Posts from the “Uncategorized” Category

The importance of listening to shape clinical guidelines in a fast-changing world – Jenny Bennison

Posted on December 7, 2018

SIGN’s stakeholder feedback report was published in August of this year and it’s my job as Chair of the Strategy subgroup of SIGN Council to ensure we listen to that feedback and act upon it. A lot has changed in NHSScotland since we published our first SIGN clinical guideline on prophylaxis of venous thromboembolism in 1996. The World Wide Web had only come into being in 1991 and busy healthcare professionals had to search for information about new therapies from scientific journals held in medical libraries, or rely on clinical update lectures, whilst trying to avoid the lures of pharmaceutical advertising and sponsorship. Today, information about the latest clinical trial is available anytime, anywhere and accessible from a smartphone – the challenge, for clinicians…

Categories: Uncategorized

Using SIGN to improve diabetes care in a forensic mental health service – Claire Borthwick

Posted on November 27, 2018

At The State Hospital, a high-security forensic mental health service for patients from Scotland and Northern Ireland, our team used SIGN 116 guidelines for the management of diabetes to develop our service. The following recommendation was identified as a clinical need: Children and adults with type 1 and type 2 diabetes should be offered psychological interventions (including motivational interviewing, goal setting skills and CBT) to improve glycaemic control in the short and medium term. “A range of professionals were willing to provide input during the development phase and their expertise and contributions were integral to the successful development of the programme manual.” The lead dietician approached me (a trainee health psychologist) with a request for a group psychological intervention to be developed for patients…

Categories: Uncategorized

Staff culture can really help unlock improvements in the care of older people – Eddie Docherty

Posted on November 19, 2018

Eddie_Docherty_2 Last year, Scotland’s population was estimated to be 5,424,800 – a record high and an increase of 6% on 2017. The largest increase was in the 75 and over age group (+31%). It is, of course, good news that we are all living longer. However that increase in older age groups is hugely significant for our health and social care system.

The likelihood of being admitted to hospital is, as expected, highly correlated with the age of the population. Around one person in three of the Scottish population aged over 75 was admitted at least once to hospital in 2016/17. By way of contrast, just under one in 11 people aged 25-44 were admitted.

“Dumfries and Galloway had some of the dynamics no doubt many boards and hospitals have: staff who were doing their utmost, in sometimes very difficult conditions, endeavouring to give the best care they possibly could.”

At the same time as we have an increasing demand in our hospitals, we have other pressures to manage which can impact on care, for example ongoing difficulties in recruiting to a range of posts, and a perennially challenging financial context.

Acute hospital care In Dumfries and Galloway had some of the dynamics no doubt many boards and hospitals have: staff who were doing their utmost, in sometimes very difficult conditions, endeavouring to give the best care they possibly could.

So when the inspections on the care of older people in two of our hospitals highlighted a number of concerns and challenges, it was a very difficult message for staff to manage – even though we knew the findings were accurate.

There is a natural emotional response that comes from staff who are working hard, doing their best and feeling like the criticism is unfair. After all, no-one was coming to work to do a bad job. I have no doubt many who have received challenging inspection reports have felt the same.

Yet, after that initial, understandable, emotional response, what has happened since those inspection reports were published has been hugely positive. That subsequent reaction has been down to the staff themselves who chose to respond to the challenges in a way that that has empowered them and benefited patients.

Culture was the key

The key to the positive response was in managers and staff using the feedback, taking stock and ‘owning’ the areas that needed improvement. There was no one silver bullet to the improvements taking place but a combination of factors which included:

An understanding that answers to improvements lay ‘in the room’
Teams delivering care were empowered to make the changes they needed to make (eg if paperwork was not helping manage care then they could change it to something that did)
We had a strong group of individuals who wanted to make the changes
The key thing to change was culture (of person-centred care) and it was staff who could shape this
Staff felt strongly connected with the patients and their families as the hospitals and their workforces were an integral part of the local community.

So, having weathered the challenge, staff developed an action plan and used improvement methodology from Healthcare Improvement Scotland’s ihub to support the improvements, look at best practice from elsewhere to understand how to make change happen.

“The key to the positive response was in managers and staff using the feedback, taking stock and ‘owning’ the areas that needed improvement. There was no one silver bullet to the improvements taking place but a combination of factors.”

It has taken at least 6-8 months for changes to feel tangible and there have also been some personnel changes which have added impetus to the cultural change. However, it is important to say that it is the teams themselves that have taken responsibility for change.

The impact

The latest inspection reports in to the two hospitals concerned are in stark contrast to the initial reports – inspectors positively commenting on team work, ethos and person-centred care. It has been a major turning point for staff. It feels like there has been a clear psychological change – and a change to a more positive perception of inspections themselves. Staff will now welcome the inspectors and the inspection process, knowing that this is an opportunity to get better. And they know that they can make the most of the improvement support that is available from Healthcare Improvement Scotland and feel they are able to embrace both aspects.

“The latest inspection reports in to the two hospitals concerned are in stark contrast to the initial reports – inspectors positively commenting on team work, ethos and person-centred care. It has been a major turning point for staff. It feels like there has been a clear psychological change – and a change to a more positive perception of inspections themselves.”

Added benefits

One of the added benefits of the changes was that, across the service in Dumfries and Galloway there has been a less fragmented feeling, and more of a feeling of a team ethos. In addition, it also feels like there has been change in the working environment to one that is a more open, learning environment.

No resting on laurels

There remains room for improvement and I’m not saying we have solved all issues. But it feel like we are more confident and in a better place to use challenges from inspections, and the improvement support available, to improve care in a way that might not have happened before. And for that, the staff in Dumfries and Galloway hospitals can take a huge amount of credit.

Eddie Docherty is Director of Nursing at NHS Dumfries and Galloway.

Categories: Uncategorized

Why cervical screening is important and how you can shape the standard of care – Karen Grant

Posted on November 16, 2018

Every three years, I receive a letter in the post. It’s an invitation that could change my life. Unfortunately, it is not an invitation to Bradley Cooper’s Hollywood mansion – it is, in fact, way more important than that. The invitation is for me to attend for my smear test. Every time the letter arrives, I feel my heart sink. I really don’t want to go. But, I know what it means and how important the test is in detecting early signs of cervical cancer. “Every three years, I receive a letter in the post. It’s an invitation that could change my life. Unfortunately, it is not an invitation to Bradley Cooper’s Hollywood mansion – it is, in fact, way more important than that.…

Categories: Uncategorized

How pharmacy teams are helping to reduce harm from high risk medicines – Mark Easton

Posted on November 12, 2018

Measton In Scotland, one in five adults are dispensed five or more medicines at any one time and there are 4 million prescribing errors occurring in primary care every year. With a pharmacy almost on every high street, the numbers involved are huge which is why improving safety in pharmacy, particularly around high risk medicines, is a vital piece of work.

As a community pharmacist and the National Pharmacist Clinical Lead for the Scottish Patient Safety Programme, I’m working with pharmacies to help improve safety.

A few years ago, I became involved in some pilot work within NHS Grampian as part of the Scottish Patient Safety Programme (SPSP) Pharmacy in Primary Care Collaborative, which was funded by The Health Foundation.

We tested a pharmacy Patient Safety Climate Survey, which produces a ‘snapshot’ of the safety culture in a pharmacy. It is designed to start a conversation about patient safety and provide a focus on where pharmacies can make improvements. We also tested care bundles for warfarin and for non-steroidal anti-inflammatory drugs (NSAIDs), which are a range of medicines that can relieve pain, reduce inflammation, and bring down a high temperature. These can include medicines such as aspirin and ibuprofen. NSAIDs are widely available on prescription and across the counter. However, this class of drugs is associated with more emergency hospital admissions due to adverse drug reactions than any other class of medicine. Some UK studies have shown that almost 30% of all adverse drug reaction related hospital admissions are linked to NSAIDs and Scottish data indicates that NSAIDs are implicated in over 50% of all bleed related hospital admissions and 60% of deaths due to bleeds. As both the bleed risk and the Acute Kidney Injury (AKI) risk are linked to NSAIDs, these outcomes are predictable, and therefor potentially preventable.

We discovered that pharmacies undertaking the Pharmacy Patient Safety Climate Survey led to conversations about patient safety and a focus on where pharmacies can make improvements. As a result, some pharmacies introduced a daily communication huddle or a communication record book. These in turn led to improvements in key safety and patient information being shared and disseminated more effectively, while other pharmacy teams improved their data collection around ‘near misses’. This led to a better focus on areas of potential harm and improved training.

The Pharmacy Patient Safety Climate Survey is now available to every community pharmacy team in Scotland through the national pharmacy contract, meaning that people all over Scotland are receiving safer care from their pharmacy.

“We discovered that pharmacies undertaking the Pharmacy Patient Safety Climate Survey led to conversations about patient safety and a focus on where pharmacies can make improvements. As a result, some pharmacies introduced a daily communication huddle or a communication record book. These in turn led to improvements in key safety and patient information being shared and disseminated more effectively.”

This improvement drive was further developed in a large piece of work that I have been involved in this year which has seen the roll out of an NSAIDs Pharmacy Pack.

We knew that there were clear ways to improve care. For example, informing people to take NSAIDs with or after food reduces the risk of gastrointestinal side effects .We knew that earlier recognition by patients of the side effects allows action to be taken before they develop into something more serious. We also knew that raising awareness among patients of the medicine sick day rules can reduce the risk of acute kidney injury, as a result of a dehydrating illness.

To help pharmacies prevent adverse drug reactions, the NSAIDs care bundles were developed into the NSAIDs Pharmacy Pack, which gives clear guidance and improvement resources to help reduce gastric bleeding and acute kidney injury.

Pharmacy staff who are using the pack have reported that they are having better quality conversations with patients, and are informing them of the ‘medicine sick day rules’ which is to stop taking certain medicines if they have a dehydrating illness and restart their medication when they are well again. Before many patients were unaware of this key information. An unintended result of the better quality conversations has been that patients are willing to share additional key information relevant to their health which the pharmacist was previously unaware of, this has the potential to significantly improve the safe delivery of pharmaceutical care.

“To help pharmacies prevent adverse drug reactions, the NSAIDs care bundles were developed into the NSAIDs Pharmacy Pack, which gives clear guidance and improvement resources to help reduce gastric bleeding and acute kidney injury.”

One patient who has been prescribed NSAIDs told us that he had previously had an episode of sickness and became acutely unwell spending several days in hospital due to the reaction of his sickness with his medication. He said: “I was picking up my prescription and the pharmacist gave me a little card, this told me what to do if I had another dehydrating illness. Sometime later, I had another episode of sickness, but I remembered the card. As a heart failure patient you have it drilled into you that you must take your medication, but I followed the instructions on the card and I stopped taking the NSAIDs medication. I then became better. So, that little card made a big difference, to me as I didn’t have to spend days in hospital again.”

The NSAIDs Pharmacy Pack has now been distributed to every community pharmacy in Scotland and is supporting pharmacy teams to provide key safety messages to patients and customers whenever NSAIDs are dispensed or purchased, which will make a real difference to people’s health outcomes.

I’m looking forward to continuing to build on safety work by supporting pharmacists and pharmacy technicians in their improvement journey, and through the development of new models of care in GP practices and through better use of prescribing data, leading to better integration of pharmaceutical care across the primary care sector.

Mark Easton is National Clinical Lead (Pharmacist) at the ihub Primary Care Improvement Portfolio.

More information about the Pharmacy Safety Climate Survey is available by visiting the ihub website

Categories: Uncategorized

Creating standards that give people a voice – Fiona Wardell

Posted on November 6, 2018

Fiona Blog Pic In my role as Standards and Indicators Lead for Healthcare Improvement Scotland, I’m sometimes asked, “What impact do standards have?”

On hearing this question, two key answers spring to mind: the quality of health and social care services that our standards work to improve, and also the people who use those services and the impact our standards can have on their lives.

But, first of all, let me explain what we mean by standards.

A set of standards is primarily a document setting out what people who use services should experience, and how organisations and services can demonstrate how they have met these standards. So they impact on the planning, design and delivery of services, and support both national consistency and improvement. And with our commitment to ensure they are focused on real outcomes, they have huge potential to impact on people’s experience of care and support. When we develop standards for health services (and more recently social care services), we work with experts (including those who are experts due to their experience of particular services) from across Scotland. Services and people, therefore, are closely connected.

“With our standards for people who have experienced rape, sexual assault and child sexual abuse, already we are seeing improvements in care and support with compassion and responsive care driving changes in the training of staff.”

Take the development of our neurological care standards as an example. A key driver for Sue Ryder championing for our organisation to develop standards for people living with neurological conditions was their belief that our standards positively impact on bringing about changes and improvements in the delivery of care and support. This expectation was founded in part through our work on HIV, where our standards have led to direct improvements in care and support for people living with HIV in Scotland, such as the development of integrated care pathways, which tell care providers, people using services and their carers, what should be expected at any point along a journey of care. NHS boards welcomed them as an opportunity to focus on the key quality issues relating to HIV care.

Similarly, with our standards for people who have experienced rape, sexual assault and child sexual abuse, already we are seeing improvements in care and support with compassion and responsive care driving changes in the training of staff. For example, work is being undertaken to recruit and train more female forensic examiners which would enable people’s request for a female examiner to be fulfilled. Another example is our work to develop the Health and Social Care standards, which included targeted engagement with young care experienced children. As a direct result of their feedback, the standards were revised and updated to include the importance of feeling ‘valued, loved and secure’.

A vital part of our standards development process is reaching out to ‘seldom heard’ groups to capture their feedback, and to use this feedback to further develop our standards. Every comment is heard. Every comment is responded to. This week I met with survivors of child sexual abuse to hear their views and ensure the things that we think are important and have identified as priorities in our indicators, matter to them. In the summer, when we were consulting on our pregnancy and newborn screening standards, we met with parents and carers of children born with fetal anomalies. Again, we wanted to hear from them, first hand, to make sure our standards are focusing on the things that are important. And we’re sharing all these comments with our development groups and ensuring that our standards are revised to reflect this feedback.

“When we were consulting on our pregnancy and newborn screening standards, we met with parents and carers of children born with fetal anomalies. Again, we wanted to hear from them, first hand, to make sure our standards are focusing on the things that are important.”

And for me, this is a really important area of ‘impact’. Our standards reflect and echo the voices and experiences of people who use services. They give people the opportunity to help shape what high quality care looks like. And that feedback sits alongside evidence, practice and professional judgement. Through this approach, we connect with people with lived experience (and their families), we build relationships, raise awareness of our work, the work of our organisation and the value of collaborative working. When we evaluate our processes there is a constant theme saying, “We felt heard”.

Moreover, following publication of our standards for people who have experienced rape, sexual assault and child sexual abuse, we received very positive feedback from individuals who could see their specific suggestions and comments had been incorporated throughout the document. For example, one young woman had noted during consultation the importance of being able to have a shower, a cup of tea and replacement clothing after her forensic examination. She contacted us to say how grateful and proud she was to see her words included in the standards. An unexpected impact, but imperative to delivering truly person-centred care.

But in thinking about the impact on standards, I’m also acutely aware of the impact that they have on me personally. Hearing someone say, “Thank you for listening. I hope my story makes something better for someone else” is a gift. It keeps me enthused, motivated, connected to my work and also connected to the impact we can have on real people and their lives.

Dr Fiona Wardell is Standards and Indicators Lead at Healthcare Improvement Scotland

Visit the Healthcare Improvement Scotland website for more information on the range of standards we produce.

Categories: Uncategorized

With every challenge comes opportunity – Ruth Glassborow

Posted on October 11, 2018

A fresh perspective on Scotland’s progress in improving and redesigning health and social care

Ruth-3711-Edit We know the challenges facing our health and social care system are, and will continue to be, significant. They are well understood; increasing demand, ongoing difficulties recruiting to a range of posts, and an ever more challenging financial context.

When helping providers improve care it can be easy to feel daunted by the challenges as they can seem so difficult to address. So recently I was fascinated to see our context through others’ eyes.

Over the last year, through the support of the Health Foundation, I’ve been privileged to participate in Sciana, a new European network of Healthcare Leaders.

To say I was surprised when some colleagues from another European country described their main challenge as too much money in their system is an understatement. And the reason why they described it as a challenge: they have no incentive to change and they know that the current system is not fit for purpose for today’s health and care needs.

It gave me a new perspective on our financial challenges as they are enabling a much needed redesign of our health and social care system. It reminded me of a quote from an Integration Joint Board (IJB) Chief Officer (CO) “Crises and challenges have created the sense of urgency and the willingness to think the unthinkable that allows us to tackle the wicked issues”.

“We have proved that we can do change at scale in Scotland”

This rings very true to me as, in the midst of our challenges, we also have so much to celebrate. The improvement and redesign work happening across Scotland every single day is really impressive. Healthcare Improvement Scotland’s ihub has just published our latest Impact Report which details just some of the fantastic success stories taking place across health and social care in Scotland.

Through the Scottish Patient Safety Programme (SPSP), we have proved that we can do change at scale in Scotland. This year we are celebrating 10 successful years of SPSP and the data around safety work speaks for itself.

But it is worth pointing out what we have learned about how that success has been created:

Relentless focus on skilling up those who deliver care in quality improvement techniques
The development of national learning systems which bring those working on common improvement challenges together to share learning and problem solve
Person-centred, evidence and data informed improvement work.
The political support for an approach which takes time initially, but delivers sustainable results at scale in the longer term.

Yet, when we set up the ihub at Healthcare Improvement Scotland, we were clear that the nature of the challenges meant that we needed to go even further. In addition to our continuous improvement approach we needed to also focus on system and service redesign. We believe that both are vital if we are to deliver the transformation of health and social care that we all aspire to and so desperately need.

Relationships are the glue that holds our system together. So all our work is co-designed, co-owned and co-delivered with partners – with the aim of building local improvement capacity to meet local need. A recent count of organisations we actively worked in partnership with during 2017-18 highlighted an incredible 117 separate organisations. And thanks to the work of programmes such as the Children and Young People Improvement Collaborative and NHS Education for Scotland’s Quality Improvement training programmes we now have quality improvement expertise that has been built up not just in health but also in the wider social care and educational environments.

“We actively worked in partnership with an incredible 117 separate organisations during 2017-18”

Our collective response in challenging conditions is aided by the fact that we all share the same simple goal – better health and wellbeing outcomes for people in Scotland.

One look at the stories in the Impact Report and we can see what is possible. There are amazing people in every service in Scotland working tirelessly every day to deliver and improve our health and social care services; sometimes in very challenging circumstances. I often hear comments highlighting that we are delivering improvement in Scotland despite the challenging context; hearing from colleagues in other countries has got me wondering if maybe we are delivering such exciting innovations precisely because of the challenging context.

What for me is unquestionable is that we wouldn’t be achieving any of this without the dedication and commitment of those involved in supporting and delivering health and social care across Scotland. It leaves me confident that whether it is because of, or despite of, our circumstances, by working together we will continue to find solutions that deliver better outcomes for people in Scotland.

Ruth Glassborow is Director of Improvement with Healthcare Improvement Scotland.

Click here to access the The ihub Impact Report.

Categories: Uncategorized