Strategies for adapting under pressure: an interview study in intensive care units.

Background: Healthcare systems are operating under substantial pressures. Clinicians and managers are constantly having to make adaptations, which are typically improvised, highly variable and not coordinated across teams. This study aimed to identify and describe the types of everyday pressures in intensive care and the adaptive strategies staff use to respond, with the longer-term aim of developing practical and coordinated strategies for managing under pressure.

Adaptive strategies used by surgical teams under pressure: an interview study among senior healthcare professionals in four major hospitals in the United Kingdom.

Background: Healthcare systems are operating under substantial pressures, and often simply cannot provide the standard of care they aspire to within the available resources. Organisations, managers, and individual clinicians make constant adaptations in response to these pressures, which are typically improvised, highly variable and not coordinated across clinical teams. The purpose of this study was to identify and describe the types of everyday pressures experienced by surgical teams and the adaptive strategies they use to respond to these pressures.

Participatory Design, Project Clients, and Healthcare User Groups.

Aim: This study is the third in a series of investigations that explored the role of project user groups and how they impact on the design of a healthcare facility. Previous studies focused on a wide range of users, whereas this study sought the views of project clients.

Background: The "project client" represents the organization responsible for the procurement of a healthcare facility.

User Group Consultation: Design Quality and Project Success.

Aim: User group consultation is more effective when participants work toward commonly agreed goals and objectives. To understand how they set these goals, this research explored how "user group" participants from diverse professional discipline backgrounds define the concepts of "design quality" and "project success," and their connection on a healthcare facility design project.

Background: User group consultation is often time-consuming, frustrating, and expensive.

Patient safety regulation in the NHS: mapping the regulatory landscape of healthcare.

Objectives: The current research project sought to map out the regulatory landscape for patient safety in the English National Health Service (NHS).

Method: We used a systematic desk-based search using a variety of sources to identify the total number of organisations with regulatory influence in the NHS; we researched publicly available documents listing external inspection agencies, participated in advisory consultations with NHS regulatory compliance teams and reviewed the websites of all regulatory agencies.

Results: Our mapping revealed over 126 organisations who exert some regulatory influence on NHS provider organisations in addition to 211 Clinical Commissioning Groups.

Interdisciplinary User Groups and the Design of Healthcare Facilities.

Aim: This Australian research explores how "user group" participants from diverse professional discipline backgrounds understand, define, perform their roles, and assess the outcomes of the healthcare design process.

Background: Part of the design process in Australia and New Zealand, the purpose of interdisciplinary user group consultation is to design the best healthcare facilities possible within the parameters set by project clients and funding bodies.

Method: An online survey was used to explore how user group participants viewed the process, including how well informed they felt they were about their role/s in it, its success in achieving specific outcomes for their project, and how they felt their project client, owner, or funding body assessed these same issues.

Measurement and monitoring of safety: impact and challenges of putting a conceptual framework into practice.

Background: The Measurement and Monitoring of Safety Framework provides a conceptual model to guide organisations in assessing safety. The Health Foundation funded a large-scale programme to assess the value and impact of applying the Framework in regional and frontline care settings. We explored the experiences and reflections of key participants in the programme.

Implementing an integrated in-situ coaching, observational audit, and story-telling intervention to support safe surgery.

This article describes an intervention that combined in-situ coaching, observational audits and story-telling to educate theatre teams at University College London Hospitals about the Five steps to safer surgery (NPSA 2010). Our philosophy was to educate theatre teams about 'what goes right' (good catches, exemplary leadership etc) as well as 'what could be improved'. Results showed improvements on 'behavioural reliability' metrics, a 68% increase in near miss reporting and a reduction in surgical harm incidents.

Safety analysis over time: seven major changes to adverse event investigation.

Background: Every safety-critical industry devotes considerable time and resource to investigating and analysing accidents, incidents and near misses. The systematic analysis of incidents has greatly expanded our understanding of both the causes and prevention of harm. These methods have been widely employed in healthcare over the last 20 years but are now subject to critique and reassessment.

Understanding safety in healthcare: the system evolution, erosion and enhancement model.

The paper summarises previous theories of accident causation, human error, foresight, resilience and system migration. Five lessons from these theories are used as the foundation for a new model which describes how patient safety emerges in complex systems like healthcare: the System Evolution Erosion and Enhancement model. It is concluded that to improve patient safety, healthcare organisations need to understand how system evolution both enhances and erodes patient safety.

Republished: creating a safe, reliable hospital at night handover: a case study in implementation science.

Background: We developed protocols to handover patients from day to hospital at night (H@N) teams.

Setting: NHS paediatric specialist hospital.

Method: We observed four handover protocols (baseline, Phases 1, 2 and 3) over 2 years.

Safety measurement and monitoring in healthcare: a framework to guide clinical teams and healthcare organisations in maintaining safety.

Patients, clinicians and managers all want to be reassured that their healthcare organisation is safe. But there is no consensus about what we mean when we ask whether a healthcare organisation is safe or how this is achieved. In the UK, the measurement of harm, so important in the evolution of patient safety, has been neglected in favour of incident reporting.

What's in my buckets today? Foreseeing and forestalling patient harm.

Operating theatre teams work in an imperfect system characterised by time pressure, goal conflicts, lack of team stability and steep authority gradients between consultants and other team members. Despite this, they often foresee and forestall errors that could harm patients. The paper discusses the strengths and limitations of using Reason's three buckets model of error prevention as a framework for training operating theatre staff how to foresee and forestall incidents.

Creating a safe, reliable hospital at night handover: a case study in implementation science.

Background: We developed protocols to handover patients from day to hospital at night (H@N) teams.

Setting: NHS paediatric specialist hospital.

Method: We observed four handover protocols (baseline, Phases 1, 2 and 3) over 2 years.

Flexibility: beyond the buzzword-practical findings from a systematic literature review.

Objective: The goal was to identify practical, cost-effective, design-related strategies for "future-proofing" the buildings of a major Australian health department.

Background: Many health buildings become obsolete before the end of their effective physical lives, requiring extensive reconfiguration or replacement. This study sought to move beyond the oft-used buzzword flexibility to seek effective strategies to accommodate future change (future-proofing) that could be further explored in Australia and other developed countries.

Reinterpreting the hospital corridor: "wasted space" or essential for quality multidisciplinary clinical care?

The planning of New South Wales (NSW) and other Australian health facilities is guided by the Australasian Health Facility Guidelines (AHFG), which prescribe allowances for circulation (corridors and similar areas for movement between spaces) of between 10% and 40% of functional floor areas. A further allowance of up to 28% for Travel and Engineering is then assumed (University of NSW & Health Capital Asset Managers' Consortium, 2005). Therefore the "circulation" and "travel" space manifested as the corridors and similar movement spaces within health facilities is both extensive and expensive.

Involving and communicating with patients and the public.

Patient safety incidents have physical and emotional consequences for those involved, including patients, carers, relatives and healthcare staff. This article, the fifth of seven in this series, focuses on Step Five of the Seven Steps to Patient Safety (National Patient Safety Agency (NPSA) 2004): involve and communicate with patients and the public. The article discusses how to communicate with patients and their carers who have been involved in a patient safety incident that led to moderate harm, severe harm or death.