Clinical outcomes, quality improvement and professional recertification: lessons from UK cardiac surgery

2010 ◽  
Vol 92 (5) ◽  
pp. 168-169
Author(s):  
Ben Bridgewater ◽  
Owen Nicholas ◽  
Leslie Hamilton ◽  
Graham Cooper
Keyword(s):  
Cardiac Surgery ◽  
Quality Improvement ◽  
Clinical Outcomes ◽  
Healthcare Professionals ◽  
Care Quality ◽  
Published Data ◽  
Form Part ◽  
Care Quality Commission ◽  
The Uk ◽  
Cardiac Surgeons

At the time of writing this paper, mortality outcomes for cardiac surgeons in the UK are being updated on the Care Quality Commission (CQC) website. The initial clamour for results to become available followed events in paediatric cardiac surgery at Bristol and recommendations from the subsequent inquiry (see http://www.bristol-inquiry.org.uk/). A decade later these published data remain unique in British medicine. More recently legislation was introduced to regulate healthcare professionals and outcomes data will form part of the evidence required. What are the lessons from cardiac surgery?

scholarly journals What Does a Systems Approach to Quality Improvement Look Like in Practice?

2022 ◽  
Vol 19 (2) ◽  
pp. 747
Author(s):  
Sharon J. Williams ◽  
Stephanie Best
Keyword(s):  
Quality Improvement ◽  
Systems Approach ◽  
Secondary Data ◽  
Healthcare Systems ◽  
Care Quality ◽  
Secondary Case ◽  
Care Quality Commission ◽  
Leadership Structure ◽  
The Uk

Universally improving healthcare systems is difficult to achieve in practice with organisations implementing a range of quality improvement (QI) approaches, in varying and changing contexts, and efforts ranging from project-based improvements to whole system change. This study aimed to identify how organisations overcome the challenges to improving the quality of the services they deliver. Drawing on the eight challenges from the ‘Quality and Safety in Europe by Research (QUASER) hospital guide, we assessed eight cases reported by the UK-based regulator Care Quality Commission as improving their performance. A thematic analysis of these secondary data established that all eight challenges had been addressed or considered in varying degrees. Education and physical and technological challenges seemed less prominent than developments made to address other challenges such as developing leadership, structure, and culture to support improving quality. This paper relies on the analysis of secondary case data and one framework to assess improvement efforts. Further research is required to consider other models and frameworks and to collate longitudinal data to capture the dynamics and increasing the maturity of improving healthcare systems in practice.

scholarly journals Outcomes: the Battle for Hearts and Minds

2011 ◽  
Vol 93 (7) ◽  
pp. 238-240
Author(s):  
Ben Bridgewater
Keyword(s):  
Hospital Mortality ◽  
Clinical Outcomes ◽  
Care Quality ◽  
Operative Risk ◽  
Care Quality Commission ◽  
Comparative Results ◽  
The Uk ◽  
Hearts And Minds

The cardiac surgical community in the UK has been at the forefront of collecting, analysing and publishing clinical outcomes. The outcome we have focused on is post-operative, risk-adjusted, in-hospital mortality, and comparative results for hospitals and the majority of surgeons have been published through the Care Quality Commission website since 2005.

Do we need medical leadership or medical engagement?

2015 ◽  
Vol 28 (3) ◽  
pp. 173-184 ◽  
Author(s):  
Peter Spurgeon ◽  
Paul Long ◽  
John Clark ◽  
Frank Daly
Keyword(s):  
Care Quality ◽  
Current Evidence ◽  
Organisational Performance ◽  
Content Type ◽  
Care Quality Commission ◽  
The Uk ◽  
Medical Leadership ◽  
First Time ◽  
Practical Implications ◽  
A Current

Purpose – The purpose of this paper is to address issues of medical leadership within health systems and to clarify the associated conceptual issues, for example, leadership versus management and medical versus clinical leadership. However, its principle contribution is to raise the issue of the purpose or outcome of medical leadership, and, in this respect, it argues that it is to promote medical engagement. Design/methodology/approach – The approach is to provide evidence, both from the literature and empirically, to suggest that enhanced medical engagement leads to improved organisational performance and, in doing so, to review the associated concepts. Findings – Building on current evidence from the UK and Australia, the authors strengthen previous findings that effective medical leadership underpins the effective organisational performance. Research limitations/implications – There is a current imbalance between the size of the databases on medical engagement between the UK (very large) and Australia (small but developing). Practical implications – The authors aim to equip medical leaders with the appropriate skill set to promote and enhance greater medical engagement. The focus of leaders in organisations should be in creating a culture that fosters and supports medical engagement. Social implications – This paper provides empowerment of medical professionals to have greater influence in the running of the organisation in which they deliver care. Originality/value – The paper contains, for the first time, linked performance data from the Care Quality Commission in the UK and from Australia with the new set of medical engagement findings.

scholarly journals Costs of postoperative morbidity following paediatric cardiac surgery: observational study

2020 ◽  
Vol 105 (11) ◽  
pp. 1068-1074 ◽  
Author(s):  
Emma Hudson ◽  
Katherine Brown ◽  
Christina Pagel ◽  
Jo Wray ◽  
David Barron ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Cohort Study ◽  
Health Service ◽  
Financial Burden ◽  
Hospital Costs ◽  
Incidence Rates ◽  
Care Quality ◽  
Patient Costs ◽  
Paediatric Cardiac Surgery ◽  
The Uk

ObjectiveEarly mortality rates for paediatric cardiac surgery have fallen due to advancements in care. Alternative indicators of care quality are needed. Postoperative morbidities are of particular interest. However, while health impacts have been reported, associated costs are unknown. Our objective was to calculate the costs of postoperative morbidities following paediatric cardiac surgery.DesignTwo methods of data collection were integrated into the main study: (1) case-matched cohort study of children with and without predetermined morbidities; (2) incidence rates of morbidity, measured prospectively.SettingFive specialist paediatric cardiac surgery centres, accounting for half of UK patients.PatientsCohort study included 666 children (340 with morbidities). Incidence rates were measured in 3090 consecutive procedures.MethodsRisk-adjusted regression modelling to determine marginal effects of morbidities on per-patient costs. Calculation of costs for hospital providers according to incidence rates. Extrapolation using mandatory audit data to report annual financial burden for the health service.Outcome measuresImpact of postoperative morbidities on per-patient costs, hospital costs and UK health service costs.ResultsSeven of the 10 morbidity categories resulted in significant costs, with mean (95% CI) additional costs ranging from £7483 (£3–£17 289) to £66 784 (£40 609–£103 539) per patient. On average all morbidities combined increased hospital costs by 22.3%. Total burden to the UK health service exceeded £21 million each year.ConclusionPostoperative morbidities are associated with a significant financial burden. Our findings could aid clinical teams and hospital providers to account for costs and contextualise quality improvement initiatives.

How do explicitly stated hospital trust values relate to their CQC ratings?

BMJ Leader ◽  
2018 ◽  
Vol 2 (2) ◽  
pp. 68-70
Author(s):  
Nathan Hamnett ◽  
Naomi Patel ◽  
Kathryn Nelson ◽  
Tom Harrison ◽  
Nicholas White
Keyword(s):  
Quality Improvement ◽  
National Health Service ◽  
Health Service ◽  
Service Delivery ◽  
National Health ◽  
Care Quality ◽  
A Value ◽  
Care Quality Commission ◽  
Organisational Values ◽  
Range Of Values

IntroductionFor National Health Service(NHS) Trusts in the process of setting internal organisational values, it would be useful to see if there was a correlation between certain organisational values and Care Quality Commission (CQC) ratings to enable quality improvement.MethodsTo examine this, we identified the CQC ratings of the NHS England provider trusts and identified and listed the trust’s values. These values were then categorised and a comparison made of well-performing and underperforming trusts.ResultsA total of 43 different values were identified, with a total of 800 values being used across all 188 trusts. In the reviewed hospitals, a broad range of values were found with some not meeting common definitions of what a value is. All trusts included some aspect of behaviour in their values.ConclusionWell-performing hospitals are more likely to be open and honest with aspirational values, whereas those which are not are more likely to be focused on day to day service delivery with operational or proscriptive values. There was considerable variation from the published NHS constitution values with outstanding and good trusts having more variance from the values in the NHS constitution than trusts rated requiring improvement or inadequate.

P0773ESTIMATING THE BURDEN OF CHRONIC KIDNEY DISEASE (CKD) IN THE UK: COMPARISON OF TWO HEALTH ECONOMIC POLICY ANALYSIS METHODS

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Juan Jose Garcia Sanchez ◽  
Michael Xu ◽  
Elisabeth Sörstadius ◽  
Oliver Darlington ◽  
Phil McEwan ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Health Economic ◽  
Economic Policy ◽  
Kidney Disease ◽  
Disease Progression ◽  
Clinical Outcomes ◽  
Published Data ◽  
The Future ◽  
The Uk ◽  
Analytical Approaches

Abstract Background and Aims Chronic kidney disease (CKD) represents an important health policy concern due to a growing population and its associated morbidity and mortality. Predicting the future burden of CKD overall and in high-risk populations such as patients with elevated albuminuria, type 2 diabetes (T2D) or heart failure (HF) is important if healthcare services are to be resourced properly. Health economic policy models based on epidemiological and clinical outcomes data provide a useful way by which to make such predictions; different methods of varying complexity have been employed to do this. This study aims to compare two different analytical approaches to estimating the burden of CKD in the UK, and to estimate how this is predicted to change in the future. Method Analysis 1 and 2 characterised the prevalent and incident CKD population, disease progression, clinical outcomes, costs and quality of life sourced from published data over a 5-year horizon. Analysis 1 utilised an open cohort analysis based on a Markov framework, with health states defined by CKD stages. Disease progression was modelled through the application of published estimates of the rate of estimated glomerular filtration rate (eGFR) decline, stratified by the presence of T2D, HF and albuminuria. Results Conclusion

How psychiatric in-patient care for people with learning disabilities is transforming after Winterbourne View

2014 ◽  
Vol 19 (3) ◽  
pp. 146-149 ◽  
Author(s):  
Gyles Glover ◽  
Ian Brown ◽  
Chris Hatton
Keyword(s):  
Learning Disabilities ◽  
Design Methodology ◽  
Psychiatric Care ◽  
Care Quality ◽  
Published Data ◽  
Content Type ◽  
Care Quality Commission ◽  
Future Care ◽  
Shed Light

Purpose – Two censuses, from 2010 and 2013, respectively, shed light on the trend in use of in-patient psychiatric care for people with learning disability or autism following the BBC documentary exposing abuse of patients at Winterbourne View. The purpose of this paper is to consider the implications of the detailed trends for future care for this group. Design/methodology/approach – Published data from a recent (September 2013) census are compared with the re-analysis of a census undertaken by the Care Quality Commission in March 2010. Findings – An overall 35 per cent reduction in numbers of in-patients is made up of larger falls in groups generally easier to discharge (older, female, in general as opposed to secure units). There is also substantial variation around the country. Research limitations/implications – There are some uncertainties about the comparability of the two censuses and the question of how complete enumeration was of people with learning disabilities in general mental illness beds. Originality/value – The paper raise the question of whether the beds that are reducing fastest may be those most likely to be of value to a high quality and sustainable service in the long term.

An objective assessment of safety to drive in an upper limb cast

2012 ◽  
Vol 38 (3) ◽  
pp. 321-324 ◽  
Author(s):  
H. L. Stevenson ◽  
N. Peterson ◽  
C. Talbot ◽  
S. Dalal ◽  
A. C. Watts ◽  
...  
Keyword(s):  
Upper Limb ◽  
Healthcare Professionals ◽  
Objective Assessment ◽  
Insurance Companies ◽  
Published Data ◽  
Cast Immobilization ◽  
Different Types ◽  
Left And Right ◽  
The Uk ◽  
Evidence Based Guidelines

Patients managed with upper limb cast immobilization often seek advice about driving. There is very little published data to assist in decision making, and advice given varies between healthcare professionals. There are no specific guidelines available from the UK Drivers and Vehicles Licensing Agency, police, or insurance companies. Evidence-based guidelines would enable clinicians to standardize the advice given to patients. Six individuals (three male, three female; mean age 36 years, range 27–43 years) were assessed by a mobility occupational therapist and driving standards agency examiner while completing a formal driving test in six different types of upper limb casts (above-elbow, below-elbow neutral, and below-elbow cast incorporating the thumb [Bennett’s cast]) on both left and right sides. Of the 36 tests, participants passed 31 tests, suggesting that most people were able to safely drive with upper limb cast immobilization. However, driving in a left above-elbow cast was considered unsafe.

scholarly journals SP4.2.8 Does Care quality commission need to change its inspection strategy after COVID-19?

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Shruti Bodapati ◽  
Raghvinder Gambhir
Keyword(s):  
Care Quality ◽  
Specific Domain ◽  
Care Treatment ◽  
Time Period ◽  
Inspection Strategy ◽  
Care Quality Commission ◽  
The Uk ◽  
Effective Domain

Abstract Aim To see if the Care quality commission’s (CQC) overall inspection ratings and specific domain ratings had any association with COVID-19 related deaths. Methods We looked at CQC ratings of the Shelford group of trusts and 10 trusts with maximum number of deaths in the time period from the first wave till 23rd January 2021. We then looked at each of the 5 domains: safe, effective, caring, responsive, and well led, to see if they were in any way indicative of the number of deaths in that trust. Results Among the 19 trusts studied (one trust featured in both groups) only 1 had an overall outstanding rating; 10 were rated good, 8 required improvement. None were rated inadequate in any of the domains, 16 /19 were rated good in effective domain which means “there care, treatment and support achieves good outcomes”. In safe domain 13/ the 19 were rated as requires improvement which means that “a patient may not be protected from avoidable harm”. Conclusion COVID-19 is no respecter of the CQC ratings, even if the trust was rated as well led and had good ratings in all other domains it could still have the highest mortality figures from COVID in the UK. CQC probably needs to add a 6th domain to its future inspections to assess the readiness the trusts for future Pandemics.

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