A joined-up NIHR approach to patient safety research

by Stephen Campbell, Director of the NIHR Greater Manchester PSTRC

On 6 February 2019, NIHR Greater Manchester PSTRC Centre Manager Karen Considine, Research Leads Niels Peek and Justin Waring, and Director, Stephen Campbell attended a Joint Workshop on Research for Patient Safety and Quality.

The meeting involved a wide range of organisations with a focus on patient safety, including representatives from the NIHR Imperial PSTRC and Yorkshire & Humber PSTRC, the National Institute for Health Research (NIHR), Department of Health & Social Care, NHS England, NHS Improvement, Academic Health Science Networks (AHSNs) and Patient Safety Collaboratives, as well as researchers from other NIHR funding streams such as Programme Grants and Policy Research Units.

The focus of the meeting was partnership working to ensure the maximum benefit for patients and members of the public, as well as meeting the needs of the health and care system locally and nationally.

The work of the three NIHR PSTRCs was showcased to provide examples of translational research and partnership working, and also the importance of involvement and engagement, co-design approaches and patient and public involvement.

The collective aim is to develop a better and more responsive way for the full network of organisations funded by NIHR to work with patients and providers. Through this collaborative approach, best practice can be shared to ensure the prevention of poor and unsafe care, and the provision of effective and safer care.

Past PhD Fellows: Shoba Dawson

In this series, we catch up with past Greater Manchester PSTRC PhD Fellows to see what they are doing now and how their PhD projects affected patient safety. This edition, our past PhD Fellow is Shoba Dawson.

What did you learn during your PhD project?

My PhD project explored how patient and public involvement (PPI) in health services research can be made more inclusive from the perspectives of people of South Asian origin and health services researchers.

While I learnt a lot about the topic area, I also learnt the importance of being tenacious and determined to reach the end goal. Through my PhD, I had a unique opportunity to work in collaboration with patient and public contributors, which not only enhanced the quality of my PhD project but was also a rewarding experience.

I believe that doing a PhD helped me to develop as an independent researcher through learning and developing a number of transferable research skills such as: determining the best and most realistic approach to answer a research question, considering the relevance and impact of the research project to diverse stakeholders such as patients, researchers and policymakers, and disseminating work to a wide range of audiences through different formats.

How has your PhD changed the patient safety landscape?

My PhD project was the first to examine the views and experiences of both researchers and South Asians regarding PPI in health services research. The findings addressed some of the gaps in knowledge regarding barriers and facilitators to involving people from black, Asian and minority ethnic (BAME) groups in PPI. It also identified some unique issues showing that PPI approaches need to be tailored to the group in question.

I hope my PhD has contributed (even in a small way) to understanding strategies to widening inclusivity in PPI in health services research and patient safety.

What you are doing now and where you see yourself going in your future career?

I work as a senior research associate at the Centre for Academic Primary Care, University of Bristol. I am working on two reviews in collaboration with researchers at the Universities of Manchester and Newcastle.

In the future, I intend to continue to build my research profile in evidence synthesis and contribute to improving primary healthcare services.

How was it for you? Reflections on involvement

This edition’s reflection comes from Stephen Barlow, a member of the public who is involved in the Marginalised Groups: Mental Health theme’s research advisory panel.

Why did you become involved in the ‘Mutual Support for Mental Health’ research advisory panel (supporting the mental health workstream  in the PSTRC)?

I’ve had mental health problems for years and frankly the treatment I’ve received has mostly been poor. There are a range of reasons for this from lack of funding to frankly incompetence. If I can do anything to make future treatment better I will always get involved.

How do you think the Greater Manchester PSTRC has benefitted from your involvement – what difference do you feel that you made?

To me the benefit to the university is that myself and the rest of the group look at the project as members of the public, by which I mean that we look at what has been written ‘normally’ not in ‘uni speak’. In that way we translate the jargon into normal terms understandable to the whole public, not only academics.

How do you feel that you have benefitted from your involvement?

I feel that I’m part of something important and helping future treatment, and meeting people with similar stories to me.

Would you recommend becoming involved in research to other patients? If so, why?

Yes, simply because you could be part of something that could shape better treatment in the future.

How can research help to prevent patient harm in prisons?

by Maria Panagioti, Senior Research Fellow and Jenny Shaw, Clinical Professor

Preventing patient harm is a public health priority. Over 100 studies have been carried out across different countries in the past 20 years to estimate how often patient harm occurs, to understand its main causes, and to find ways of preventing harm from occurring or minimising its negative effects.

This important patient safety research has focused on hospitals and in primary care. We now know that around six percent of people from the general population experience an avoidable incident of patient harm whilst being treated in healthcare services (e.g. medication errors, misdiagnosis, wrong-site surgery etc).

We know virtually nothing about how common patient harm is in prison, nor what the main causes are, or how serious and lasting are the health consequences for affected people.

Currently, there are over 84 thousand people in prisons in England. People in prison often have complex needs with physical and mental health problems and drug or alcohol dependence being more common than amongst people in the general population. These health problems are in addition to other social issues such as poverty, unemployment, poor education/health literacy and homelessness. While in prison, people are away from their families and carers and at the same time they have few opportunities for self-care or to  proactively prevent harm.

Prison is also a very difficult place to provide healthcare services. GPs are the main care providers for people in prison. Other common health services provided include mental health care, which is provided by psychiatrists and psychiatric nurses, substance use services, dentistry, and obstetric/maternity care for women. Patient harm can occur in any of these healthcare interactions but for people in prison, the recording of care, and the care itself, is not always joined-up.

The high percentage of turnover in prisons makes things worse. Turnover is particularly high among un-sentenced people. Transition phases such as the early phase of imprisonment or transfer to other prisons or back into the community are times when continuity of care can break down, with a likely increased risk of patient harm.

An award of £850K has recently been awarded by the National Institute for Health Research Policy Research Programme (NIHR PRP) to investigate the frequency and nature of avoidable patient harm in prison healthcare in England. This new and exciting research programme is led by Professor Jenny Shaw in partnership with several members of the NIHR Greater Manchester Patient Safety Translational Research Centre, as well as colleagues from the University of Nottingham and the University of Cardiff.

This research will generate the first estimates worldwide of how often avoidable patient harm happens, and the types of avoidable harm that take place  in prison healthcare. As part of the work plan, a large study of 15 thousand patient records will take place across 12 prisons in England. Interviews are also planned with service users and other stakeholders.

The research will commence in April 2019, with results expected in late 2021 . For the first time, the NHS will have solid evidence of the nature and frequency of avoidable patient harm in prison healthcare and will be able to develop policies and plans to improve patient safety in prisons. This research will help practitioners in prisons to improve their working practices and patient groups to work towards making improvements to patient safety in prison healthcare. 

Researcher profile: Ben Brown

by Carly Rolfe

Dr Ben Brown wears many hats. GP. Academic. Serial fellowship holder. Or, according to a recent Wellcome profile piece ‘clinician, scientist…entrepreneur’. However you frame it, at the heart of Ben’s work is the desire to make a difference for patients, both on an individual basis and at an organisation level.

The NIHR Greater Manchester PSTRC is fortunate to have Ben working in its Safety Informatics theme, through which he’s involved in a number of projects.

One such project is developing an artificially intelligent algorithm that reads patient letters and aims to improve efficiency, by highlighting which require GP input and which are merely for information. The PSTRC is funding the testing of this algorithm in general practices.

Ben is also developing PATCHS, which uses machine learning to help triage patients’ requests for primary care appointments.  It hopes to ensure patients are directed to the most relevant healthcare professional, rather than automatically seeing a GP.

Ben is currently funded by the Wellcome Trust as a Clinical Research Career Development Fellow, based at the University of Manchester. You can read his full interview in this Wellcome Trust Researcher story.

First event kicks off cross-PSTRC PhD network

by Carly Rolfe

There are three NIHR Patient Safety Translational Research Centres (PSTRCs) in England – Greater Manchester, Imperial, and Yorkshire and Humber. Each PSTRC funds a number of PhD Fellows, with the ultimate aim of increasing research capacity and innovation in the field of patient safety.

In order to provide PSTRC PhD Fellows with an opportunity to network, to forge links with other early career researchers and to give and receive feedback on research projects, a cross-centre PSTRC PhD Network was set up.

Led by Yorkshire and Humber PSTRC, the first PSTRC PhD network event took place on 5 February in Leeds. PhD Fellows were invited to give an oral presentation on their own programme of work, with constructive feedback being provided by a panel made up of senior PSTRC researchers and Research Leads.

Other key sessions were led by PSTRC researchers, covering topics as diverse as involving marginalised groups in patient safety research, maximising the impact of research, and the challenges of designing research on the economics of patient safety.

Greater Manchester PSTRC PhD Fellow Ahmed Ashour, said of the event:

“Getting the opportunity to showcase your work and see other students work in an environment like the one at the PhD network is extremely useful and motivational! I left the network meeting feeling inspired by the discussions with plenty of ideas and comments that I could not wait to get to work on!”

Improving the quality and safety of healthcare for homeless people – using meaningful engagement and co-design

by Caroline Sanders, Research Lead for Marginalised Group: Patients and Carers theme in the NIHR Greater Manchester PSTRC

Homeless people are known to have much worse health than the general population, with more than double the rate of physical and mental health problems, and live around 30 years less than the general population(1). It is also known that homeless people have more problems accessing appropriate healthcare, sometimes due to organisational and bureaucratic barriers, but also because they often feel stigmatised and treated badly when they do seek healthcare(2).

Such barriers are important in relation to patient safety because our previous research within the NIHR Greater Manchester PSTRC has shown that patients place great emphasis on the importance of relationships and communication, as well as trust, for enabling safety within healthcare.

In our ‘marginalised groups’ research theme, we are asking “can we make some changes for the better and to improve the quality and safety of healthcare for homeless people?”  This has been the starting point for our collaboration with the Museum of Homelessness (MoH), and together with the Public Programmes Team (see related blogs by Matt Turtle from MoH, and Bella Starling from the Public Programmes Team), we have embarked on a collaborative journey to develop meaningful engagement which will feed into, and throughout, our research process.

We held a workshop in late 2018, called ‘Actions for Change’ where the Museum of Homelessness used a series of objects and related stories donated by homeless people and service providers. Stories are commonly viewed as a way of enabling us to walk in someone else’s shoes as a means of prompting change. One thing was clear from the approach taken by the MoH team: you do not passively view the objects they exhibit, rather you are immersed in the stories as they are brought to life by the storytellers.

Somehow the objects became powerful symbols of experience. Material things are often evident when people tell stories of their experiences, but frequently they are left to fade into the background as one of the more mundane aspects of experience.  What the MoH does in placing objects at the centre of stories, is to make visible important aspects of the lives of the people who have donated them, with many implications for provision of services and patient safety.

The event prompted many lively discussions amongst multiple stakeholders (homeless people, service providers, charities, commissioners and healthcare decision-makers) touching on crucial topics including barriers to access; the need to empower people about their ‘rights’ to health care; the impact of trauma and meeting psychological support needs.

In moving forward, we are extending this work to weave some of these stories into our planned research to draw out further perspectives rooted in personal experience, and to enable co-design and testing of fitting solutions.

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References

¹ Fransham M, Dorling D (2018) Homelessness and public health, BMJ, 360: k214

² Brennan R (2018) Delivering Healthcare to Homeless People: lessons from Scandanavia and the USA, Winston Churchill Memorial Trust