oxford and kings international health conference 2016, presentation 4 - frontline staff (abstract...

IHC2016,AbstractRef0282 Spencer,Rajpal,LangdonandDickerson,June2016 Slide1

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Something&happens,&but&it’s&a&liSle&hard&to&predict.&Presentation 4

The importance of including frontline staff safety assessments in the Healthcare system design process




Team Members

Dr Jennifer SpencerHealthcare Fellow, University of Cambridge, Cambridge UK

Dual CCT CAMH and ID psychiatry, MRCPsych, MB, BAO, BCh, BMedSci, BA,

Dr Gagan RajpalThe Peacemaker. CCT ID Psychiatry, MRCPsych, MD

Dr Patrick LangdonResearch Associate, Universities of Cambridge and Lancaster

PhD, BSc

Dr Terry DickersonAssistant Director EDC, University of Cambridge, Cambridge UK

PhD, MiMechE, CEng, BSc




How did this project start, back in 2011?

The Assistant Director of the University of Cambridge Engineering Design Centre, Terry Dickerson, and Jenny Spencer had a fight.

Jenny and Terry had only just met.

Terry thought human error in the NHS was caused by people working in the frontline.

Jenny told him human error was caused by people higher up in the organisational hierarchy.




What they agreed to do.

Have a contest.




They designed a research project to see if they could decide

who was right.




Theory/Framework: Design Research Methodology

Blessing etal,2009




What the project was designed to do.

Compare and contrast• Classify problems using

WHO patient safety classification system

• Add or change categories as needed

Health Services Research: Evidence Based Practice

Assess the Clinical Safety and Effectiveness of the Quality Assurance methods under study using Adequate and Appropriate Research techniques (Quantitative, Qualitative and/or Mixed Methodologies)

Assess Managerial Safety Awareness And Frontline Staff Safety Awareness




Assess safety awareness at different hierarchical levels within an NHS Mental Health trust

Using 1. a Prospective Hazards Analysis2. a Quality Control feedback form3. a Safety Culture assessment tool

Hierarchical Levels within an NHS Mental Health trust

2.QualityControlform

2.QualityControlform

1.ProspectiveHazardsAnalysis

1.ProspectiveHazardsAnalysis

Members of the Executive Board

Nurse Manager

Team Leader

Frontline Nursing and Allied Health

Staff

Clinical Director

Medical Consultant

Trainee Doctor

3.M

anchesterPatie

ntSa

fety

AssessmentFram

ework

Methodology

GP Commissioner




MethodologyProspective Hazards Analysis Team Meetings




MethodologyQuality Control sheet (for Frontline Staff)




Structured Observations (Robson2006,adaptedfromSpradley,1980)1. Space Layout of the physical setting; rooms,

outdoor spaces, etc.2. Actors The names and relevant details of the

people involved.3. Activities The various activities of the actors.4. Objects Physical elements, furniture etc.5. Acts Specific individual actions.6. Events Particular occasions, eg Meetings.7. Time The sequence of events.8. Goals What actors are attempting to accomplish.9. Feelings Emotions in particular contexts.

Use of the Quality Control Sheet

1. Describe using Structured Observation

2. Opinion – change/improvement




Frontline staff Opinion

Why problems weren’t currently being reported before they occurred within in the service

• Fear of being thought of as a whistle blower • Fear of political trouble (“keep your head down”) • Fear of punishment, bullying or harassment for self or a colleague • Fear of blame • Fear of legal implications • Feeling like it won’t change anything anyway




How Frontline staff concerns were addressed

• Frontline staff were informed they were welcome to submit forms anonymously

• They were given the opportunity to opt-in on a case-by-case basis and were informed that completing and submitting a form would signpost consent for the form to be used.

• Information was often collected in team meetings with the door closed. Group decisions were made with respect to the significance and frequency criteria for each problem.

• Team discussions revealed further problems as discussions around submitted problems ensued




Assessment of CultureManchester Patient Safety Assessment (MaPSaF)

https://safetydirector.wordpress.com/tag/safetyNculture/ andNRLS-0199E-MaPSaF-safety-culture-2006-v1




Results 1: System Design diagrams

• Frontline staff were more aware of interconnected nodes where communication occurred between different teams.

• They were additionally more aware of safety concerns that were occurring and being addressed within the confines of the frontline staff communication network.




Results 2: Safety Culture assessmentsManagerial and Frontline Staff Perceptions

• Both Managerial and Frontline Staff perceived Safety culture to be predominantly Bureaucratic.

• They perceived Individual Teams to be more Proactive and less Reactive than the Organisation as a whole (p<0.01)




Conclusion

• Quality control sheets were seldom used outside of team meetings and team discussions, however some important anonymised observations were made via this methodology during clinical work time.

• Assessment of frontline staff’s safety viewpoint is essential to good Change Management Practice in this Mental Health Service Crisis Team.

(Jenny won)• The Prospective Hazards analysis toolkit provided both managers and staff with a

structured platform for thinking about the design and interactive nodes of the service.• Both Frontline staff and Managers had an easier time recalling their concerns when they

met in teams to discuss their findings. Even staff who turned in Quality Control sheets wished to discuss them (anonymously) with their peers before taking a firm stand on them.

(Terry won)




References1. Blessing LTM. DRM, a design research methodology. Dordrecht ; London: Springer; 2009. 2. Great Britain. An organisation with a memory: report of an expert group on learning from adverse events in the NHS. London:

Stationery Office; 2000.3. Hudson P. Applying the lessons of high risk industries to health care. Qual. Saf. Health Care. 2003 Dec;12(Suppl 1):i7–i12. 4. Kontogiannis. A systems perspective of managing error recovery and tactical re-planning of operating teams in safety critical domains.

Journal of Safety Research. 73-85. April 2011.5. Mid Staffordshire NHS Foundation Trust, Great Britain. Parliament. House of Commons. Report of the Mid Staffordshire NHS

Foundation Trust Public Inquiry: executive summary. London: Stationery Office; 2013. 6. Mikulic, Prebezac. A critical review of techniques for classifying quality attributes in the Kano model. Managing Service Quality. 46-66.

2011.7. O’Connor, Walliser, Philips. Evaluation of a Human Factors Analysis and Classification System Used by Trained Raters. Aviation Space

and Environmental Medicine. 957-960. October 2010.8. Parker D, Lawrie M, Hudson P. A framework for understanding the development of organisational safety culture. Saf. Sci. 2006

Jul;44(6):551–62. 9. Parker D, et al. Measuring safety culture.pdf [Internet]. [cited 2013 Apr 6]. Available from:

http://www.health.org.uk/public/cms/75/76/313/2600/Measuring%20safety%20culture.pdf ?realName=rclb4B.pdf10. Parker D. Managing risk in healthcare: understanding your safety culture using the Manchester Patient Safety Framework (MaPSaF). J.

Nurs. Manag. 2009 Mar;17(2):218–22. Schein EH. Organizational culture and leadership. San Francisco: Jossey-Bass; 2010.11. Ulbrich, Troizsch, van den Anker, Pluss, Huber. How teams in networked organisations develop collaborative capability: processes,

critical incidents and success factors. 488-500. 2011.12. Ward J, Clarkson P, Buckle P, Berman J, Lim R, Jun G. Prospective hazard analysis: tailoring prospective methods to a healthcare

context - CUED Publications database [Internet]. [cited 2012 Mar 27]. Available from: http://publications.eng.cam.ac.uk/323930/

oxford and kings international health conference 2016, presentation 4 - frontline staff (abstract...

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