Tag Archives: healthcare

New research themes in the PSTRC

1 Feb

All-theme banner

The PSTRC will build on its existing themes of Safety Informatics and Medication Safety, and their specific focus on digital and diagnostic interventions and polypharmacy. However, the 2017-2022 PSTRC differs from its predecessor in having two new themes:

  • Safer Care Systems and Transitions
  • Safety in Marginalised Groups.

Safer Care Systems and Transitions will build on the centre’s previous work on multimorbidity to look at transitions and pathways of care. Transitions can be from one part of the NHS to another (e.g. hospital to primary care), between NHS and private care providers, between the health and social care sectors, or between other sectors and sites including the voluntary sector, self-help groups or “home.”  Most research and advances in patient safety are typically found within single discrete care settings, such as the emergency department. Less attention has been paid to safety between (transitional) primary, social and community providers and hospital care settings.

The second new theme is Safety in Marginalised Groups. Marginalised Groups include people that are excluded from mainstream social, economic and cultural life. This includes those with mental illness or at risk of suicide or self-harm, people living in nursing homes, the homeless, people with sensory impairment or who speak English as a second language. Such groups are at greater risk of experiencing adverse patient safety outcomes.

In all research themes, service responsibility and patient responsibility for patient safety go hand-in-hand. They are equal – it is a shared responsibility that requires co-design and partnership working, which is why the PSTRC has an involvement and engagement approach supporting all its research.

Safety in Marginalised Groups: Why a new theme for the PSTRC?

1 Feb

shutterstock_640908130_mentalhealth

Much of the work that took place in the first NIHR Greater Manchester PSTRC focused on involving patients and carers in its work. Examples of this were the James Lind Alliance Priority Setting Partnership, and public engagement events such as The Nest and More Than Just a Number.

In the second incarnation of the Greater Manchester PSTRC, one of the four themes, and a new theme for the centre, is Safety in Marginalised Groups. This research theme will focus on improving patient safety for marginalised groups of people, who are at a higher risk of harm within the healthcare system. The increased risk can be caused by a number of factors, for example, we know that Black and Minority Ethnic (BME) groups have poorer health outcomes, as well as poorer access to, and experiences of, healthcare services. People may also be marginalised because of stigma and poor access to services for specific conditions (e.g. mental health problems). Or they may be marginalised because of the circumstances or settings in which they live (e.g. living alone, caring for someone at home, living in a rural setting, in a care home or prison, or being homeless).

This theme has two main strands of research: the first on mental health and the second on patients and carers. Over the next five years, the Safety in Marginalised Groups theme researchers will work closely with researchers in other themes to explore a number of key issues, challenges and opportunities for improving safety in marginalised groups including:

  • communication
  • self-management: the co-design of tools to aid patients in their healthcare journeys
  • using mobile technology to monitor health.

A major component of the new theme will be mental health and it is particularly exciting that the PSTRC will be teaming up with the Centre for Mental Health and Safety. Some of the key safety outcomes in mental health involve suicide or self-harm. The proposed programme of work will look at the components of a ‘safe mental health service’ as well as investigating treatment gaps in the care of people who self-harm.

Find out more on our Safety in Marginalised Groups webpage.

What are Marginalised Groups?

1 Feb

Marginalised

You may not be familiar with the term marginalised groups. So what do we mean by marginalised?

The Oxford English dictionary definition of marginalisation is: “To render or treat as marginal; to remove from the centre or mainstream; to force (an individual, minority group, etc.) to the periphery of a dominant social group; (gen.) to belittle, depreciate, discount, or dismiss.” Within the academic literature, similar definitions have been used. For example, some simply state that marginalised groups are ‘populations outside of “mainstream society”’ (Schiffer K, 2008).

The term is increasingly replacing and/or being associated with other similar terms which you may be more familiar with, such as ‘vulnerable groups’, ‘seldom heard groups’ or ‘hard-to-reach groups’. Although each is different, all these terms include two main aspects. Firstly, there is a main/dominant/central individual or group, (e.g. the government) exerting power over another individual/group, with some sort of disadvantage occurring. In other words, the process of marginalisation leads to unequal outcomes.

Marginalisation is a dynamic process and people can move in and out of such groups. Many people can fall into one or more categories or groups simultaneously, meaning that it is a complex area to research.

In patient safety terms, people belonging to such marginalised groups are likely to experience more and perhaps different patient safety issues in relation to the general population. The truth is we simply don’t know as this is an under-researched area. What we do know however is that there are many barriers to accessing care for those considered to belong to marginalised groups such as migrants, the homeless, and people living in poverty and include issues relating to the way the health and care systems function. We want to understand the range of issues and people we ought to consider in our forthcoming research. This is why we in the Marginalised Groups theme are conducting a review of the published academic literature, identifying and analysing the existing literature on marginalised groups and patient safety in the United Kingdom. This will allow the theme to prioritise its patient safety research agenda over the coming five years.

How do I get more involved in my patient safety?

1 Feb

Patient Safety Guide_combined images with arrow

We have been working together with patients, carers, members of the public, GPs and pharmacists to design a PSTRC patient safety guide for patients and carers. This will be a useful resource to help answer key questions about primary care patient safety and to identify points where patients and carers can make their own care safer.

The guide consists of a short booklet, website and cue card prompts which people can use flexibly:

  • to plan for a consultation
  • as a memory aid
  • to help make the most of the time a person has with a healthcare professional
  • to support their own care at home.

As part of this project, the PSTRC has held co-design events which have brought together members of the public, patients, carers, GPs and pharmacists to discuss how everyone can work together to make care safer. Discussions have focused on key points in the care pathway and actions that each person could identify to improve their patient safety with the priorities that were identified for their own care. These discussions were then used to develop and refine the guide.

Since completing the initial development stage of the patient safety guide, work has been taking place with key national stakeholders to further refine the guide and the centre will continue to co-develop the project and the testing of it with patients, carers and healthcare professionals.

If you’re interested in hearing more about the guide, or to find out more about future co-design events, please contact Rebecca Morris at rebecca.morris@manchester.ac.uk.

New Theme Overview: Safer Care Systems and Transitions

1 Feb

Safer Care Systems_banner_hospitalpatientdoctors

The research for this new theme will take place at the Universities of Nottingham (lead: Justin Waring) and Manchester (lead: Stephen Campbell) and sites of study include hospitals, mental health services, community pharmacy and primary care.

A patient’s journey through different parts of the health service is called a “pathway,” and it is already known that patients can be put at particular risk when they move along their pathway and receive care from different organisations. Concerns for patients might include: “Has all the relevant information been passed from my GP to my hospital consultant (or the other way round)? Am I getting the same advice from different health professionals about my health problems or are people giving me contradictory advice?” Patient transfers, i.e. when people are in between different services and perhaps reliant on self-care or support from family members, can bring additional risks.

In this theme, these issues will be explored in four main topics:

  • ‘mental health’ (also in collaboration with the Marginalised Groups theme)
  • ‘information storage and transfer systems’ and ‘patient-held care records’ (both in collaboration with the Safety Informatics theme)
  • ‘governance and regulation’ (in collaboration with the Medication Safety theme)

Specific research projects being worked up include threats to safety in mental health transitions, and the potential role of patient-held care records in improving safety across the patient pathway. Through this programme of work, the key factors in transitional safety will be identified, followed by the development and testing of new systems of routine data collection and analysis to measure them.

PhD Studentship: Effective Legal and Regulatory Responses to Patient Safety Incidents at Transitions of Care

1 Feb

Sarah Devaney (School of Law) and Gavin Daker-White (School of Health Sciences) will be supervising this a PhD studentship on ‘Effective Legal and Regulatory Responses to Patient Safety Incidents at Transitions of Care’ as part of the Safer Care Systems and Transitions research theme. To date, most transitions research has been conducted around hospital discharge (and back to GP led care).

There is very little legal and regulatory research existing in this area. The legal and regulatory response (e.g. to safety failures) tends to focus on individual services, clinical teams or individuals. However, a recent UK Government Bill proposes more of a whole systems approach, drawing on lessons learned in the aviation industry.

This study will generate information in an under-researched field as well as comprising the first collaboration between the Greater Manchester PSTRC and the University of Manchester’s School of Law. It extends the research interests of the centre to include issues such as medical ethics, informed consent and the regulatory responses to medical error or professional malpractice.

Ukraine and China delegation visits to learn about patient safety

1 Feb

At the end of November, PSTRC staff met with delegations from Ukraine and China to talk about the quality and safety of care.

The Ukraine delegation consisted of senior healthcare managers and clinicians from the region of Poltava, who were visiting to learn about quality and safety interventions in the Greater Manchester healthcare system, especially around cardiovascular disease. They met at The University of Manchester with Stephen Campbell, Darren Ashcroft and Niels Peek from the PSTRC and Ben Squires, Head of Primary Care Operations at the Greater Manchester Health and Social Care Partnership. 

Stephen Campbell met with a delegation from the China National Health Development Research Center and the Health Family Planning commission, as part of visit organised by the Institute of Global Health Innovation at Imperial College London, St Mary’s Campus. Stephen spoke about quality and safety measurement and incentivisation in Primary Care.