Sandwell and West Birmingham hospitals NHS trust: technology innovation award runner-up

Dr Matthew Lewis (far right) takes part in an electronic board round with his team.

Sandwell and West Birmingham hospitals NHS trust's established electronic bed management system (eBMS), which runs across its three acute hospitals, was expanded to help reduce bed-blocking and improve the quality of patient care.

The system can track a patient from admission to an acute medical unit until they are discharged to go home and keeps a log of the care they receive along the way.

Dr Matthew Lewis is the trust's group director for medicine and emergency care and a consultant in gastroenterology. He says: "At an individual patient level it's a single tool which enables us to co-ordinate the care we provide in different teams both inside and outside the hospital."

The eBMS, says Lewis, has become "the centrepiece of an electronic board round", where every day a ward's multi-disciplinary team will refer to the system to discuss a patient's progress and his or her readiness to go home.

The eBMS has other benefits too. "On a different level, it is also used as a way for us to look at the [bed] capacity issue. It means at any one time we can see whether we are on track or not," he says.

The eBMS has real-time operational dashboards, which track variations in patient flow, showing any reduction in length of stay, bed turnover intervals and delayed discharge. "The dashboards allow key staff to monitor at ward level any specific area of patient care during the inpatient stay which will cause a queue," says Lewis.

eBMS also includes 44 manual flags that can be applied to highlight a clinical patient alert and another 37 clinical alert flags are automatically triggered via electronic messaging from the hospital's other IT systems. These alerts are passed on to doctors via text, email, dashboard or bleep.

Lewis adds: "The combined functionality of patient-flow tracking, coupled with the many alerts and flags, enables the clinicians to have up-to-date information in real time to enable them to make informed clinical decisions quickly, that not only saves lives but improves the overall experience of patients during their inpatient stay."

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Sussex partnership NHS trust: winner, hospital admissions award

Dr Lisa Page says the way the trust uses mental health triage nurses is unique. Photograph: Sussex Partnership NHS Trust

A year ago people with mental health problems turning up at A&E in Brighton often had to wait four hours to be seen. Around 12% of patients would get fed up waiting and leave; those who were prepared to sit it out frequently ended up being inappropriately admitted to the hospital's observation ward, where they stayed until being assessed by the specialist mental health team.

But today, the number of patients with mental health problems being admitted to the observation ward at the Royal Sussex county hospital through A&E has dropped by 50%. More than 85% of patients are seen and assessed by the mental health team within four hours. Anybody turning up and A&E with a mental health problem is automatically referred to a specialist mental health triage nurse within an hour – something which Dr Lisa Page, consultant in liaison psychiatry at Sussex partnership NHS trust, says is unique. "I don't know of any other hospital which uses the triage nurse in the way that we do, although others do have proactive teams in A&E."

The improvement in waiting times and the introduction of the mental health triage nurse is part of the Brighton Urgent Response Service (Burs), which was introduced in January to tackle the 30% year-on-year rise in unscheduled mental health attendances at the East Sussex seaside town's A&E.

Page says the reduction in observation ward admissions is good news for patients and A&E staff but also for the clinical commissioning group (CCG) because of the high tariff associated with this kind of admission. "That is where the savings are coming from as we are no longer having that large number of patients admitted," she says.

Burs, set up by Sussex partnership NHS trust in collaboration with Brighton CCG and the acute trust, also includes a 24-hour urgent phone line for GPs, mental health patients and carers who are new to the system. GPs can book a patient a next-day appointment at the mental health clinic – rather than the previous minimum five-day referral. Patients and carers are offered telephone advice from a Burs practitioner and are referred as necessary. A dedicated mental health nurse is also available in the community between 8am and 8pm Monday to Friday and from 8am to 6pm at weekends. A new waiting room for people with mental health problems, which provides a calm and quiet environment has also been established at the Royal Sussex as part of the scheme.

Page says her mental health team is busier than ever and that it is too soon to say whether the number of people turning up at A&E has pulled back from its 30% year-on-year rise. But she feels Burs is ensuring that people are seen more appropriately and more quickly. She says: "Referrals to our team have gone up by a third because we are now seeing people who in the past would have come to A&E and left. We haven't curtailed the 30% but we have made some inroads – it would have been even busier without Burs."

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Southern health NHS foundation trust: winner, leadership award

Clinical psychologist Claire Corbridge brainstorming examples of how to deliver integration at a Going Viral session. Photograph: Southern health foundation trust

Southern health NHS foundation trust is one of the largest mental health and learning disability trusts in England. It has a staff of 9,000 working across 150 sites, spanning five counties and was created following the merger of Hampshire partnership NHS foundation trust and Hampshire community healthcare NHS trust in 2011.

A key challenge for the new trust was how to ensure that everybody felt part of the same organisation and shared the same values, behaviours and goals. Part of the solution was its Going Viral leadership development programme which, since its launch in June last year, has coached, developed and supported 550 staff. Another 240 will join the programme this autumn.

Richard House, interim head of leadership and management development, says Going Viral has its roots in the trust's organisational and people development strategies which define the attitudes, values and behaviours expected from its workforce in achieving its core aims. He says: "The NHS Constitution goes some way towards doing that but it isn't specific about behavioural expectations."

The Going Viral programme has three modules that tie in with the trust's core objectives – how to redesign services to improve quality and provide better value for money; how to integrate health and social care with partners and how to provide better outcomes and experiences for patients. The course, which takes place over six months, is delivered in nine-and-a-half day sessions. The learning groups are deliberately made up of staff from different departments so they can develop together.

House says the programme is different from others because it does not select employees according to their NHS banding, but by the amount of influence and responsibility they have. He says: "We have tried to include people, not by their pay band or whether they have management responsibility, but by how influential they are in their multi-disciplinary team. For example, a consultant physician who is only responsible for him or herself."

The programme was introduced before the publication this February of the damning Francis report into the Mid Staffordshire NHS foundation trust.

That report identified how an "insidious negative culture" and "disengagement from managerial and leadership responsibilities" contributed to Mid Staffs' failings. Going Viral, says House, is confronting those leadership challenges identified by Francis.

He says: "I think people feel more listened to and empowered and involved in the processes and realise what is expected of them. It's been transformational for people. One medic said to me 'I wanted to hate the programme and went in with that attitude; but I realise now it was one of the best learning opportunities I have ever had.'"

Health Education England and other trusts from around the country have already taken an interest in Going Viral. The trust, which has its headquarters in Southampton, is organising an open event for later this autumn about the leadership programme and how it fits into its organisational development work. House says: "This is too important not to share with others – to enable them to take on this grand scale change."

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Portsmouth hospitals NHS trust: hospital admissions award runner-up

An initiative by the diabetes inpatient team has cut hypoglycaemic episode admissions by nearly 20%. Photograph: Portsmouth hospitals NHS trust

A hospital has seen a 33% drop in the number of diabetes patients calling 999 or turning up at A&E following a hypoglycaemic episode, while admissions fell by nearly 20% following an initiative that helps patients manage their care better and educates GPs about best practice.

The diabetes inpatient team at Portsmouth hospitals NHS trust wanted to tackle the recurring number of diabetes patients being admitted to hospital following a hypoglycaemic event.

It decided that a diabetes consultant and specialist nurse would visit every GP practice in the district twice a year to discuss diabetes management and spread best practice. Educational events were also held at local nursing and residential homes to help improve diabetes management.

A new telephone hotline was set up with South Central Ambulance Service for paramedics to call the hospital inpatient team if they had treated a hypoglycaemic patient. That patient would then be contacted by the team within 24 hours.

Any diabetic patient admitted to hospital following a hypoglycaemic event was given advice about managing their care to prevent another attack.

After the project was launched, the number of hypoglycaemic people arriving at A&E or being seen by a paramedic between November 2011 and November 2012 was 83 – a drop of 33% compared to the previous 12 months. During the same period the number of hospital admissions fell by nearly 20% from 85 to 63.

Dr Partha Kar, the trust's diabetes clinical director, says: "As far as we are aware our pathway is the first to show discernible benefits of hypoglycaemic admissions thereby showcasing how a simple innovative approach can help patient care. The pathway can achieve little unless dovetailed with educational support for primary care which has formed the crux of the local model of diabetes care."

The initiative is part of the trust's Super Six Diabetes model of care designed to move more care away from hospital into the community.

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National blood service, Oxford University hospitals NHS trust: technology innovation award runner-up

Oxford University hospitals NHS trust uses handheld computers at the bedside to scan the identity barcode on a patient's wrist band.

Introducing an identity barcode on a patient's wrist band, using handheld computers at the bedside, electronically controlling the temperature of blood fridges and tracking stock have improved patient safety Oxford University hospitals NHS trust's national blood trust and saved £528,000.

The trust wanted to reorganise its bedside and laboratory transfusion service in order to reduce the number of deaths from "wrong transfusion" – the second most frequent cause of death from transfusion reported to the UK's serious hazards transfusions scheme. In the past 15 years, errors in the UK transfusion service were responsible for 27 deaths and 120 cases of major morbidity.

Oxford hoped that by using technology it would also reduce the amount of time staff spent checking blood, reduce blood wastage and the inappropriate use of supplies, as well as speed up the supply of blood in emergencies.

Consultant haematologist professor Michael Murphy says: "For many members of the public or patients to think a process that is so important is relying on bits of paper and people looking at long numbers, is just unbelievable."

Today transfusion patients are identified by a barcode on their wrist band, which is scanned by a nurse at the bedside using a handheld computer. The nurse also scans his or her own barcode before following the transfusion process written on the computer screen.

There is now a complete electronic audit trail of blood supplies after the blood bank IT system was linked to others in the trust, which has led to significant improvements in blood sample collection, the collection of supplies from fridges and the transfusion-related admin.

Paperwork has been cut by 52 minutes per patient and the bedside transfusion process now requires one nurse instead of two. The initiative is recognised as an exemplar NHS evidence, quality, innovation, prevention and productivity project. The Oxford team wrote a national specification for the electronic transfusion service for the former National Patient Safety Agency.

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Southerners are less trusting, but people who trust are more likely to cooperate to save the environment, baylor study shows

Main Category: Water - Air Quality / Agriculture
Also Included In: Psychology / Psychiatry
Article Date: 03 Aug 2013 - 0:00 PDT Current ratings for:
Southerners are less trusting, but people who trust are more likely to cooperate to save the environment, baylor study shows

Southerners are generally not as trusting as people who live in other parts of the country, but trusting people are more likely to cooperate in recycling, buying green products and conserving water, a new Baylor University study on environmental protection shows.

"A lot of researchers have reported trust as kind of a cure-all for protecting the environment through cooperation. Southerners are just as willing, but less trusting," said lead author Kyle Irwin, Ph.D., an assistant professor in Baylor's College of Arts & Sciences.

"The question our study raised was that if trust isn't a catalyst for environmental cooperation for Southerners, what is?"

The study, published in The Sociological Quarterly, was based on analysis of a data sample of 650 respondents - 238 of them Southerners - from the 2010 General Social Survey, Irwin said. "The South" as defined by the U.S. Census Bureau includes 16 states (listed below) and Washington D.C.

Previous studies by other researchers have shown that trust is important in working together to protect the environment, but the study by Irwin and co-researcher Nick Berigan, Ph.D., a visiting assistant professor at East Tennessee State University, is the first to look at cultural factors, Irwin said.

"Southerners are relatively close-knit and interact within small and dense networks," he said. "Social spheres often overlap: People that work together may go to church together, attend sports events for their kids. This type of network often produces a lot of solidarity and trust within the 'in group,' but distrust toward outsiders."

Compared to Southerners, non-Southerners have a large number of weak and transient friendships. Social networks in the non-South are considered individualistic, and that promotes trust of people who might be considered outsiders, he said.

"There's been a slew of research on the relationship between trust and environmental protection," Irwin said. "The more trust people have, the more willing they are to make sacrifices to hold up their end to solve problems."

But Southerners' cooperation in pro-environment efforts does not hinge on trust as much as non-Southerners' cooperation does.

The new study measured trust with the question of "Generally speaking, would you say that most people can be trusted, or that you can't be too careful in dealing with people?" Among Southern respondents, 24.9 percent of respondents trusted others; 38.7 of non-Southern respondents did so.

The study shows that political views and education are associated with cooperation in the South, with Democrats more willing to make cuts in living standards and more educated people more willing to pay higher taxes to help protect the environment. Also in the South, confidence in the government was associated with greater willingness to pay higher taxes.

Irwin said that further study is needed to draw firm conclusions, but the research suggests that pro-environmental efforts in the South might target Republicans by assuring them that long-term benefits of conservation outweigh short-term costs and are consistent with their values, rather than mandated by those with liberal political views.

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
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*States listed as Southern by the U.S. Census Bureau include Alabama, Arkansas, Delaware, Florida, Georgia, Kentucky, Louisiana, Maryland, Mississippi, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Virginia and West Virginia. Washington, D.C. also is included.

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People likely to safeguard common goods when they trust in leaders, have a sense of belonging

Main Category: Psychology / Psychiatry
Also Included In: Public Health
Article Date: 28 Jul 2013 - 0:00 PDT Current ratings for:
People likely to safeguard common goods when they trust in leaders, have a sense of belonging

Every day, people donate to charities, volunteer to clean up city parks, or scale back their driving to curb air pollution. But some take these public goods for granted and ride free on the efforts of others. They watch public television but never make a donation to fund it. Or they run their lawn sprinklers during a drought while their neighbors follow government pleas to limit water consumption.

A new report in Psychological Science in the Public Interest, a journal of the Association for Psychological Science, examines more than 25 years' worth of studies on the use and support of public goods ranging from radio broadcasts to drinking water. Psychological researcher Craig Parks (Washington State University, Pullman) and his co-authors emphasize the urgent need to broaden thoughtful use of public goods, noting that charitable contributions are at historic lows, fossil fuel reserves are shrinking, and climate change threatens the planet's future.

In the report, the researchers discuss a variety of scientific findings on conditions that foster cooperative use of common resources, including:

Strong group identity

People are more likely to act cooperatively when they have a strong sense of belonging to a collective. A 2003 European study showed that fishermen who were strongly connected in their communities were more judicious with fishing stocks than were their counterparts in more loosely connected communities.

Smaller community size

Cooperation is likely to be stronger in smaller groups, particularly when one's contribution is easily identified. Psychological research suggests that cooperation decreases in large groups because people feel less influential, less identifiable, and less responsible for the group's welfare.

High trust in leaders

Citizens are more willing to help out in urgent situations when their government leaders act in transparent and trustworthy ways. A study of people's behavior during a 1991 water shortage in California showed that residents exercised more constraint on their water consumption if they felt local authorities were rationing water fairly.

The article also cites factors that lead to incongruous use of resources, including:

Intergroup conflicts

People often try to prevent those in an opposing group from benefiting from a good or resource in order to advance their own groups' interests. Parks and his co-authors cite as an example the 2011 debate in the U.S. Congress over the nation's debt ceiling. The Obama administration wanted to raise the debt ceiling to support such public goods as Social Security and the military. Republicans who fought the increase drew anger from many Americans, but in doing so helped enhance the GOP's reputation as a party of fiscal watchdogs.

Ideology/values

Individuals may withhold support for a public good that they see as useless or objectionable. Examples of this are environmentalists who fight a highway expansion, or political conservatives who reject public radio as too left-leaning.

Cognitive disconnection

Threats to some common resources are so vast or abstract that people struggle to comprehend the consequences. The most salient example is people's struggle to envision the impact that climate change will have on future generations.

Parks and his colleagues propose some policy steps that could promote better care of public resources. Research shows, for example, that people tend to act for the benefit of those who are powerless or helpless. Framing future generations in that light (e.g., talking about the more-hostile climate that we stand to leave for our great-grandchildren) can spark people today to be more diligent about reducing their carbon footprint, they suggest.

The researchers also argue that policymakers, in promoting optimal use of public goods, must concentrate on building the public's trust in order to garner cooperation.

"Sincere and concerted attempts to collect public input and a general 'let's work together' approach will do much to enhance group identity," they write. "Toleration of a certain amount of deviation from policy, at least in the early stages of implementation, will show that policy makers are forgiving. And last, a policy that gives citizens more than they might have expected - a more well-developed public good and broader access to it - will convey an image of generosity."

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
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Co-authors on the article are Jeff Joireman of Washington State University, Pullman, and Paul A.M. Van Lange of Vrije Universiteit, Amsterdam.

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