Introduction

The term ‘second victim’ refers to the healthcare professional who experiences emotional distress following an adverse event. This distress has been shown to be similar to that of the patient—the ‘first victim’. The aim of this study was to investigate how healthcare professionals are affected by their involvement in adverse events with emphasis on the organisational support they need and how well the organisation meets those needs.

Methods

21 healthcare professionals at a Swedish university hospital who each had experienced an adverse event were interviewed. Data from semi-structured interviews were analysed by qualitative content analysis using QSR NVivo software for coding and categorisation.

Results

Our findings confirm earlier studies showing that emotional distress, often long-lasting, follows from adverse events. In addition, we report that the impact on the healthcare professional was related to the organisation’s response to the event. Most informants lacked organisational support or they received support that was unstructured and unsystematic. Further, the formal investigation seldom provided adequate and timely feedback to those involved. The insufficient support and lack of feedback made it more difficult to emotionally process the event and reach closure.

Discussion

This article addresses the gap between the second victim’s need for organisational support and the organisational support provided. It also highlights the need for more transparency in the investigation of adverse events. Future research should address how advanced support structures can meet these needs and provide learning opportunities for the organisation. These issues are central for all hospital managers and policy makers who wish to prevent and manage adverse events and to promote a positive safety culture.

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Abstract: Introduction

Pay for performance is increasingly used as a way of improving the quality of medical care. We previously showed that a pay for performance scheme targeting a range of processes measures in hospitals in the North West of England was associated with a substantial reduction in mortality for pneumonia, myocardial infarction and heart failure equivalent to 890 fewer deaths (Sutton et al. Reduced Mortality with Hospital Pay for Performance in England. New England Journal of Medicine 2012;367:1821–28). This analysis only assessed mortality in the first 18 months after introduction of the scheme. We now report mortality outcomes at 42 months to see whether the effect was sustained.

Methods

Difference-in-differences regression analysis based on mortality for 230,985 patients admitted with pneumonia, myocardial infarction and heart failure to incentivised hospitals 18 months before and 42 months after the introduction of the program. These were compared with mortality in the following control groups: 1,260,545 patients admitted for the same three conditions to all 132 other hospitals in England, 50,400 patients admitted for six non-incentivised conditions to the incentivised group of hospitals and 285,301 patients admitted for non-incentivised conditions to all other hospitals in England. Analyses were adjusted for differences in age, gender, primary diagnosis, co-morbidities, type of admission, and location from which the patient was admitted.

Results

Preliminary analyses suggest that the gains in mortality seen 18 months after the introduction of the pay for performance programme were not sustained at 42 months.

Discussion

Pay for performance schemes remain controversial, and there are many unanswered questions about how and when they work. Our previous analyses were important because the incentive scheme that was introduced (Premier HQID) had no impact on mortality when introduced in the US, but appeared to have a substantial impact on mortality when introduced in the UK. However, our long term analyses suggest that these improvements were not sustained. We will comment on a number of possible reasons for the observed effects. One factor is that during the study period, the financial incentives changed from being bonuses to penalties for hospitals in the scheme.

Declaration of competing interests

None.

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Introduction

Hospital mortality, readmission and length of stay (LOS) are commonly used measures for quality of care, given availability in administrative data. However, these measures are interrelated. For example, a short LOS due to patient’s death should be interpreted differently than short LOS in survivors. And patients who died cannot be readmitted. In this study we aim to disentangle the relationship between mortality, readmission and LOS and propose a way to jointly report the three figures to facilitate insight and evaluation of quality of care.

Methods

Data from the Global Comparators Project were used, in which 22 hospitals from 5 countries have reconciliated the different coding systems of their administrative admission data to obtain risk-adjusted hospital outcomes. Patients discharged between 2007–2011 were included. Three outcomes were considered: mortality, readmission, and prolonged LOS (>75 percentile). We analyzed all patients, stroke patients and colorectal patients as we expected these conditions to vary in short-term mortality and readmission/long LOS.

We assessed the correlations between the three standardized outcomes: mortality versus readmission (survivors), mortality versus long LOS, readmission (survivors) versus long LOS (survivors) and long LOS (deaths) versus long LOS (survivors). Second we constructed a composite measure with 5 levels: survivors no readmission normal LOS (best), survivors no readmission long LOS, survivors readmission normal LOS, survivors readmission long LOS, deaths (worst). This composite measure was analyzed using ordinal regression, to obtain a single standardized rate to compare hospitals.

Results

A total of 4,134,359 admissions were included in the analysis, with 76,517 for stroke and 31,736 for colorectal patients. The overall mortality rate was 3.1%, the readmission rate (in survivors) was 7.4% and 20.5% of the admissions had a long LOS (for stroke: 13.9%, 7.1% and 23.0%; for colorectal: 5.0%, 10.4% and 45.7%).

The median number of admission per hospital was 170,497 (range 9,294 to 430,731). Standardized (risk-adjusted) outcome rates varied largely between hospitals: 55–140 (mortality), 58–116 (readmission), 50–165 (long LOS).

No correlation was found between standardized mortality and readmission rates, and between readmission and long LOS rates (survivors). However, standardized mortality and long LOS rates were positively correlated (r=0.73, p=0.0001), indicating longer hospital stay in patients who died. Long LOS (survivors) was highly correlated with long LOS (deaths) (r=0.74 p<0.01), indicating that some hospital had a long LOS regardless of their mortality rates.

The figure shows the variation in the composite outcome measure, consistent with a variation in standardized rates between 43 and 171 (for stroke: 34–162; for colorectal: 33–1.9).

This composite measure correlated well with all individual measures, except readmission (r=0.06 p=0.79) caused by the smaller variation between hospitals in readmission rates, therefore weighted less.

Discussion

The three outcome measures were highly related. Disentangling the interrelations in outcomes facilitates insight so that hospitals get better directions for quality improvement. We propose to summarize the three outcomes into a single composite measure. The variation between hospitals in this composite measure is larger than for the individual measures, indicating a more accurate (detailed) representation of quality of care.

Declaration of competing interests

None.

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Abstract: Introduction
Twitter and other social media are increasingly used by patients to discuss their experiences of healthcare. Social media might provide a new way for health services to listen to the voices of patients and improve their services. Little is known about how patients are communicating with hospitals via this route, and whether there is any association with traditional measures of patient experience such as surveys.

Methods
We recorded tweets aimed at all acute hospital trusts with Twitter accounts in England for one year from April 2012. We performed a qualitative content analysis of a random sample of 1000 tweets, to see what information they contained about care quality. Using natural language processing techniques, we calculated the sentiment of all the tweets towards hospital. We compared twitter sentiment to patient experience measured by traditional survey at the hospital level, using Spearmans rank correlation coefficient.

Results
We collected 187,000 tweets over one year. The mean number of tweets per trust was 2499. 9.8% of tweets were related to quality of care care – and most of these related to patients experience of interactions with staff. We found no correlation between the sentiment of tweets about hospitals and patient experience measure by traditional survey methodology (Rho=0.08, p=0.56).

Discussion
Although social media are increasingly used by both the public and healthcare professionals to communicate, caution should be taken in using social media data to measure care quality. The information contained within tweets was able to provide valuable individual insights about some patients experiences of care, however the views expressed appeared less likely to be representative of the experiences of the wider population receiving care.

Declaration of competing interests
This work has been funded by the Commonwealth Fund.

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The article discusses a British government plan to reform long-term sick leave, designed to engage private specialist services in support of employees and bring them back to work faster. Comments from human resources (HR) professionals on the issue are presented, including Chartered Institute of Personnel &amp; Development (CIDP) head of public policy Ben Willmott, British Labour party shadow work and pensions minister Kate Green, and Frances O’Grady of the Trades Union Congress (TUC).

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Article outlining approaches to 5 key HR conversations, from dealing with a bully to proving the value of the HR function.

In England, the NHS is ‘organising itself around a single definition of quality: care that is effective, safe and provides as positive an experience as possible’ enshrined in the NHS Outcomes Framework, as a set of measurable indicators.

Delays in discharging patients from hospital while they are waiting for social care to be arranged are costing the NHS in England about £100m each year, a documentary claims

Hospital discharge delays ‘cost NHS £100m’ – (HSJ Article request full text from Trust Library Services or call 01942 822508)

Team leadsers should be the ones agitating for radical change.

Cultural competency is a recognized and popular approach to improving the provision of health care to racial/ethnic minority groups in the community with the aim of reducing racial/ethnic health disparities. The aim of this systematic review of reviews is to form a comprehensive understanding of the current evidence base that can guide future interventions and research in the area. Finds some evidence that interventions to improve cultural competency can improve patient/client health outcomes. However, a lack of methodological rigor is common amongst the studies included in reviews and many of the studies rely on self-report, which is subject to a range of biases, while objective evidence of intervention effectiveness was rare.

BMC Health Services Research 2014, 14:99 doi:10.1186/1472-6963-14-99

Health Foundation report on a roundtable discussion, 30 January 2014.  This report highlights the following key points from the presentations and discussions on the day:

1. The extent of the £30bn financial gap was accepted, but it may be too optimistic if the NHS budget is not protected in future years.
2. The NHS in England does not appear particularly ‘flabby’ next to health systems in other developed countries.
3. The current financial squeeze might affect the system’s ability to achieve the service transformation required to close the £30bn funding gap by 2021. Asking the system to deliver radical, transformational change may be unrealistic given the day-to-day pressures to deliver, but the financial squeeze may prompt the action needed.
4. Proper alignment between quality, efficiency and funding decisions is vital. Short-term interventions to improve quality must not increase the scale of the financial challenge to come.
5. There are a number of cultural barriers which make innovation more challenging. The system rarely tackles failure well and there is very little recognition or reward for success. As a sector, the health system could be much better at ‘spread’ of good and innovative practice.
6. Radical transformation of services is required.
7. The centre should play a bold, supportive and facilitative role and avoid the perception of micro-management.
8. The time has come for an honest conversation with the public about what the NHS might look like over the next decade and how that vision might be funded.
9. There are signs of optimism despite the financial challenges. For example, the prominent focus on integration and person-centred care could bring about positive changes.

The report also summarises some potential areas of focus to support the NHS to deliver improved efficiency in both the short and medium term.

The Fair Deal policy allows newly transferring staff continued access to a public service pension scheme. It replaces the previous policy which required employers to provide transferring staff access to a broadly comparable pension scheme and the option of a transfer of their accrued pension rights.

The authors offer opinions on diversity in the workplace. They cite their own research on attitudes and behaviors of employees in support of the contention that workers feel pressure from management to minimize their differences from others within their organizations. Managers are urged to be aware of their own implicit demands for conformity among employees

Person-centred, individualised, personalised, patient-centred, family-centred, patient-centric and many other terms have been used to signal a change in how health services engage with people. This  Health Foundation rapid review summarises research about measuring the extent to which care is person-centred.

Three key questions guided the review:

• How is person-centred care being measured in healthcare?
• What types of measures are used?
• Why and by whom is measurement taking place?

The review signposts to research about commonly used approaches and tools to help measure person-centred care. It aims to showcase the many tools available.

A spreadsheet listing 160 of the most commonly researched measurement tools accompanies the review. This allows users to search according to the type of tool, who it targets and the main contexts it has been tested in.

The report makes clear that there is no ‘silver bullet’ or best measure that covers all aspects of person-centred care. Combining a range of methods and tools is likely to provide the most robust measure of person-centred care.

Additional Item

• Spreadsheet of measurement tools

Based on the findings from the environmental scan, literature review, and technical expert panels discussions, this report provides a set of recommendations for consideration that could serve to advance the design, implementation, monitoring, and evaluation of value based purchasing programs to generate critically needed knowledge to guide policymaking.

Additional Item

• Executive Summary

Health Foundation report that presents the lessons from an evidence review and case study work undertaken by McKinsey Hospital Institute. Draws on the literature and empirical evidence about effective networks to describe the component parts of a successful improvement network.

While the review found no ‘one size fits all’ formula for successful network design, it did identify five core features of effective networks. These are:

• common purpose
• cooperative structure
• critical mass
• collective intelligence
• community building.

These features are interdependent, and interact to give a network energy and momentum. They ensure a clear direction, credibility and increased scale and reach, while enhancing knowledge, encouraging innovation and creating meaningful relationships. All five features are mutually reinforcing, and their combined effect enables quality improvement, learning and change to happen.

“Improving services for older people requires us to consider each component of care, since many older people use multiple services, and the quality, capacity and responsiveness of any one component will affect others.”

Making our health and care systems fit for an ageing population
D Oliver, C Foot, R Humphries
The King’s Fund
March 2014

(QIPP Article request full text from Trust Library Services or call 01942 822508)

Recently, the Health Foundation brought together senior health sector leaders to consider whether the NHS can close the £30bn funding gap through greater efficiency.

The discussion was stimulated by Monitor’s publication last year of Closing the NHS funding gap: how to get better value healthcare for patients, which highlighted the financial challenges facing the NHS in England. The discussion identified four key areas where there were opportunities to make significant productivity gains across the NHS by 2021 and beyond:

Link to report ‘Closing the NHS funding gap: how to get better value healthcare for patients’
http://www.monitor.gov.uk/closingthegap

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The appointment of Stuart Rose to advise on leadership in the NHS reminded me of a visit I made to Marks and Spencer 25 years ago during my first spell at The King’s Fund. This took place shortly after the Thatcher government published its plans to create an internal market in the NHS, introducing the separation between commissioners and providers. I wanted to understand whether the NHS could learn any lessons from how M&S related to the suppliers of the goods sold in its stores.

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