Since 2009 the Health Foundation has funded a series of programmes supporting front-line teams to ‘close the gap’ between best practice and the routine delivery of care. Teams have done this in a number of ways:
- by harnessing the power of clinical communities
- by changing the relationship between health professionals and service users
- by developing a shared purpose across clinical and corporate support teams.
Between 2014—17 we ran a programme specifically focused on closing the gap in patient safety. Nine teams sought to implement and evaluate evidence-based interventions across a diverse range of care settings and population groups – from community pharmacies to care homes, and from the frail elderly to young people with long term conditions.
Interventions chosen by teams reflected some important themes in the Health Foundation’s vision for improving patient safety. These included seeing patients, carers and families as active partners in patient safety and building a culture of safety to empower staff to make changes to improve care. Another central theme was addressing risks and hazards within systems before they lead to harm to patients, in contrast to the prevailing reactive safety culture that exists in much of health care.
There are three different examples that give a sense of the range and diversity of the work that went on:
Sepsis is a time-critical condition caused by the body’s reaction to infection, which can lead to organ failure, septic shock and death. When Northumbria Healthcare NHS Foundation Trust identified a higher-than-expected mortality rate for people admitted with sepsis, they introduced a quality improvement project. Patients were screened and, where sepsis was identified, treated using the Sepsis Six care bundle. Their Think Infection Spot Sepsis campaign was implemented in 52 wards across the trust with over 7,000 patients screened. Patients assessed using the screening tool were shown to have a 21% lower mortality rate than those where the tool was not used. The initiative has been estimated to have saved 158 lives, 1,339 ITU bed days and £1.65m.
Outcomes for acutely sick children in paediatric care are significantly worse in the UK than in other countries. To address how teams identify and respond to signs of deterioration, the Royal College of Paediatrics and Child Health led a programme to implement safety ‘huddles’ in paediatric intensive care units and wards. This involved a ten minute exchange of key information between clinical and non-clinical staff, based around a framework developed in previous Health Foundation research. Twelve hospitals embarked on the programme, which had risen to 28 by the end of it. A number of benefits of implementing the huddle were identified including earlier anticipation of deterioration, improved teamwork and increased patient satisfaction. A programme to spread the initiative more widely has now begun.
Care homes in England provide support for nearly 400,000 people, often with complex care needs, but teams suffer from high turnover rates and limited investment in skill development. A team based at Essex County Council developed a programme to provide staff across 90 care homes with training, tools and resources on quality improvement methods. This was a ground-breaking initiative: transferring and adapting methods more commonly used in health care and other sectors. As a result, two-thirds of care homes reported improvements in safety culture [£] including a greater focus on preventing and monitoring safety incidents. Additional council funding means that over 100 homes continue to be involved.
Beyond the impact of these individual projects, the programme produced valuable learning about how improvement happens more generally. This included how interventions sometimes need to be adapted to new contexts and how discrete improvement interventions can be a powerful force in building improvement capability more broadly across organisations. This is learning we are now taking into our future work to support scaling and spreading improvement.
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John Illingworth is an Improvement Fellow at the Health Foundation.