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Technology is great, but let’s not forget the human touch

Published and last updated by Catherine Dale
catherine dale hsj webinar blog

The adversity of Covid-19 has taught us that the best inpatient care innovations aren’t necessarily the most technologically advanced – they’re the ones that make a difference to patient experience.

I recently took part in a Health Service Journal webinar looking at how the NHS can reduce isolation and improve wellbeing during Covid-19 and beyond. Joining the panel was a great chance to share and reflect on experiences with colleagues from across the health sector.

Something that really struck me was how we all agreed that being an inpatient in a hospital can be very isolating already, but Coronavirus has definitely made this aspect of things much worse. Hospitals have had to increase their infection control measures and as a by-product of this, vulnerable people are having markedly lonelier experiences during their stays.

The innovations brought about in response to Covid that I had heard about mainly focused on outpatients, I hadn’t heard as much about how inpatient experience was being addressed. Something which Covid-19 has made really evident was how much the management of patient wellbeing is usually supported by the visits of family and friends. Some can really struggle being separated from their families and miss out on things that clinical teams, no matter how caring or well-prepared, cannot offer, such as home-prepared food and other comforting items from home.

Some hospitals have relied on volunteers to fill this gap during the pandemic, however, these services are reduced because they tend to be retired people so they are part of the Covid-19 at risk population. Some trusts have responded by moving volunteer services to telephone-based communication to continue to support inpatients.

“One thing Covid-19 has done is to remove organisational barriers to implementing and improving technology solutions – something that we hope can continue in the future”

I enjoyed hearing about all the tech solutions my hospital colleagues had implemented to improve patient wellbeing: iPads in cases on trolleys so patients can video call their relatives: media and digital magazines or on demand entertainment to minimise the isolation. One thing Covid-19 has done is to remove organisational barriers to implementing and improving technology solutions – something that we hope can continue in the future.

The unexpected challenges for these innovations were not around hospitals and care settings being able to provide technology, but in the capabilities of the end users (in this case patients) to make use of that technology. While rapid uptake of video conferencing technology has encouraged some trusts to invest in technology that facilitates one click video call, not all technology solutions will help improve emotional wellbeing. It remains vital to focus on patient and person-centric care when procuring or deploying technology – the latest gadgets will do no good at all if they aren’t easy for patients with differing levels of digital confidence to use.

However, I was pleased to hear about small acts of kindness including non-ward staff volunteering as tech support on the wards to troubleshoot issues. Some even went as far as creating individual solutions for patients like building mobile phones for patients with only landline home connections.

During the course of my recent work at the Health Innovation Network, I have also been pleased to see some non tech innovations making a real difference. For example, some PPE-clad clinical staff have started wearing picture name badges that have been making a difference to patients in terms of personal connection. Solutions like these are quick and cost effective to implement, and they help bridge the gap in human connection that COVID has created.

“New technology often feels like it offers shiny solutions to difficult problems, but in the end, it has got to work for patients ”

My colleagues also discussed how uncertainty can lead to poorer patient experience. During Covid-19, technology has really helped to connect multi-disciplinary teams (MDTs) and there could be an opportunity for technology to help inform people about their care and care plans. Being informed about what’s happening with your care and treatment while you are lying in a hospital bed, can certainly help people with their wellbeing, even if there is uncertainty, and could lead to better recovery.

There are clearly benefits from the changes brought by digital that will continue to be sustained post Covid-19, such as the reduced need for travel to hospitals for follow up appointments which help the environment and reduced risk of deterioration through better connected MDTs.

However, patients want to feel at home as much as possible while admitted as inpatients and entertainment is not the only way to make this possible for them. We must not let the momentum slip when it comes to patient communication, and we should maximise the opportunities to present important information straight to patients’ own devices where possible.

When thinking about solutions to improve inpatient isolation and patient experience in the Covid age, the crucial step is speaking to patients themselves. We need to involve patients throughout the process. New technology often feels like it offers shiny solutions to difficult problems, but in the end, it has got to work for patients and resolve challenges they actually experience.

The most important takeaway for me was we can’t forget the personal; people appreciate meaningful contact with humans. Covid has clearly demonstrated that the importance of human face-to-face contact is as true for staff as it is for patients.

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Patient Safety, Healthcare Worker Safety: Two sides of the same coin

Published and last updated by Ayobola Chike-Michael

Ayobola Chike-Michael, Patient Safety Project Manager at the Health Innovation Network (HIN) shares her thoughts on how safe health care workers means safe patients.

Focusing on Healthcare workers

Patient safety is a global health priority that aims to prevent errors and adverse effects to patients associated with health care (WHO, 2020). Exponential medical development has contributed to healthcare becoming more effective and efficient. However, these new technologies, medicines and treatments, also present ‘wicked problems’ that demand unprecedented and multifaceted solutions. The 17 of September every year has been coined as World Patient Safety Day, set to promote patient safety by increasing public awareness and engagement, enhancing global understanding, and working towards solidarity and action.

The theme for this year is ‘Safe health workers, Safe Patients’ placing the spotlight on health care workers. The biggest threat to the world in recent times, particularly this year is Covid-19, a pandemic that turned health care workers worldwide into soldiers fighting at the war front. Covid-19 has so far posed the greatest pressure on health care workers and they have had to face the challenges daily. Most of these issues have always been there, but the pandemic magnified them and demanded more from every health care worker.

Speaking to a friend who has been a nurse for 25 years recently, she recounted how one day at the height of the pandemic, she was kitted up for protection before entering the ‘Covid-19 zone’ at work. She admitted how unprepared she was despite her years of experience.  She had taken one look at the room filled with sick Covid-19 patients on one side and on another noted body bags ready to be filled. In her words, she said, ‘it was really a war, there was no time to make sense of everything going on’. After a couple of hours of caring for sick patients and managing expectations of relatives, she described how she steamed up under the protective personal equipment, dripping uncontrollably with sweat and finally bursting into tears.

Recent research showed that many have also suffered psychological and emotional distress, infections, burnout, uncertainty, moral injury, violence, stigma, depression and even death (WHO 2020 and Only Human report 2020). The pandemic has brought new challenges and new ways of working and we cannot talk about patient safety in 2020 and beyond, without talking about staff safety first.

Nobody should have their safety impacted at work and we certainly cannot look away from the risks presented to health care workers whose place of work this year, has been more like the war front. These workers not only have to provide care through it all, but they also must bear the outcome of their lived experience. They must be looked after well, during and after. A Yoruba proverb says, ‘if you find yourself and your child engulfed in fire, you must dust yourself first before you are able to dust your child’. That is, ‘the instinct in an accident is to protect oneself before the thought of anyone else, even your child.

“Most of these issues have always been there, but the pandemic magnified them and demanded more from every single health care worker.”

The link between patient safety and worker safety

It’s no surprise, therefore, that there is a firm link between patient safety and health worker safety. The safety of both patients and staff are inextricably linked, like two sides of the same coin. They are co-dependent. Staff safety is a prerequisite to patients’ safety. Only a safe health care worker can ensure a safe patient.

Stress is the first culprit that creates burnout among health care workers and has a significant impact on the quality of care given to patients and their overall safety. The top reasons for stress are high workload, long hours, strained interpersonal relationships and lack of teamwork. These and many more cause health care workers to be more prone to errors and experience a decline in their own health. (WHO/IOSH, 2020).

Let us share some other painful facts:

  • Health workers have the highest risk of Covid-19 infections, in fact, 10 per cent of all cases globally are among health workers
  • Between 44 per cent and 83 per cent of nurses in clinical settings in Africa have chronic low back pain
  • Between 17 per cent and 32 per cent of health care workers in high-income countries suffer from occupational burnout
  • Globally, 63 per cent of health workers report experiencing a form of violence at the workplace
  • Medical professions are also at higher risk of suicide in all parts of the world
  • During the Covid-19 pandemic, 23 per cent of front-line health care workers suffered depression and anxiety and 39 per cent suffered insomnia
  • One in three health care workers in high income countries suffer from work-related burnout at the workplace (WHO/IOSH, 2020).

Recommendations for post-covid recovery

Global players such as the United Nations, WHO, International Labour Organisation (ILO) among others have shared some resolutions to take necessary steps to alleviate some of these painful facts at country level. Other organisations are working equally hard regionally and locally. All have committed to scale up efforts to improve and promote healthier and safer workplaces. Further recommendations have also been made to support global advocacy for health care workers’ safety.

A few are:

Part of the journey to recovery from the pandemic is the intentional focus on the safety of health care workers. It is important before, during and after the 17 of September, to promote patient safety particularly by increasing awareness on this year’s focus – health care worker’s safety. No one is excluded in responding to the global call for action to speak up for health care workers safety. It is directed to everyone:  patient, family, carer, health care worker, local and international organisations, policymakers, regulators, administrators, managers, patient representative organisations and academic or research institutions. All hands must be on deck to promote the safety of health workers.

Never again should any health care worker have to work without adequate PPE, never again should any health care worker be overwhelmed with stress, bear the brunt of lack of resources or face avoidable harm for their patients or themselves. As Tedros Adhanom (Director General, WHO) succinctly puts it ‘Together we have a duty to protect those who protect us.’

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Patient safety and experience: our response to Covid-19

Published and last updated by Rahel Gerezgiher

Patient safety and experience: our response to COVID-19

Our Patient Safety and Experience, Healthy Ageing and Digital Transformation Teams have been working in partnership to support our local health and care system response to Covid-19.  Working as part of the NHS National Patient Safety Improvement Programmes, our work over the next six months will focus on the following areas to contribute to the NHS response to Covid-19.

Deterioration

Failure to recognise or act on signs of deterioration can result in missed opportunities to provide necessary care and give patients the best possible chance of survival (Patient Safety Alerts 2016, 2018). This area therefore continues to be a major patient safety priority for the NHS during the Covid-19 outbreak. A good system of managing deterioration includes processes and solutions that enable:

  • Early detection of physical deterioration. This includes a physiology assessment and early warning tools such as soft signs and the NEWS2 score. A growing number of digital solutions to support these processes are also available.
  • An understanding of what is “normal” for a resident.
  • Staff knowing what to do next if a person’s health deteriorates. Agreed escalation processes are required, including end-of-life preferences, advanced care and treatment escalation plans.
  • Staff to effectively communicate their concerns. This includes human factors and structured communication.

We already have a south London managing deterioration improvement programme as part of the national patient safety improvement work. Consequently, our team is contributing to national developments and assisting regional and local efforts aimed at optimising patient outcomes during the pandemic. We are also building connections with a growing number of digital projects aimed at enabling remote assessment and monitoring of patients within the community setting.

Our Programme Director for Patient Safety and Experience, Catherine Dale, is a national co-lead for the Patient Safety Collaboratives on deterioration and was instrumental in the delivery of a very successful national webinar for GPs working hard at the front line to tackle Covid-19.

“High quality, safe care can be achieved through preparation, planning and education; the National Patient Safety Improvement Programme has created this important national program to rapidly develop the skills and knowledge for bedside staff to deliver safe tracheostomy care everywhere.”
Brendan McGrath – National Clinical Advisor for National Patient Safety Improvement Programme Covid-19 Response (Safe Tracheostomy Care); Intensive Care Consultant, Manchester University NHS FT

The team will be very happy to hear from you if you want to know more about any of our projects above or discuss support for your local work, contact hin.southlondon@nhs.net

You can also access nationally available resources and webinars on the AHSN Network Patient Safety COVID-19 webpage here.

Helping break unwelcome news

Published and last updated by Rita Mogaiji

Helping break unwelcome news COVID-19 outbreak

Health Education England has published a set of materials and films which aim to support staff through difficult conversations arising from the Covid-19 outbreak.

The AHSN Network was part of a small group of people that helped pull this resource together in less than two weeks.

The framework includes posters and films based on the evidence base from Real Talk and then filmed with willing volunteers.

You can also follow #UnwelcomeNews on Twitter.

Start here for an introduction to the framework: Discussion of Unwelcome News during the Covid-19 pandemic: a framework for health and social care professionals

You can watch the films here:

  1. The framework
  2. Community
  3. Breaking bad news
  4. Ceilings of treatment

Then access the resources here:

Follow this link for more information on patient safety during Covid-19.

Covid-19: Patient Assessment the role of physiology and oximetry

Published and last updated by Rahel Gerezgiher

COVID-19: Patient Assessment the role of physiology and oximetry

The assessment of patients who are unwell with Covid-19 or other causes presents a significant challenge for GPs and clinicians working in Primary Care. The Royal College of General Practitioners (RCGP) and the AHSN Network are holding a joint webinar looking at the role of oximetry and other physiology in that assessment.

The webinar will be led by:

  • Dr Jonathan Leach, RCGP Honorary Secretary and Covid Lead
  • Dr Alison Tavaré, Primary Care Clinical Lead at West of England AHSN
  • Dr Simon Stockley, RCGP Lead for Acute Deterioration and Sepsis

Overview of content to be explored:

  • Clinical features of Covid-19
  • Importance of oximetry in Covid
  • Clinical judgement and physiology in Patient assessment
  • Role of NEWS2 in General Practice and Care Homes
  • Remote oximetry in the assessment and management of Covid disease in the community
  • This will be followed by a Q and A session.

The webinar will be held on Wednesday 29 April, 13.30 – 14.30pm and you can register here. The webinar will be recorded and shared afterwards.

Creating waves across the Pond

Published and last updated by Rahel Gerezgiher

Creating waves across the Pond

Written by Catherine Dale, Programme Director – Patient Safety and Experience.

My friend gave the opening keynote speech at this month’s Institute for Healthcare Improvement (IHI) National Forum in Orlando, Florida. I was moved to tears in the audience watching her.

I got to know Tiffany Christensen this April when we both taught on the IHI’s inaugural Co-Design college in Boston, Massachusetts. I was teaching the Experience-Based Co-Design approach. Tiffany shared her insights both as a life-long cystic fibrosis patient and as a professional patient advocate with a working career in healthcare improvement.

Tiffany spoke of contending with a double lung transplant which was unsuccessful, meaning she was facing imminent death. When offered a second double lung transplant, Tiffany was initially completely thrown as she had accepted the fact that she was going to die. Being offered another chance of life was an enormous challenge to her, but in coming through that experience Tiffany chose to dedicate her working life to enhancing healthcare for others. She joined a Patient and Family Advisory Council – a core part of healthcare structure in the USA – and trained in improvement methods.

When we met at the Co-Design college, she was struck by the way that Experience-Based Co-Design enables patients to have a more active and influential role in improving healthcare. This reminded me that when ‘patient involvement’ became a buzz phrase in the NHS in the early 2000s I had often wondered ‘involvement in what?’ you can’t just be ‘involved’ without context or purpose. For me the most compelling area for patients to be involved in is improving and re-designing healthcare. I am biased as this is the field of work I have devoted myself to for the past decade and a half. But I find it so rewarding that I want to provide others with that same opportunity – hence training people in Experience-Based Co-Design every chance I get!

Tiffany and I delivered a workshop ‘Co-design is Caring: Experience Meets Experience’ at the IHI National Forum with Andrea Werner from Bellin Health in Wisconsin. The participants were extremely enthusiastic about the approach. One tweeted “It was amazing! It’s all about the ‘we’ not ‘me’ – value and include the voice and experience of patients!”

It was fantastic to have this opportunity to share and encourage co-design between staff and patients. So I was incredibly proud that ‘co-design’ was a core message in the keynote discussion between Tiffany, Derek Feeley and Dr Rana Awdish

When Tiffany gave her closing thought in her keynote I found myself gently weeping: we should not consider our efforts to improve healthcare to be drops in the ocean, every one of us is a ripple and we don’t know how far that ripple will have an effect.

If, like Derek Feeley, CEO of IHI, you would like to see healthcare evolve from patient-centred care to partnership with patients you can start here or contact me for further encouragement. If we add all our ripples together we will create waves.

Pictured above: Tiffany Christensen (left) and Catherine Dale (right)

Note: Many thanks to the Point of Care Foundation, IHI and the Health Innovation Network for enabling me to attend the IHI National Forum in December 2017.