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Ongoing Projects

NIHR King's Patient Safety and Service Quality Research Centre

Investigators: M.Lowe-Lowrie*, N.Fulop, M.Clarke, D.Guest, J.Sandall.
Project Funding: National Institute for Health Research Patient Safety Research Centre Funding.
Research staff: Nicola Mackintosh, Kathryn Ehrich, Luke Cowie

King's Patient Safety & Service Quality Research Centre is funded by the National Institute for Health Research (NIHRThe Centre brings together NHS professionals with academic experts from a wide range of backgrounds, including management and the social sciences, to focus on investigating ways to improve the care of patients. The Innovations Programme looks at both the translation of novel technologies into health care and innovative ways of organising service delivery differently to bridge ‘gaps’ in care and improve quality and safety for patients. We draw upon social science perspectives provide a greater understanding of the nature of innovation with a view to informing ongoing safety and quality activities by a range of stakeholders. 

Theme 1 Improving Patient Journeys Through and Across Care Systems 

A key issue in distributed care systems is how latent risk and escalation of care for deterioration in the patient condition are managed at a professional/patient interface and at an organisational level. We focus on the how services are organised and what happens within them. 

Managing complications in medicine and maternity and the implementation of patient safety tools and strategies on the frontline 
We aim to explore how patient safety strategies and tools (designed to facilitate the management of deterioration and escalation of care) are implemented and assimilated into the workplace  in two different settings (intra-partum and medical care). We explore which contextual features facilitate ‘mindful’ application of these tools in order to develop and test a best practice model of ‘what works in what circumstances’ and To explore patient experience and potential contribution to patient safety. This is a two year study in four wards (2 medicine and 2 maternity) in two Foundation Trusts, involving ethnography and evaluation of implementation.

Publications
Mackintosh,N. Finlay,S. (2008) Failure to rescue: Problems and Solutions, Working Paper, NIHR King's Patient Safety and Service Quality Research Centre, http://www.kingspssq.org.uk/programmes/innovations/failure-to-rescue-problems-and-solutions/

Sandall J, Morton C, Bick D. (2010) Safety in childbirth and the three 'C's: Community, context and culture, Midwifery, 26, 481-482.

Mackintosh, N. & Sandall, J. (2010) Intelligent Assessment Tools in Healthcare: technological fix or the potential for unintended consequences? Special Issue on Close Calls, near misses and early warnings, CARR Centre for Risk & Regulation, London School Economics.

Mackintosh,N. Rainey,H. Sandall,J. (2010) Managing Complications in Maternity And Acute Medicine, Report to King’s Health Partners, PSSQ.

Mackintosh, N. & Sandall, J. (in press-0nline) Overcoming gendered and professional hierarchies in order to facilitate escalation of care in emergency situations: The role of standardised communication tools, Social Science and Medicine.

Theme 2 Innovative Service Delivery Models 

As the provision of health care becomes increasingly complex across a range settings and healthcare providers, there is evidence that failures in referral and handover affect patient safety and quality, particularly where critical incidents are frequent. This fragmented and distributed nature of healthcare leads to disadvantaged populations falling through gaps in services. 

Impact of new service delivery models on Safety and Quality in Maternal Health Care : Cochrane Review of Midwife-led care 
Midwives are primary providers of care for childbearing women around the world. However, there is a lack of synthesised information to establish whether there are differences in morbidity and mortality, effectiveness and psychosocial outcomes between midwife-led and other models of care. This review compares midwife-led models of care with other models of care for childbearing women and their infants. Findings have informed Midwifery 20/20 and maternity policy in USA, Australia and Brazil.

Publications
Hatem M, Sandall, J. (Joint First Author and Contact Author) Devane D, Soltani H. Gates,S. (2008) Midwife-led versus other models of care for childbearing women, Cochrane Database of Systematic Reviews 2008, Issue 4. Art. No: CD004667. DOI: 10.1002/14651858.CD004667.pub2.

Sandall J. (2008) Midwife-led versus other models of care for childbearing women: implications of findings from a Cochrane meta-analysis. Evidence Based Midwifery 6(4): 111.

Hatem M, Sandall, J. (Joint First Author and Contact Author) Devane D, Soltani H. Gates,S (2009) Comparaison des modèles de soins obstétricaux dirigés par les sages-femmes à d'autres modèles de soins offerts aux femmes enceintes: une revue systématique Cochrane, Pratiques et organisation des soins, 2009, vol. 40, no4, pp. 267-274.

Sandall,J., Hatem.M., Devane,D., Soltani,H., Gates,S. (2009) Discussion of findings from a Cochrane Review of midwife-led versus other models of care for childbearing women, Midwifery, 25, 8-13, doi:10.1016/j.midw.2008.12.002
 “article most likely to change clinical practice” and has been summarized in the DynaMed Weekly Update 270109. Hatem M, Sandall, J. (Joint First Author and Contact Author) Devane D, Soltani H. Gates,S. (2008) Midwife-led versus other models of care for childbearing women, Cochrane Database of Systematic Reviews 2008, Issue 4. Art. No: CD004667. DOI: 10.1002/14651858.CD004667.pub2.

Sandall,J. Devane,D. Soltani,H. Hatem,M. Gates,S. (2010) Improving Quality and Safety in Maternity Care: The Contribution of Midwife-Led Care, Journal of Midwifery and Women’s Health, Vol. 55, Issue 3, Pages 255-261.

Theme 3 Assessing the Impact of Innovative Health Technologies

The advancement of medical care is, in large part, driven by clinicians and patients who, respectively, develop and undergo novel healthcare technologies. However, as such technologies develop and are translated into mainstream clinical care, their short and long-term safety can be hard to gauge.

Managing technique-centred innovations in healthcare and impact of safety and quality of care including patient experience In order to better understand the safety and quality of such innovations, this project explores the development, diffusion, governance and impact of technique-centred innovations at Trust level. The findings from this study will both contribute to the theoretical discussions surrounding the development and translation of technique-centred innovation in healthcare, and provide the basis for developing a best practice model for its assessment and governance. 

Publications
Finlay,S. Sandall,J. (2009) Balancing Innovation and safety, NIHR PSSQ Working Paper, http://www.kingspssq.org.uk/programmes/innovations/failure-to-rescue-problems-and-solutions/

Finlay,S. Sandall,J. (2009) Assessing the safety, quality, and patient experience of technique-centred innovations in healthcare, Report to the King’s College Hospital, PSSQ.
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