Themed issue on Quality & Safety plus HSJ roundup.

Considering chance in quality and safety performance measures: an analysis of performance reports by boards in English NHS trusts – BMJ Quality & Safety. Schmidtke, K. A., Poots, A. J., Carpio, J., Vlaev, I., Kandala, N.-B., Lilford, R. J.
Hospital board members are asked to consider large amounts of quality and safety data with a duty to act on signals of poor performance. However, in order to do so it is necessary to distinguish signals from noise (chance). This article investigates whether data in English National Health Service (NHS) acute care hospital board papers are presented in a way that helps board members consider the role of chance in their decisions.

How might health services capture patient-reported safety concerns in a hospital setting? An exploratory pilot study of three mechanisms – BMJ Quality & Safety,  O’Hara, J. K., Armitage, G., Reynolds, C., Coulson, C., Thorp, L., Din, I., Watt, I., Wright, J.
Emergent evidence suggests that patients can identify and report safety issues while in hospital. However, little is known about the best method for collecting information from patients about safety concerns. This study presents an exploratory pilot of three mechanisms for collecting data on safety concerns from patients during their hospital stay. Interviewing at the patient’s bedside is likely to be the most effective means of gathering safety concerns from inpatients, potentially providing an opportunity for health services to gather patient feedback about safety from their perspective.

Self-care after hospital discharge: knowledge is not enough – BMJ Quality & Safety, Horwitz, L. I.
In this issue of BMJ Quality and Safety, Greysen and colleagues present results of a large, multi-institutional interview study of readmitted patients’ perspectives of post-discharge care. Investigators interviewed over 1000 patients while they were readmitted to one of 12 academic medical centres and asked them a variety of questions about barriers to recovery after their previous discharge. More than half of patients reported difficulty carrying out the care plan given to them when they were first discharged from the hospital, even though the vast majority reported no difficulties understanding what they were supposed to do.

Turning the page on hospital communications slowly – BMJ Quality & Safety, Wu, R.
In hospitals, breakdowns in communication has been found to be a major source of errors. Communication between clinicians can occur at scheduled times or rounds, through face-to-face meetings or may be facilitated through the use of communication tools such as pagers. For the latter, often urgent communication between clinicians about a patient is required. Problems in communication can result in a failure to rescue or result in poor coordination of care.

Closing the loop: a process evaluation of inpatient care team communication – BMJ Quality & Safety, Kummerow Broman, K., Kensinger, C., Hart, H., Mathisen, J., Kripalani, S.
Interprofessional communication is a core component of healthcare delivery in inpatient settings and a key contributor to safe and efficient inpatient care. Communication is implicated in two-thirds of medical errors and accounts for a significant proportion of nurse and clinician time. Inpatient teams rely on multiple communication methods ranging from paging and stationary telephones to wireless mobile devices, but comparative evaluations of communication systems are largely limited to qualitative outcomes. With respect to safety and efficiency, key measures of communication system performance include frequency of task disruption and reliability of ‘closed loop’ communication, meaning the sender receives a sufficient response to address the communication need. We sought to understand communication processes in two different patient care areas of a single hospital using traditional (non-mobile) versus mobile phones…

Understanding patient-centred readmission factors: a multi-site, mixed-methods studytags: Editor’s choice – BMJ Quality & Safety, Greysen, S. R., Harrison, J. D., Kripalani, S., Vasilevskis, E., Robinson, E., Metlay, J., Schnipper, J. L., Meltzer, D., Sehgal, N., Ruhnke, G. W., Williams, M. V., Auerbach, A. D.
Patient concerns at or before discharge inform many transitional care interventions; few studies examine patients’ perceptions of self-care and other factors related to readmission. Patients readmitted within 30 days reported understanding their discharge plans, but frequent difficulties in self-care and low anticipatory guidance for resolving these issues after discharge.

The role of embedded research in quality improvement: a narrative review  – BMJ Quality & Safety Vindrola-Padros, C., Pape, T., Utley, M., Fulop, N. J.
The use of research evidence to facilitate improvements in healthcare quality continues to be a topic widely debated by scholars and practitioners. The concept of ‘knowledge mobilisation’ has been developed, with strategies to help bridge this gap. These strategies include the development of “a culture of partnership between academic researchers and decision-makers to assist in strengthening the development of policy, practice and social innovation, or the co-production of knowledge”. It is based on the premise that knowledge that is collected and created ‘on the ground’, through daily interaction and negotiation with practitioners, managers and service users, will provide better insight into the issues affecting these stakeholders, be more relevant to the local context and will, therefore, be more easily incorporated into changes in practice.

The problem with red, amber, green: the need to avoid distraction by random variation in organisational performance measures – BMJ Quality & Safety Anhoj, J., Hellesoe, A.-M. B.
‘The Problem with…’ series covers controversial topics related to efforts to improve healthcare quality, including widely recommended but deceptively difficult strategies for improvement and pervasive problems that seem to resist solution.

HSJ roundup: (contact the library for further details on any of these HSJ articles)

• CQC seeks change in powers to ‘favour’ patients  
  The Care Quality Commission has asked the Department of Health to change its regulations so they “operate in favour” of service users.
• CCGs’ financial forecast deteriorates by £70m in a month 
  The forecast overspend by clinical commissioning groups this year has increased by almost £70m in the last month, as local leaders struggle to hit efficiency targets.
• Trusts could be refused bailouts to pay suppliers 
  The Department of Health has warned NHS trusts they could be refused cash bailouts even when suppliers are refusing to deal with them due to late payments.
• Trusts set February deadline for merger
  Birmingham Children’s Hospital and Birmingham Women’s Hospital foundation trusts will integrate by 1 February 2017, the providers have confirmed.
• 13 services could be decommissioned at major hospital trust  
  One of the largest acute trusts in the country faces 13 services being decommissioned and 17 being redesigned by July, a leaked document has revealed.