Reflecting on experiences of care: an exploratory qualitative descriptive study of the perspectives of stroke survivors, families and staff

ObjectiveThe aim of this study was to identify barriers and enablers from the perspectives of stroke survivors, carers and staff to understand the experiences of care.DesignThe study used a qualitative descriptive methodology and employed semistructured interview technique.SettingA metropolitan stroke rehabilitation unit in Western Australia providing rehabilitation services for inpatients and outpatients.ParticipantsOverall, 10 participants (four staff, four stroke survivors and two primary carers) were interviewed. Transcripts were analysed using thematic analysis.ResultsExperiences of care focused on lack of time, urgency to regain mobility, postshock recovery, uncertainty about the future and the importance of accepting help once home. There was a degree of mismatch between staff experiences of the reality of what can be provided and the experiences and expectations of stroke survivors and families. However, the benefits of a specialised rehabilitation unit were found to contribute to a positive patient experience overall. The specialised unit demonstrated that services must optimise staff time with patients and carers in the poststroke rehabilitation journey to ensure benefits for the long-term well-being for both.ConclusionSeeking patient, family and staff experiences of care can provide valuable insights into facilitating better patient, family and staff engagement for preparation for home-based rehabilitation for stroke survivors and their caregivers. Further research with a larger sample across diverse hospital settings would provide even greater insight into strategies to best address the reality of rehabilitation care and readiness of patients when returning home to the community.

What can data mining tell us about patient safety? Using linear discriminant analysis to identify characteristics associated with positive safety rating in London NHS organisations.

Objective: To identify key characteristics associated with a CQC positive and negative safety rating across London NHS organisations. Design: Advanced data analytics and linear discriminant analysis. Data sources: Linked CQC data with patient safety variables sources from 10 publicly available datasets. Methods: Iterative cycles of data extraction, insight generation, and analysis refinement were done and involved regular meetings between the NHS London Patient Safety Leadership Forum and analytic team to optimise academic robustness alongside with translational impact. Ten datasets were selected based on data availability, usability, and relevance and included data from April 2018 to December 2019. Data pre-processing was conducted in R. Missing values were imputed using the median value while empty variables were removed. London NHS organisations were categorised based on their safety rating into two groups: those rated as "inadequate" or "requires improvement" (RI) and those rated as "Good" or "outstanding" (Good). Variable filtering reduced the number of variables from 1104 to 207. The top ten variables with the largest effect sizes associated with Good and RI organisations were selected for inspection. A Linear Discriminant Analysis (LDA) was trained using the 207 variables. Effect sizes and confidence intervals for each variable were calculated. Dunn′s and Kruskal-Wallis tests were used to identify significant differences between RI and Good organisations. Results: Ten variables for Good and RI NHS organisations were identified. Key variables for Good organisations included: Organisation response to address own concerns (answered by nurse/midwife) (Good organisation = 0.691, RI organisation = 0.618, P<.001); fair career progression (answered by medical/dental staff) (Good organisation = 0.905, RI organisation = 0.843, P<.001); existence of annual work appraisal (answered by medical/dental staff)) (Good organisation = 0.922, RI organisation = 0.873, P<.001); organisation's response to patients' concerns (Good organisation = 0.791, RI organisation = 0.717, P<.001); harassment, bullying or abuse from staff (answered by AHPHSSP) (Good organisation = 0.527, RI organisation = 0.454, P<.001); adequate materials supplies and equipment (answered by "Other" staff) (Good organisation = 0.663, RI organisation = 0.544, P<.001); organisation response to address own concerns (answered by medical/dental staff) (Good organisation = 0.634, RI organisation = 0.537, P<.001); staff engagement (answered by medical/dental staff) (Good organisation = 0.468, RI organisation = 0.376, P<.001); provision of clear feedback (answered by "other" staff) (Good organisation = 0.719, RI organisation = 0.650, P<.001); and collection of patient feedback (answered by wider healthcare team) (Good organisation = 0.888, RI organisation = 0.804, P<.001). Conclusions: Our study shows that healthcare providers that received positive safety inspections from regulators have significantly different characteristics in terms of staff perceptions of safety than those providers rated as inadequate or requiring improvement. Particularly, organisations rated as good or outstanding are associated with higher levels of organisational safety, staff engagement and capacities to collect and listen to patient experience feedback. This work exemplifies how a partnership between applied healthcare and academic research organisations can be used to address practical considerations in patient safety, resulting in a translational piece of work.

Wikisource as a tool for OCR transcription correction: The National Library of Scotland’s response to COVID-19

This chapter focuses on the National Library of Scotland’s Wikisource transcription correction project, an organization-wide effort during lockdown that generated 1,000 fully accurate transcriptions of 3,000 Scottish chapbooks, which the Library had uploaded to Wikisource, Wikimedia’s online library of digitized, out of copyright works. The project, which contributed to the Library being awarded Partnership of the Year 2020 at the Wikimedia UK AGM, is thought to be the largest ever staff engagement with Wikimedia, and has had significant benefits to the Library and staff well beyond the original aims of the project. Initially set up to improve the quality of optical character recognition (OCR) transcriptions in order to make the chapbooks more discoverable and searchable, the project gave staff a purpose and sense of belonging during lockdown, provided an opportunity to work with a varied and fascinating collection, and enabled them to develop new skills in editing Wikisource, drafting guidance documentation, and managing projects. Further to this, the initiative greatly increased library staff engagement with Wikimedia, led to the formation of a Wikimedia Community of Interest, and resulted in the embedding of Wikimedia activity in staff work.

Wellness Sustainability via UN Sustainable Development Goal#3 Wellness, #12 Responsible Production/ Consumption, and #16 Peace

The purpose of this paper is to explore the key elements of wellness sustainability related to transformative servant leadership style in business and social organizations for staff engagement with literature search using the keyword, “new wellness skills” on papers published in 2020. Thirteen papers were found relevant. Review of the papers showed that some factors were associated with wellness. They included raisin diet, grapes nutrition awareness, antioxidant, happiness emotion and adaptiveness. As a proactive, innovative and transformative servant leader, it is time to re-visit the key elements for new skills on wellness sustainability with a new market and a team of capable and loyal workforce under COVID-19.

Risk management in the public sector: challenges in its adoption by Brazilian federal universities

ABSTRACT The aim of this study was to analyze the perception of the members of the risk committees of federal universities in Brazil regarding the challenges in the adoption of risk management in those institutions. Currently, federal universities are obliged by law to manage their risks. This is a recent process that presents them with considerable challenges, which have scarcely been explored. Studying the challenges in adopting risk management enables federal universities to gradually improve their overall management, with the aim of adopting the process in the best way possible. This study contributes to the professional and academic areas by proposing a set of actions within the operational context of the universities to improve the maturity level of the risk management of those institutions. The procedure adopted was a survey covering 68 federal universities in operation in 2019. The quantitative study was based on a questionnaire sent to the public servants on their governance, risk, and control committees, which had a 73% response rate. The data were analyzed using descriptive statistics and position and dispersion measures. Perception was analyzed regarding the challenges arising from the adoption of risk management, in which a lack of process mapping, the need for staff engagement and training, the emergence of divergences concerning the treatment of risk, and excess demands on staff were highlighted. The evidence indicated that risk management can guarantee and facilitate compliance with laws, regulations, norms, and standards, as well as the identification of external scenarios that can influence the occurrence of events that negatively impact not only the universities but the whole community.

BLANKETS: a toasty tool to improve social history documentation for our older patients

A thorough social history is an important component of all medical clerkings and is particularly crucial when admitting an older patient. Standards exist to guide the social history content but are rarely referenced in practice. This quality improvement project conceived and implemented the novel BLANKETS (Bladder and bowels, Legal arrangements, Activities of daily living, Neurology (cognition), Kit (dentures, hearing or visual aids), EtOH and smoking, Trips, walking aids and exercise tolerance, Setup at home) tool for social history documentation, derived from existing standards, at a specialist medical inpatient hospital setting. Over a 15-week period with two cycles of intervention involving 125 patients in total, there was good staff engagement and overall improvement in social history documentation with 194/403 (48.1%) vs 199/545 (36.5%) criteria met overall and on average 6.3/13 vs 4.7/13 criteria documented for each patient. The social history BLANKETS tool is a memorable acronym to prompt clerking doctors to take a thorough and focused social history which is intrinsic to determining appropriate rehabilitation goals for effective discharge planning and setting appropriate ceiling of care decisions.

714 Venous Thromboembolism Risk Re-Assessment Within 24 and 72 Hours After Admission (Closed-Loop Audit)

Introduction NICE and Poole Hospital guideline state venous thromboprophylaxis (VTE) risk assessment must be done on admission and at consultant review (within 24hr and 72hr after admission) Changing from paper to electronic patient records(EPR) system omits some mandatory protocols. Although VTE risk assessment on admission remains mandatory on EPR, records of re-assessment within 24 and 72hr becomes optional. Method 100 random patients admitted to the orthopaedic department, before and after implementation of change. Results The initial data indicates 0% of recording for re-assessment after admission. This action led to incorrect dosage and duration of chemical VTE prophylaxis in 20% of the patients. After presenting the data to stakeholders, an instruction of entering VTE re-assessment on EPR was done by a teaching session and by putting up posters. A discussion with the IT department resulted in setting up a dropdown-box for VTE re-assessment on EPR. Re-audit shows a slight improvement in the recording from 0% to 3% for within 24hr and 22% for within 72hr. Feedbacks indicates an insufficient time, a lack of senior staff member involvement and established workplace culture. Conclusions Despite some improvement, more junior and senior staff engagement, including cultural changes, are needed to achieve the national standard.

576 Striving for Excellence: Beacon Application Submission and Achievement

Introduction The American Association of Critical-Care Nurses (AACN) Beacon Award (BA) recognizes individual nursing units with Gold, Silver, or Bronze level for excellence. The BA signifies an effective and systematic approach to policies, procedures and processes that include engagement of staff and key stakeholders; fact-based evaluation strategies for continuous process improvement; and performance measures that meet or exceed relevant benchmarks. Units designated with BA show an overall higher morale and lower turnover rate. Being a verified burn unit and Magnet designated facility, the unit practice council (upc) began the application process for Beacon. Methods The application process started in 2017 through a core group of UPC members. Different sections of the application were written through the guidance of the team leader and with support of the unit management. Data was gathered from various hospital departments and dashboards which included: leadership structures and systems, appropriate staffing and staff engagement, effective communication, knowledge management and learning development, evidence-based practice and processes, and outcome measurements. After data collection/synthesis, small group meetings were conducted to complete the application. The application was reviewed and edited by the unit management prior to submission. Highlights included: low infection rates in the unit exceeding national benchmarks, peer supporter events for burn survivors, team bonding, community outreach, multiple abstract submission/presentations from nursing at local/national conferences, high patient satisfaction scores, implementing new burn care practices based on evidence, and interdisciplinary rounds. Results Burn unit was designated as a Beacon Gold Award Recipient in 2019. This designation lasts for three years. Our burn unit became one of seven units in the nation with BA and is the second one to achieve Gold designation. During and after this process, there was an increase in staff engagement, teamwork, and exceptional quality metrics. Conclusions Persistent effort combined with teamwork and leadership can help a unit achieve Gold BA designation. This award requires ongoing work to refine processes and promote evidence-based practices.

Improving mealtimes for patients and staff within an eating disorder unit: understanding of the problem and first intervention during the pandemic—an initial report

BackgroundMealtimes occur six times a day on eating disorder (ED) inpatient units and are a mainstay of treatment for EDs. However, these are often distressing and anxiety provoking times for patients and staff. A product of patients’ distress is an increase in ED behaviours specific to mealtimes. The aim of this quality improvement project was to decrease the number of ED behaviours at mealtimes in the dining room through the implementation of initiatives identified through diagnostic work.MethodsThe Model for Improvement was used as the systematic approach for this project. Baseline assessment included observations in the dining room, gathering of qualitative feedback from staff and patients and the development of an ED behaviours form used by patients and staff. The first change idea of a host role in the dining room was introduced, and the impact was assessed.ResultsThe introduction of the host role has reduced the average number of ED behaviours per patient in the dining room by 35%. Postintervention feedback demonstrated that the introduction of the host role tackled the disorganisation and chaotic feeling in the dining room which in turn has reduced distress and anxiety for patients and staff.ConclusionsThis paper shows the realities of a quality improvement (QI) project on an ED inpatient unit during the COVID-19 pandemic. The results are positive for changes made; however, a large challenge, as described has been staff engagement.