Tag Archives: James Lind Alliance

How can we improve safe communication and co-ordination of care between primary and secondary care?

19 Apr

Part four in the James Lind Alliance Primary Care Patient Safety Priority Setting Partnership blog series: Part One, Part Two, Part Three

by John Taylor, patient attendee of the JLA Primary Care Patient Safety PSP final workshop

JLA PSP Top 10_Number 3Question 1 for me is, have there been any high grade research papers published already on this subject? If yes, then are there meta-analyses showing useable findings, and how old are these and have the findings been overtaken by newer recommendations?

Acting as Devil’s Advocate I would ask ‘who has posed this topic’ and ‘what evidence has been the basis for it’ and ‘how reliable or high grade is the evidence?’

As a  patient with multimorbidity, I personally feel that communications and coordination of care between primary care in its broadest sense and secondary care are often multi-centred and compartmentalised by ‘treatment episodes’ only indirectly linked, and even then through less than state of the art IT systems which may or may not be multi-site interoperable, which makes communication often slow, occasionally lost in space or paper chases and definitely not entirely in the best interest of good patient care.

So, how could improvements which would benefit the whole system be researched and put into practice?

Should lessons be learned from commercial users of communication systems who successfully run large scale businesses and care for the wants and needs of customers in ways which fulfil demand and generate repeat business, i.e. satisfied end users, and also learn from systems which have failed in their purpose due to poor design or uneconomic cost over runs or just failing to understand the needs of the users. Best practice should produce the designed outcomes consistently and be adaptable to cope with new needs as they are identified and designed to do this with minimum disruption and cost, there are many Healthcare Providers who have produced local workarounds which suit the needs of patients and providers with safe communications and care, NHS England, NHS Digital or NIHR RfPB (National Institute for Health Research Research for Patient Benefit) might be the vector to investigate how these develop and how well they might scale up.

I am constantly amazed and delighted at how, for example, Amazon handle their returns communications and customer care, they will respond to a ring back request within seconds, take the details, issue a printable label, arrange pick up and confirm by email then refund or replace as soon as the item is received at their depot. If Amazon and others can do this why is it so difficult for primary, secondary and, dare I say it, social care to learn how to communicate safely, rapidly and without arguing over ownership between themselves and patients, so that information flows freely, accurately and safely through the system, benefiting patients and providers alike.

Accurate and timely information is the key to good outcomes and thus improvements need to be constantly sought and implemented, carrying on doing what we have always done is not an option.

What are patient and clinician priorities for research in primary care patient safety?

9 Dec

by Rebecca Morris, Research Fellow in General Practice theme

jla_rmorrisblog_blank_fork

Over the last few months I have been working on the James Lind Alliance (JLA) Primary Care Patient Safety Priority Setting Partnership (PSP) (to find out more about the JLA read Richard Morley’s blog ‘Welcome to the Revolution’). The aim of our PSP is to ask ‘what are the questions that patients and clinicians have about primary care patient safety?’ The final aim is to produce a list of the 10 top uncertainties (or questions) that need to be addressed by research.

What have we been doing? Anyone could submit their question about primary care patient safety to our survey which was open from June to mid-July for 6 weeks. We advertised the survey in many places with the support of our steering group, their networks, and other organisations to reach as many people as possible and we had a total of 443 questions submitted.  Thank you to everyone who took part! 

The next stage in the JLA process involved working through the list to categorise the questions into different categories and by the areas of primary care (eg pharmacy, general practice, dentistry, out of hours care, self-management or broader primary care questions).  Then we worked through the list of questions to combine duplicate or similar questions. This produced a list of 173 possible uncertainties.

What are we doing at the moment? We are currently searching the literature to see if these questions have been answered using the JLA criteria for a ‘certainty’. We have been working with Central Manchester Foundation Trust libraries that have been searching the literature and we have been reviewing the searches to see if any of these questions have been answered. Any questions not answered already will then form a list of ‘uncertainties’. There has been a great range of questions posed which has made very interesting to look through such a diverse spread of topics. The next stage is to work with our PSP to initial prioritise the list of uncertainties and then in January we will have another survey which will open to everyone to help us identify the top 30 uncertainties to take to the final workshop in March, 2017.

What’s next and how can you get involved? Thank you to everyone who has taken part so far or worked with us to identify the literature. It’s a fascinating project with lots of great questions being posed and shows how many important areas there are for primary care patient safety research. Now I want to pass it back to you to help us prioritise the key areas for primary care patient safety research from these questions so please keep your eye out for the next survey in January, 2017. Thanks!

To keep up to date with what is happening and find out when the next survey is open follow @JLA_PtSafetyPSP

Patient Safety in Dentistry

29 Jul

By Barry Kinshuck, Dental Adviser representing the British Dental Association

BDA Logo

My name is Barry Kinshuck and I have been asked to represent dentistry by the British Dental Association in the excellent project to be undertaken by the James Lind Alliance Primary Care Patient Safety Priority Setting Partnership.

As a dental practitioner in Wigan for nearly 40 years and a dental adviser in Wigan and now Greater Manchester I have seen continuous changes and improvements in patient safety in dentistry.

The dental profession is committed to providing safe dental care, which is necessary for ensuring good general health, and aims to minimise risks and establish an open culture of patient safety, in which practitioners can learn from their own and others’ experience.

Duty of Care

Responsibilities for health and safety are set out in the Health and Safety at Work Act 1974 (the Act) and associated regulations. The Act seeks to protect all those at work – employers, employees and the self-employed, as well as members of the public who may be affected by the work activities of these people.

Care Quality Commission inspects dental practices and wants to see evidence that a dental practice is:

  1. Safe
  2. Effective
  3. Caring
  4. Responsive to patients’ needs
  5. Well led

Safety is top of the list and dental practices should be able to demonstrate how they:

  • Manage risk
  • Prevent infection
  • Provide suitable premises and equipment
  • Manage  and maintain equipment
  • Manage medical devices
  • How lessons are learnt and improvements are made when something goes wrong
  • What systems, processes and practices are in place to keep people safe and safeguard them from abuse?

The General Dental Council

This is the organisation that regulates dental professionals and in their document Standards for the dental team makes several statements of relevance with respect to patient safety:

  • Principle one (put patient’s interests first) states in standard 1.5.4 ‘You must record all patient safety incidents and report them promptly to the appropriate national body’.
  • Principle eight (raise concerns of patients at risk) states in standard 8.1 ‘You must always put patients’ safety first’.

The James Lind Alliance Primary Care Patient Safety Priority Setting Partnership provides an opportunity for the British Dental Association to understand what areas of patient safety matter most to patients and healthcare professionals.

 

Welcome to the Revolution

26 Feb

by Richard Morley, James Lind Alliance Adviser

JLA_PSP_10Priorities_IMG_0066_cropped

Final 10 priorities from a previous Priority Setting Partnership

As the James Lind Alliance Priority Setting Partnership (PSP) in Patient Safety in Primary Care gets underway, I am delighted to be able to start a series of blogs about our work. It’s my privilege to be the partnership’s JLA Adviser and Chair of the Steering Group, and to help navigate a committed group of patients and health professionals through the JLA method and to change the research agenda for the benefit of primary care patient safety.

My first encounter with the JLA was in 2011, working with the JLA Pressure Ulcer PSP. I was interested to see how social media might help us to engage with our stakeholders and set up a Twitter account. In just a few short days we received our first Tweet. It said “Welcome to the revolution”. And while we may not be engaged in a mutiny, our work will, in its own way, be contributing to a sea-change in the way that research priorities are identified.

Why James Lind?

In 1747, Royal Navy Surgeon James Lind aboard the Salisbury, conducted the first recorded trial in to the treatment of scurvy.  His trial involved 12 sailors, chosen to be as similar as possible, and given the same diet, and who were allocated to six groups and given a range of common remedies. Lemons and limes proved effective and the eventually lime juice formed part of the standard diet of Royal Navy Sailors (http://www.jameslindlibrary.org/articles/who-was-james-lind-and-what-exactly-did-he-achieve/). This saved thousands of lives and so Lind is a revolutionary hero of evidence based medicine.

Why the James Lind Alliance?

It was for this reason that Sir Iain Chalmers (also founder of Cochrane http://www.cochrane.org/) chose James Lind to be the figure-head of the James Lind Alliance when he, along with Dr John Scadding (then Dean of the Royal Society of Medicine) and Sir Nick Partridge (former Chair of INVOLVE), formed the JLA in 2014. He believed that research on the effects of treatments often overlooks the shared interests of patients, carers and clinicians. As a result, questions that they all consider important may not be addressed and many areas of potentially important research can be neglected. More recently Chalmers and Glasziou have identified how answering questions that are not the priority of patients and health professionals contributes to massive waste in research (http://researchwaste.net). The JLA helps address this imbalance.

Research priority setting in action

The JLA helps bring together partnerships of patients, carers and health professionals to identify and prioritise unanswered questions about health research. The ultimate goal is a list of the most important ten shared priorities that the partnership will subsequently promote for future research.

50 partnerships have either completed or are currently underway from Acne to Womb Cancer. The Patient Safety in Primary Care partnership will therefore be following an established route over the next year. More information about the James Lind Alliance and the JLA method can be found here: http://www.jla.nihr.ac.uk/.

Get involved!

Finally, if you are reading this, then you are probably a health professional, carer or patient with an interest in patient safety in primary care. This is your chance to be a part of that revolution and change the nature of research. Do follow @JLA_PtSafetyPSP on Twitter and visit the partnership’s website at http://www.population-health.manchester.ac.uk/PatientSafetyPSP where you will find out more information and, very soon, tell us what you would like to see researched.