1136/bmjquality.u209539.w3933

Read more here.

Reducing blood culture contamination rates in an Emergency Department

"Current guidelines advocate a contamination rate of 2–3%. From January 2013 to November 2014 inclusive, the contamination rate was 4.74% in our Emergency Department, responsible for initial management and investigation of over 40 cases of sepsis per month. A Quality Improvement team was created to try to reduce contamination rates to the recommended target."

A change of culture: reducing blood culture contamination rates in an Emergency Department
J Bentley, S Thakore, L Muir, A Baird, J Lee
BMJ Quality Improvement Report 2016;5: doi:10.1136/bmjquality.u206760.w2754

Read more here.

Improving the quality of handover in a liaison psychiatry team

"Without guidelines handover between shifts is of a poor quality, and often lacks key information to allow colleagues to identify patients and prioritise need. Education of those performing these handovers did not produce any benefits, either immediately following its delivery or in longer term follow up. The implementation of a template to aid clinicians in recording this data did produce improvements and received positive feedback from doctors."

Improving the quality of handover in a liaison psychiatry team
J Brook, M Amaro Calcia
BMJ Quality Improvement Reports 2016;5: doi:10.1136/bmjquality.u206492.w3442

Read more here.

Public health and prevention (Quality Watch)

"Against a backdrop of substantial changes to the way public health services in England are commissioned and increasing funding constraints on local government, this QualityWatch report provides an overview of public health outcomes in recent years."

Focus on: Public health and prevention (Quality Watch)
A Davies, E Keeble, T Bhatia, E Fisher
The Health Foundation, Nuffield Trust
April 2016

Read more here.

Building Q: Learning from designing a large scale improvement community

"The report identifies lessons for anyone seeking to support improvement work across organisations or through networks, as well as those engaged in designing initiatives with many diverse stakeholders. It draws on a variety of sources including the independent real-time evaluation of Q undertaken by RAND Europe."

Building Q: Learning from designing a large scale improvement community
P Pereira, H O'Malley
The Health Foundation
May 2016

Read more here.