‘Developing safer health and care systems’ theme in the NIHR GM PSRC

Professor Caroline Sanders and Dr Tom Blakeman are leading the ‘Developing safer health and care systems’ theme at the National Institute for Health and Care Research Greater Manchester Patient Safety Research Collaboration (NIHR GM PSRC). Here, Tom introduces the new theme of work.

At the GM PSRC we are committed to looking at the way services are delivered to identify how to make them safer, particularly for those who are vulnerable. We’ve designed and developed the ‘Developing safer health and care systems’ theme with the input of patients, carers, and healthcare staff to help increase the ability of our research to narrow the gap in health inequalities.

Alternative care models

Alternative care models have become increasingly important in the delivery of health and social care services. Essentially, they are new ways of working that aim to deliver care in a more efficient and effective way.

NHS England has recognised the potential of alternative care models to improve the safety and wellbeing of patients. However, it has also identified the impact of these models on patient safety as a challenge faced by health and social care providers. Our research is aimed at addressing this challenge and we will focus on models of care for vulnerable and underserved patient groups across three priority areas:

• The impact of virtual wards on the safety of older people living with frailty
  Our research on virtual wards for older people living with frailty has the potential to transform the way patients receive care. By identifying new models of care that prioritise their needs, we can help to reduce hospital admissions and improve safety outcomes for this vulnerable patient group.
• Approaches to improve discharge care and follow up for people who have had a hospital admission affected by Acute Kidney Injury (AKI)
  This research has the potential to reduce the risk of harm. By examining alternative service models that prioritise patient safety, we can ensure patients receive the support they need to recover and avoid any unnecessary readmissions.
• Models of service delivery for people with Learning Disabilities and/or Autism
  This area of our research aims to identify new models of care that prioritise the needs of patients and carers. This work has the potential to transform the way healthcare services are delivered for this underserved patient group and improve their overall quality of life.

Our approach

Our research programme is designed to ensure the voices of patients, carers, and healthcare staff are at the centre of our work.

In combination with this approach, our Systems Thinking perspective aims to enhance the ability of people, organisations, and systems to adapt and achieve safer and fairer care. This means that we are not only focused on identifying alternative service models, but also on understanding the broader systems in which they operate and how they can be improved to prioritise patient safety and wellbeing.

The research team

This theme is led by Professor Caroline Sanders and Dr Tom Blakeman at the University of Manchester. Our work around Learning Disability and/or Autism (LD&A) is led by Professor Umesh Chauhan:

• Caroline is Professor of Medical Sociology and leads on Public and Community Involvement and Engagement for the Manchester Academic Health Science Centre (MAHSC) and the NIHR Applied Research Collaboration Greater Manchester (ARC-GM). She leads qualitative and participatory research focused on patient and carer experiences of health and social care with a particular focus on marginalised and underserved groups.

• Tom leads our kidney health research. He is a GP and Clinical Senior Lecturer in Primary Care. He was a member of the NHS England Think Kidneys Programme Board (2014-2017) and was Royal College of General Practitioners’ (RCGP) Clinical Champion for Acute Kidney Injury (2017-2020) where he led the development of national guidance to improve post-discharge care following AKI. He is currently a member of the NHS England Renal Services Transformation programme. Aligned with the theme, he currently leads the NIHR funded study AsterAKI study 

• Umesh is the Chair of the Society of Academic Primary Care (SAPC) LD&A Special Interest Group. Umesh also has considerable expertise around care for people with LD&A, which is particularly useful when implementing change to improve the safety and care for people with LD&A.

Our theme aligns with the NHS Long Term Plan of building ‘strong and effective integrated care systems across England’ that reduce health inequalities and improve safety outcomes. And, by involving patients, carers, and staff in our research, we can better understand their experiences and identify alternative service delivery models that prioritise their needs. Our goal is to build strong and effective integrated care systems that reduce health inequalities and improve safety outcomes for everyone.

‘Improving medication safety’ theme in the NIHR GM PSRC

Medication-related problems are one of the most common reported causes of patient safety incidents across the NHS. Over the last 25 years, teams of researchers from the universities of Manchester and Nottingham have been working with NHS colleagues and patients to increase understanding of these problems and to find effective solutions.

We are excited to continue working to improve medication safety through our NIHR Greater Manchester Patient Safety Research Collaboration (PSRC). In the first two years we are going to focus on three areas of work in addition to our ongoing projects:

• Firstly, we are going to use the large amount of research that’s already been done to identify the best and most cost-effective ways of improving prescribing safety in primary care.
• Secondly, we will build on our existing research to find out how electronic prescribing safety systems can be improved.
• Thirdly, we will test methods to identify and correct potentially unsafe prescribing, focusing on the medicines used for mental health problems and pain.

The research will take place across primary care (such as GPs and pharmacies), secondary care (such as hospitals) and social care settings (such as care homes). The work will be led by Professors Darren Ashcroft and Tony Avery, who have a proven track record of using research findings to improve patient safety.

Most of our studies will be done in the North-West and East Midlands, and in some cases across England. They will be tested in settings where interventions will eventually be delivered, making the most of our strong working relationships with NHS providers, particularly in primary care.

Patients and members of the public will continue to have an essential role in our research, from deciding the questions that are most important to patients through to the design of studies, interpreting the findings, and sharing the most important messages. As Jill Beggs, one of our PPI colleagues, says:

“As a patient and public involvement member who has been involved with the research team setting up this work, I am encouraged to see the focus on addressing medication safety events that could have a positive impact on the lives of patients and their carers. I look forward to working with the team and other patient representatives to see this study develop into actionable interventions’.

And Anthony Chuter, another PPI colleague, says:

“The ‘Improving medication safety’ theme will help to ensure that health professionals have the best information available for prescribing medicines safely. This is vitally important for patients who want to be more involved in decisions where their safety may be at risk.”

Improving organisational safety culture across health and social care: Meet the ‘Enhancing cultures of safety’ theme team

by Dr Jennifer Creese, SAPPHIRE, University of Leicester

NHS England define “a positive safety culture as one where the environment is collaboratively crafted, created, and nurtured so that everybody (individual staff, teams, patients, service users, families, and carers) can flourish to ensure … safe care.”

A strong organisational safety culture is the key to helping healthcare organisations reach their highest potential in patient safety. As part of our vision to make health and care systems safer, our team of experts in patient safety and organisational culture in health and social care will be researching key issues within the “Enhancing cultures of safety” theme.

Prof Natalie Armstrong

Prof Carolyn Tarrant

Professors Natalie Armstrong and Carolyn Tarrant, from the University of Leicester lead this theme. Both Carolyn and Natalie are recognised global experts in qualitative (research that’s informed by hearing from those with lived experience) healthcare improvement research. The work draws on their experience of sociology and psychology. Their research group, SAPPHIRE (Social Science, Applied Healthcare & Improvement Research) is internationally renowned for its methods in healthcare quality and safety research.

They are joined by four colleagues at the University of Leicester with expertise in healthcare organisational cultures, workforce issues and patient safety:

• Dr Jennifer Creese: a sociocultural anthropologist with a special interest in cultures and identities of healthcare professions
• Dr Kate Kirk: a practicing Emergency Department nurse and researcher interested in organisational behaviour in healthcare, and particularly workforce wellbeing
• Associate Professor Nicola Mackintosh: a sociologist with a background in critical care nursing, interested in local patient safety cultures and organisational response systems
• Dr Farhad Peerally: a clinical-academic gastroenterologist with interests in health services and patient safety.

Dr Jennifer Creese

Dr Kate Kirk

Assoc Prof Nicola Mackintosh

Dr Farhad Peerally

A collaborative approach is central to this theme. The Leicester-based researchers are joined by seven expert colleagues from the University of Manchester, with expertise in healthcare management, law, human factors and psychology:

• Professor Sharon Clarke: an organisational psychologist with interests in safety culture, safety leadership and wellbeing in organisations, especially in safety-critical contexts.
• Dr Sarah Devaney: a senior lecturer in health law and regulation with a particular interest in the law’s role in enhancing patient safety.
• Dr Jane Ferguson,: a lecturer in healthcare management with a particular interest in the working lives of healthcare professionals
• Dr Victoria Moore: a lecturer in healthcare law with interests in healthcare law and regulation, and patient safety
• Dr Denham Phipps: an organisational psychologist and lecturer with interests in human factors, ergonomics and risk management in healthcare
• Professor Catherine Robinson: Professor of Social Policy Research with a particular interest in social care services
• Professor Kieran Walshe: Professor of Health Policy and Management with a particular interest in health professions regulation.

Prof Sharon Clarke

Dr Sarah Devaney

Dr Jane Ferguson

Dr Victoria Moore

Dr Denham Phipps

Prof Catherine Robinson

Prof Kieran Walshe

Patient experiences, perspectives and priorities are at the heart of this research and its goals. The academic research team is complemented by two Public and Community Involvement and Engagement (PCIE) experts whose lived experiences help to drive research priorities, design and impact:

• Mr Manoj Mistry: a family carer with more than 35 years’ experience including 12 years of involvement in health education, training and research
• Ms Khudeja Amer Sharif: CEO of Shama Women’s Centre, with more than 30 years’ professional experience leading service improvement and programmes to address health inequalities.

Mr Manoj Mistry

Ms Khudeja Amer Sharif

We’re excited to be collaborating with experts from diverse disciplines and backgrounds to develop and deliver research projects that have the potential to make a positive difference to patient safety.

We are working collaboratively with local, national and international health service partners and staff to guide policy and practice in improving organisational safety culture. We believe our approach helps to ‘close the gap’ between academic research and practice.

Our research includes:

1. Working with teams and groups across a wide range of different health and social care contexts, to understand different ways patient safety is understood and put it into practice.
2. Following the journey of patient safety guidance from where it is drafted at a national level to when it is implemented locally within a healthcare organisation. This helps us to design policies that connect with safety cultures in local settings.
3. Working to amplify the voices of health and social care staff from minority ethnic groups. The aim is to help them to feel safer in raising concerns about patient safety, which contribute to improving safety culture.

In addition to improving policy and practice in healthcare organisations, we’re dedicated to developing expertise in this area of research to help ensure developments continue in the future. This will help to ensure new health services and improvement researchers can continue to make a difference to patient safety policy and practice.

Tool developed to help care home residents and their carers to be involved in improving safety

A first-of-its kind questionnaire has been developed to gather the experiences of care home residents and family members on the safety of their care, allowing their voices to be heard. The Resident Measure of Safety (RMOS), has been designed by residents and carers alongside health and care home staff with researchers at the National Institute for Health and Care Research Greater Manchester Patient Safety Translational Research Centre.

The RMOS is a questionnaire that encourages care home residents and their family members to be actively involved in their safety. Staff in care homes can use the feedback gathered by the RMOS to develop specific solutions tailored to the issues raised.

Drs Natasha Tyler, Sally Giles and Maria Panagioti worked on the study and talk about development of the questionnaire and its impact below.

Developing the RMOS

We identified some useful previous research in this area and pulled this together with similar staff-focussed questionnaires that already exist. We then worked with a group of residents, carers, healthcare and care home staff to help create a new questionnaire. They helped us with the design and content to ensure the RMOS includes the most important questions and is easy to understand and use.

How the RMOS is different

There are some care home safety questionnaires in use. However, they are designed from the point of view of professionals. The RMOS is the first questionnaire of its kind where feedback is collected from residents in care homes, and their family members.

This is important as the experiences of residents and their family members are valuable when looking at making improvements to safety. The RMOS allows them to comment when things actually happen allowing professionals to take action quickly. It also introduces a standardised approach to safety.

We believe that the RMOS has the potential to be used during standardised assessments, such as Care Quality Commission assessments, as a way for residents and their carers to voice their safety concerns.

Our next step will be to assess the RMOS on a larger scale to see how well each element of the questionnaire works. We believe that, if used regularly the RMOS will create safety improvements inspired by the voice of residents and family members.

Want to know more?

If you want to know more, you can read our research paper about the development of the RMOS: or email Natasha Tyler.

Patient opinion: The benefits of the Patient Safety Guide

by Kay Gallacher

You know how sometimes someone comes up with a deceptively simple idea and everyone thinks – why has no one done that before? Well, I feel the Patient Safety Guide is one of those ideas.  You can download it from a website and print it out, or access it via a mobile app for iOs or Android. It’s designed to help patients and carers prepare for appointments with medical professionals like GPs, nurses and pharmacists.

I think it’s probably quite common for many of us that when you sit down to talk to a medical professional, your mind can go blank. I suddenly forget everything I wanted to discuss. I did get into a habit of making notes beforehand, but sometimes I wasn’t sure what questions I should be asking. I didn’t know where to start. The Patient Safety Guide helps patients and carers to plan what they’re going to ask before an appointment. There are suggested questions and ideas that you might want to consider. There’s space to write down any concerns, as well as what you want to talk about and what you want to get out of the consultation. I feel the guide helps to make the most of an appointment.

Also, as soon the appointment ends, it’s so easy to forget everything you’ve been told. That’s why I find it so valuable that there’s space in the guide to make a note of what was said as well as any tests that have been ordered and when the results may be due.

It’s also a good way of sharing information with others who look after your health. This is invaluable if you have a carer or multiple carers. So, for example, if you have a carer who goes with you to an appointment, they can make a note of what is said, diagnosed and prescribed. These notes are then in one place and can be shared with other carers without having to keep repeating the information.

There’s also space to make a note of all medications and their doses so that you don’t have to remember all the medications you take whenever someone asks.

It’s been developed so that we, the patients, feel more in control of our contact with doctors, nurses and pharmacists (primary care practitioners). Hopefully this will also help to make the relationship more equal.

As another patient put it: “It’s just common sense really”. Get prepared for your appointment so you don’t waste time. Have a record of what happens, tests and medicines all in one place. In other words, no more scrabbling around for all this information every time it’s needed!

Tool launched to help patients and carers improve safety across health and care

A first-of-its-kind free guide that helps patients and carers to take greater control of their healthcare and improve their safety has been launched today, 7 March 2023.

The Patient Safety Guide has been co-developed by patients, carers, GPs and pharmacists with researchers from the National Institute for Health and Care Research (NIHR) Greater Manchester Patient Safety Translational Research Centre (GM PSTRC). The centre is a partnership between The University of Manchester and Northern Care Alliance NHS Foundation Trust.

The guide helps patients and their carers decide on the most appropriate way to access healthcare (for example, whether they should visit a pharmacist, book a GP appointment, or visit A&E). It also provides guidance on how to plan for interactions with healthcare staff. There’s suggested questions to ask, and space to make notes both before and after an appointment. Information around any tests that may be recommended can be logged in the guide and it can be used as a place to list all the medications a person is taking.  

The guide is available to download from a dedicated website and via an app for iOS and Android phones. It includes specific advice for people with hearing loss and there is a version for people who have vision impairment.

Dr Rebecca Morris, lead for the Patient Safety Guide, said: “Involving patients in their safety is a central recommendation of NHS England’s National Patient Safety strategy and our team were looking at ways of doing this when we started work on our patient safety guide. We wanted to create something that gives patients the ability to understand and support their care while giving them confidence to ask the questions that are important to them.

“We believe our guide addresses some of the most common challenges faced by patients and carers while having the potential to narrow the gap in health inequalities. For example, we’re aware that some patients may take a number of different medications and are under the care of several different doctors. The guide helps the patient and their carer, if they have one, to keep track of all of this. Also, in situations where two family members may be caring for an older relative and are both taking them to different appointments, the guide is an easy way of sharing important information accurately. Alternatively, for someone who may struggle with verbal communication, they can use the guide as a way of helping their communication with healthcare staff. We hope that our guide can be adopted and used widely to help improve patient safety.”

The guide underwent two phases of testing. The first started before the pandemic and the second during it, when appointments were both in-person and virtual. This process involved eight GP practices across the North West of England. One of the GPs involved in the study, said: “I think the patient safety guide is a great idea. It seems doctors and patients sometimes talk at cross-purposes but can’t work out what the confusion is. I think the guide will help patients in a way that could improve their understanding of the system and doctors’ thinking. It could help empower patients.”

Kay Gallacher, a public contributor who was involved in developing and designing the guide, said: “For me, the NHS can seem like a complex system with its own language. I feel the guide can give patients and carers the tools they need to navigate it. The guide helps to ensure everyone can get the most out of an appointment with healthcare staff. I’ve found it particularly useful being able to use the guide to remind me what a doctor may have said at a previous appointment.

“Also, I do find my mind can go blank the moment I start to talk to a doctor, so being able to plan ahead and make a note of all the questions I want to ask helps me to make the most of the appointment. I can note down the answers and this makes it easier when trying to recall what the doctor said. I believe the guide is something that can make a big difference across health and social care and I’m looking forward to more people hearing about it so they can start using it and benefitting from it.”

The guide is now available for anyone to access via the app and online, and researchers are encouraging organisations interested in rolling it out to get in touch: Dr Rebecca Morris.

Manchester team secures funding for new research collaboration to address patient safety challenges

A team led by researchers at The University of Manchester is one of just six located across England to be awarded a share of £25 million in funding by the National Institute for Health and Care Research (NIHR) to run a Patient Safety Research Collaboration (PSRC) from 2023-2028.

The Greater Manchester Patient Safety Research Collaboration (GM PSRC) will be hosted by Northern Care Alliance NHS Foundation Trust, and the University of Manchester-led team will deliver a programme of research along with the University of Nottingham and the University of Leicester.

The collaborations will address strategic patient safety challenges within the health and care system, focusing on seven strategic areas set out by NHS England. These areas cover issues such as clinical risk scores, which enable professionals to identify people who may benefit from preventative interventions, and improving the culture and practice in organisations to promote patient safety.

Professor Lucy Chappell, Chief Executive of the NIHR, said:

“Patient safety is about maximising the things that go right and minimising the things that go wrong for people receiving healthcare. We are aligning our funding with the strategic priorities from NHS England and ensuring that we are addressing the issues that really matter to patients.

“This new round of funding gives the best researchers the opportunity to assess innovations and approaches that could shift this balance for the better.”

The PSRCs will help researchers to develop and test innovations, approaches and interventions that could improve patient safety and the safety of health and care services. The funding will also enable partnerships to be built between health and care organisations, universities, local authorities, and patients and the public. 

The collaborations are an evolution of the Patient Safety Translational Research Centres (PSTRCs), which were first funded by the NIHR a decade ago. The Greater Manchester PSTRC was one of the original centres to receive funding from the NIHR as part of the scheme.

Professor Darren Ashcroft, Director of the Greater Manchester Patient Safety Research Collaboration, said:

“We are delighted to have secured funding to continue patient safety research as one of the new Patient Safety Research Collaborations. The work we’ve delivered over the last 10 years at the Greater Manchester Patient Safety Translational Research Centre has impacted the safety of care delivered by the NHS, as our innovations have been adopted by health and social care and rolled out first regionally, then nationally. The new collaboration will allow our researchers to build on this success across four key themes of patient safety, and we’re excited to get this work underway.”

The Greater Manchester PSRC will focus on the following themes:

1. Improving Medication Safety
2. Enhancing Cultures of Safety
3. Developing Safer Health and Care Systems
4. Preventing Suicide and Self-harm

An example of the impact of the GM PSTRC’s work on NHS frontline services is the set of safety indicators developed to identify patients at risk of harm from prescribing errors. In addition, researchers helped to test and implement a pharmacist-led IT-based intervention based on these indicators that could reduce prescribing errors. This intervention has now been rolled out nationally.

Researchers at the Greater Manchester PSTRC also responded quickly to the COVID-19 pandemic, adapting existing studies and designing new ones. One study highlighted that fewer people asked their GP or hospital for mental health support during a lockdown. Another study that looked at the diagnosis and management of type 2 diabetes during the pandemic contributed to additional funding being made available to the NHS to support national COVID recovery through the creation of a ‘Diabetes Treatment and Care Recovery Innovation Fund’.

The new ‘Improving Medication Safety’ theme at the Greater Manchester PSRC will be led by Tony Avery, Professor of Primary Health Care at the University of Nottingham and Professor Darren Ashcroft at the University of Manchester.

Professor Sir Jonathan Van-Tam, Pro-Vice-Chancellor for Medicine and Health Sciences at the University of Nottingham, said:

“Being at the forefront of patient safety research is a priority for the University of Nottingham. The new Patient Safety Research Collaborations are a fantastic opportunity to improve patient safety. I’m excited to see what can be achieved here at the University of Nottingham where the Greater Manchester Patient Safety Collaboration’s work will focus on the theme of Improving Medication Safety.

“Professor Tony Avery aims to build on the success of his previous study at the Greater Manchester Patient Safety Translational Researcher Centre where he and his team developed a set of safety indicators to identify patients at risk of harm from prescribing errors. I’m looking forward to seeing the work that’s developed and the difference it makes to patient safety across health and social care.”

One of the four themes, ‘Enhancing Cultures of Safety’, will be led by researchers based at the University of Leicester. Professor Thompson Robinson, Pro Vice-Chancellor, Head of the College of Life Sciences and Dean of Medicine, University of Leicester, said:

“I am delighted that the University of Leicester has been invited to be part of this exciting new collaboration. Research seeking to ensure the delivery of safe, high quality healthcare is a key area of focus both here at the University and for our NHS partners.

“The ‘Enhancing Cultures of Safety’ theme, to be led by Professors Natalie Armstrong and Carolyn Tarrant, will ensure that efforts to improve organisational patient safety culture and practice are informed by high quality research.”

The ‘Developing Safer Health and Care Systems’ theme will be led by Professor Caroline Sanders and Dr Tom Blakeman. It will be based at The University of Manchester and aims to work with patients, carers and key stakeholders to improve how multiple health and care providers work together to deliver care safely.

The second theme to be based at the University of Manchester is ‘Preventing Suicide and Self-harm’. Professors Nav Kapur and Roger Webb will lead this work, which will identify, refine and subsequently evaluate service innovations that have enhanced patient safety in specialist mental health services, self-harm services across general hospitals and primary care.

Professor Graham Lord, Vice-President and Dean of the Faculty of Biology, Medicine, and Health at the University of Manchester, said:

“The University of Manchester has led a patient safety research centre since they were first introduced by the National Institute for Health and Care Research a decade ago. I’m immensely proud of the improvements to patient safety that have come about due to this work and anticipate new innovations that continue to strive to put the safety of patients first.”

The Greater Manchester PSRC will be hosted by Northern Care Alliance NHS Foundation Trust, Professor Phil Kalra Director of Research & Innovation, said:

“Research that focuses on patient safety across health and social care is vital. We have been impressed with the achievements of the Greater Manchester Patient Safety Translational Research Centre and are pleased to be hosting the new Patient Safety Research Collaboration from 2023. All four of the collaboration’s new themes are relevant to the NCA and we are looking forward to working together to improve patient safety.”

In addition to funding six PSRCs, the NIHR is also providing new, additional funding to establish a network between these collaborations. The network will provide a platform for strategic coordination and a focal point for collaboration between the PSRCs. 

For example, in times of national crises, such as the COVID-19 outbreak, the network could work with partners and respond as a single entity. The role of leading the network will be awarded through a competitive process, with further details provided soon.

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The NIHR PSRCs funded from 2023-2028 are:

Name	Host institution
NIHR Greater Manchester Patient Safety Research Collaboration	Northern Care Alliance NHS Foundation Trust
NIHR Midlands Patient Safety Research Collaboration	University Hospitals Birmingham NHS Foundation Trust
NIHR North West London Patient Safety Research Collaboration	Imperial College Healthcare NHS Trust
NIHR Central London Patient Safety Research Collaboration	University College London Hospitals NHS Foundation Trust
NIHR Newcastle Patient Safety Research Collaboration	The Newcastle Upon Tyne Hospitals NHS Foundation Trust
NIHR Yorkshire and Humber Patient Safety Research Collaboration	Bradford Teaching Hospitals NHS Foundation Trust

New research reveals that a tool designed by researchers to help prevent self-harm is liked by those with lived experience

Behavioural Science researchers have worked with a group of people who have a history of self-harm to understand if a new online tool can help to reduce the urge to self-harm. The research aimed to understand their thoughts, feelings and experiences of using the tool, known as a volitional help sheet. It is the first study to apply the ‘theoretical framework of acceptability’ to understanding the acceptability of an intervention for self-harm.

This research forms part of a larger study that involved designing the tool and is funded by the National Institute for Health and Care Research Greater Manchester Patient Safety Translational Research Centre (NHIR GM PSTRC).

Researchers interviewed sixteen people with a history of self-harm, who had previously used the tool to make ‘if-then plans’ to try to reduce the urge to self-harm. An ‘if-then plan’ is normally used in psychology to help people to commit to doing a certain thing in a specific situation. It allows people to plan their response to a particular set of circumstances that may arise. For example, ‘if X occurs, ‘then Y will be done’.

The research, “Exploring the acceptability of a brief online theory-based intervention to prevent and reduce self-harm: a theoretically-framed qualitative study” was published in BJPsych Open.

As well as understanding if it was liked by those who used it, researchers also sought to understand when the tool could be most useful. Those interviewed agreed that healthcare professionals (particularly GPs and mental health professionals) could use the tool during medical consultations to complement existing healthcare that patients receive.

The study’s authors hope this intervention provides a useful tool for individuals to construct their own personalised ‘if-then plans’, and can form part of a longer-term support strategy delivered by healthcare professionals for preventing self-harm.

Dr Chris Keyworth, Lecturer in Psychology at the University of Leeds and lead for this study at the GM PSTRC, said: “Using a specific framework from behavioural science, the “Theoretical Framework of Acceptability”, allowed us to explore in detail peoples’ experiences of using our tool, the volitional help sheet.

“Specifically we were able to understand how a person thinks and feels about the tool, while also being able to recognise the effort needed to engage with it by making ‘if-then plans’. In taking a qualitative approach, we were able to identify specific ways that the tool could be used – both personally, and by healthcare professionals. Importantly, this also allows us to identify areas to improve it. For example, we could add more referral resources or signposting to support services in future versions.”

The tool was designed alongside a patient and public involvement and engagement (PPIE) group with lived experience of self-harm to ensure the intervention is as acceptable as possible and requires the lowest level of effort by those who use it. This has been reflected in the views of participants taking part in the study.  Researchers are now looking at ways of making the tool more widely available online.  

Free immersive show comes to Stockport and Salford raising awareness of challenges faced by young people struggling with their mental health

After a successful first performance at the Royal Northern College of Music, an immersive show that aims to highlight the challenges faced by young people who struggle with their mental health is going on tour across the North West.

The first date is Thursday 10 November at The Lowry Theatre, Salford, and further performances will follow in early 2023.

The performance has been created by two National Institute for Health and Care Research (NIHR) centres, the Applied Research Collaboration Greater Manchester (ARC-GM), and the Greater Manchester Patient Safety Translational Research Centre (GM PSTRC).

Ten young people from diverse backgrounds worked with researchers and not-for-profit organisation Made by Mortals to create a performance that encourages audience members to walk in the shoes of a fictional character, Adam. They recorded a podcast which is combined with a live performance to create the show.

Adam is 18 years old and transitioning from children’s mental health services to adults. Immersive sound and live action combine to give a real sense of what it’s like to be Adam. Audience members are encouraged to wear an eye mask to heighten the experience. A trailer has been created to give an insight into what it’s like to attend a performance.

One of the young people involved in the performance, said:

“All of us involved have different ethnicities, ages, genders, and backgrounds. It really helped when we were creating the characters, and all of the details around their lives, because we all had such a range of experiences from our real lives that we could draw on due to the differences in our cultures and unique backgrounds. For example, we decided on the name Adam as it was ethnically ambiguous, so anyone could listen to the podcast and relate to it, because we didn’t want anyone to feel limited and as though it couldn’t be applied to them.”

An actor plays the part of Adam’s mental health support worker, Shaun. He helps to guide the audience through the story and suggests they remove their eye masks at key points during the performance. Shaun speaks about his experiences of working with Adam. The script for this was created by working alongside parents and carers with lived experience of mental health services. Shaun speaks about his relationship with Adam, the support he is able to offer and how that is changing now that Adam has turned 18.

Prof. Karina Lovell, lead for Mental Health at ARC-GM and Professor of Mental Health at the University of Manchester, said:

“We believe the podcast that’s been created with young people and Made by Mortals gives an accurate portrayal of the challenges faced by young people struggling with their mental health. It’s a powerful performance and we hope it makes a difference to not only the people who come along to the live performance, but to those who read the resource we’ll be creating on the day.”

Shaun also highlights how the music, which was co-created by the young people involved, reflected the story. This included an eclectic mix of instrumentation representing the cultural heritage of the young co-creators, and Adam’s dialogue being transformed into beautifully lyrical melodies performed live by a violinist.

Paul Hine, Director at Made by Mortals, said:

“Coproduction is at the heart of this project and it’s this that helps us to create a sense of what it’s really like for young people struggling with their mental health. We are keen for as many people as possible to experience the performance and encourage anyone interested to register for tickets.”

The performance will be followed by an interactive session where audience members are encouraged to ask questions about the show to encourage discussion.  

One of the researchers, Dr Leah Quinlivan, who leads mental health research at the GM PSTRC, said:

“An important theme of our work is mental health and this includes developing interventions for adults as well as young people. We are therefore, delighted to be involved in this project, as it has the ability to reach a diverse audience and make a difference to young people struggling with their mental health.”

Further information and details on how to book tickets for the upcoming performance at The Lowry in Salford Quays can be found on the GM PSTRC website.

Burnout in doctors impacts patient safety finds new international study

Doctors across hospitals and general practice who are experiencing burnout are twice as likely to be involved in a patient safety incident and three times as likely to leave their job, according to a new research paper that included 239,246 doctors from across America, Europe and the UK.  

The paper’s authors believe its findings highlight the importance of investing time and effort into strategies to ease burnout across all areas of medicine, particularly in emergency medicine, to ensure doctors can deliver safe and effective treatment. 

The paper, Associations of Burnout with the Career Engagement of Physicians and the Quality of Patient Care: A Systematic Review and Meta-analysis was published in The BMJ. The paper was funded by the National Institute for Health and Care Research Greater Manchester Patient Safety Translational Research Centre (NIHR GM PSTRC). The centre is a partnership between The University of Manchester and Northern Care Alliance NHS Foundation Trust. The paper was also funded by the NIHR School for Primary Care Research. 

Burnout is a reaction to prolonged or chronic work-related stress and involves exhaustion, feelings of not being able to do the job, and cynicism. It is becoming more common among doctors, and this is the largest review to critically assess published studies on the effects of the quality of care given to patients and the engagement of doctors with their career. 

Dr Alexander Hodkinson, NIHR Senior Fellow at the Centre for Primary Care, and lead for this research at the GM PSTRC, said: “We understand that doctors are under a number of pressures and with burnout taking the form of an epidemic, particularly since the COVID-19 pandemic, it’s important to understand its impact on the quality of care doctors give. The fact that both general practitioners and hospital doctors with burnout are twice as likely to be involved in a patient safety incident and are three times as likely to leave their job is significant. Therefore, for organisations such as the NHS, addressing burnout needs to be a priority. 

“Also, understanding how burnout affects a doctor’s engagement with their career is valuable.  If doctors aren’t engaged, they’re more likely to leave the profession, leading to an increase in staff turnover which can negatively impact patients and healthcare organisations.” 

The research involved analysing 170 papers and revealed that doctors experiencing burnout are up to four times more likely to be dissatisfied with their job and more than three times as likely to regret their career choice. In addition, they are twice as likely to receive low satisfaction ratings from patients.  

Aneez Esmail, Professor of General Practice at The University of Manchester who was involved in this study, said: “The pressures that many clinicians face in the NHS is impacting on their ability to deliver safe and effective care. In relation to general practice, the impact of this stress is causing doctors to experience burnout so they become despondent and think about leaving the profession (either by retiring early or leaving the NHS). This also impacts on how they deliver care to patients, with doctors who experience burnout more likely to make errors that result in patient harm. By addressing burnout, this research helps to show that care could be safer.”