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Lucy Chapman

Our experience as Patient Safety Equity Fellows within the Decluttering (Safely) for safety theme

In January this year the NIHR Yorkshire and Humber Patient Safety Research Collaboration (PSRC) offered four new prestigious Safety Equity fellowships. These fellowships provided the opportunity for PhD students at the University of Bradford to undertake a short research placement within a PSRC theme working on a project addressing inequalities in healthcare.

Welcome to our blog, where we will share our experience of the PSRC Safety Equity fellows. We are Hadeel and Monica, PhD students at the University of Bradford, and we were successful in obtaining positions as Safety Equity fellows within the Decluttering (Safely) for Safety theme led by Professor Rebecca Lawton.  Our placement was embedded in the subtheme ‘Reducing problematic polypharmacy’, led by Professor David Alldred. One of the projects within this theme ‘DEPPLOY-CH’, aims to adapt an existing intervention designed to support the process of deprescribing (reducing or stopping medicines) for older adults with frailty living in their own homes. We were involved in supporting this research which works with healthcare staff and patients to understand how to adapt the original intervention to a different setting: residents living in care homes.

Older people living in care homes are often prescribed many medicines, a phenomenon known as polypharmacy.  Taking multiple medicines can lead to unpleasant side effects and, as a result, reduced overall quality of life for these patients (Kaufman, 2019; Marvin, 2016; Porter, 2019). For this reason, it is important we recognise ways to minimise this risk, and one way to do this is through deprescribing (Huiskes, Burger et al, 2017). This involves reviewing medicines and sometimes stopping those where the potential for harm is greater than the benefits. The resources adapted through the ‘DEPPLOY-CH’ study will eventually improve the quality of life of older people living in care homes by reducing their inappropriate medicines use.

During our Safety Equity Fellowships we worked closely with the Decluttering (Safely) for Safety theme researchers and have regular weekly meetings with the wider research team. Some of the tasks we were involved in include connecting with care home staff and healthcare professionals as part of stakeholder engagement, supporting recruitment for interviews, creating and piloting surveys, and being involved in regular team discussions. The research team were hugely supportive and accepted us into the team in such a way that we have felt like equal collaborators, despite us being students early in our research journeys. The weekly team meetings were a privilege to attend as it is hugely beneficial for us to see how a such a large study is organised and decisions are made. During meetings our contributions were welcomed, and we had the chance to offer our experience to discussions as Monica has previously worked in care homes, and Hadeel, a primary care pharmacist, previously undertook medication reviews for care home residents.  The insight we therefore brought to meetings enabled us to help the research team to consider issues relating to equity in this study.

In our capacity as PhD students, it is our responsibility to lead the research we are conducting under guidance from our supervisors. Therefore, one of the most enjoyable parts of this placement was getting the opportunity to work on research as part of a team.  Additionally, a huge advantage for us as early career researchers was having this chance to work closely with experienced researchers and learn from them. This experience has also been a great way for us to get a taste of what research is like in a professional setting and observe first-hand the possible career prospects once we complete our PhDs. We would highly recommend the PSRC Safety Equity fellowships to other PhD students and are grateful to the PSRC for providing this opportunity to us.

Finally, a special mention to Professor David Alldred, Professor Liz Breen, Dr Hannah Hartley, Dr Daisy Halligan, and Hana Shamsan for welcoming us into their research team, being so approachable, always ready to listen to our ideas, and generally wonderful to work with!

References

  • Huiskes, V. J. B., Burger, D. M., van den Ende, C. H. M., & van den Bemt, B. J. F. (2017). Effectiveness of medication review: a systematic review and meta-analysis of randomized controlled trials. BMC family practice18, 1-15.
  • Kaufman, G. (2019). Polypharmacy perspectives in general practice environments. Practice Nursing30(7), 342-347.
  • Marvin, V., Ward, E., Poots, A. J., Heard, K., Rajagopalan, A., & Jubraj, B. (2017). Deprescribing medicines in the acute setting to reduce the risk of falls. European journal of hospital pharmacy24(1), 10-15.
  • Porter, B., Arthur, A., & Savva, G. M. (2019). How do potentially inappropriate medications and polypharmacy affect mortality in frail and non-frail cognitively impaired older adults? A cohort study. BMJ open, 9(5), e026171.

 

Safer Systems, Cultures and Practices Theme: A focus on equity, diversity and inclusion

Update from the Safer Systems, Cultures and Practices Theme: A focus on equity, diversity and inclusion

In this blog, Dr Lauren Ramsey shares important plans within the safer systems, cultures and practices theme to focus on the equity, diversity and inclusion of approaches to 1) incident investigations and 2) safety improvement work. These are just two of three safety activities that will be explored within the theme.

Hello, I’m Dr Lauren Ramsey – Senior Research Fellow working within our Safer systems, cultures and practices theme of work. Our theme is led by Professor Jane O’Hara and Professor Carl Macrae, and supported by a brilliant team of contributing researchers including national and international collaborators, our Research Fellow (Charlotte Overton) and our Lay Leader (Pam Essler).

 

 

As you will see from our EDI strategy, one of the broad missions of the centre is to “embrace diversity and inclusiveness across the research continuum to develop solutions that make care safer for all”. Throughout this blog, I will describe important plans within our theme to focus on equity, diversity and inclusion specifically.

A little background information about our theme…

As a theme, for the first 18 months of the Patient Safety Research Collaboration (PSRC) we are focussed on exploring the multiple cultural, contextual and institutional factors that shape the conduct of three key safety activities within the health service:

– Responding to safety events

– Safety improvement work

– De-implementing safety practices.

For the purposes of this blog, I am only focussing in detail on two of those safety activities – responding to safety incidents, and safety improvement work.

Safety Activity 1 – Responding to safety events

We are keen to understand how this important activity is supported, as it is one of the cornerstones of safety management within healthcare. Here we will be drawing upon rich evidence generated from two key programmes of work:

1a) The Response Study

The Response study began in May 2022 and will end in July 2025. The aim is to understand, in real time, how the roll-out of new policy, the Patient Safety Incident Response Framework (PSIRF), happens across the NHS in England, and what impact it has.

PSIRF aims to support NHS organisations to be more flexible in the way they respond to safety events. One of the key changes to policy is that NHS organisations will no longer be required to investigate every event that results in harm, which is likely to have important effects. You can find out more about the Response study here.

 

 

1b) The Learn Together Study

 

The Learn Together study began in October 2019 and formally ended in June 2023. The aim was to develop and test new guidance for involving and engaging patients and their families in incident investigations.

 

 

 

Importantly, ‘co-design’ methods were employed throughout the study, meaning that everything was developed together with patient and family representatives, engagement leads, managers, healthcare staff, policy makers and other important stakeholders.

In 2023, final versions of the guidance were launched to support i) patients and families to be involved and engaged in patient safety incident investigations; and ii) investigators to involve and engage patients and families in patient safety incident investigations.

 

 

 

 

 

 

 

 

The guidance has been tested within health services, redesigned based on the evidence and incorporated into national policy – PSIRF. The guides complement each other, and support both engagement leads and patients and families through the same five-stage process.

 

 

The five-stage process has been designed to support organisations and engagement leads to undertake patient safety incident investigations, in ways that ultimately reduce compounded harm – that is, not the harm caused by the original safety incident, but the harm caused by the processes that follow. You can download the guidance, as well as a series of supporting videos, and explore the background evidence here.

Safety Activity 2 – Safety improvement work

In addition to safety incidents, we are keen to understand how patient safety culture emerges, and is influenced by, the implementation and sustaining of safety improvement. Importantly, it remains unclear how cultural practices, norms and assumptions interact and impact safety across complex organisational and care boundaries.

Given the well-documented focus on safety in maternity care over the last decade in the UK, we propose to use Practical Obstetric Multi-Professional Training (PROMPT) as a useful vehicle to explore safety culture and understand how safety is situated in the healthcare system in the context of maternity care.

The evidence-based PROMPT  approach was originally developed at Southmead Hospital Bristol in 2000, centering on effective multi-professional communication via innovative approaches, including ‘in situ’ simulation of obstetric emergency.

Since development, PROMPT  has been implemented and iterated in maternity units across the globe seeing significant improvements in some cases, but with varying successes in others.

To date, research has specifically explored the success of PROMPT at Southmead hospital which was identified as an example of positive deviance (Liberati et al., 2019; Lawton et al., 2014). PROMPT has also been evaluated across eight maternity units in Victoria, Australia, in which benefits were evidenced to a lesser extent (Shoushtarian et al., 2014) and explored the rollout of PROMPT  across Scotland, but found no effect in the clinical indicator Apgar (Appearance, Pulse, Grimace, Activity, and Respiration) test scores (Lenguerrand et al., 2020)

However, research is yet to evaluate, compare and contrast the wider contextual factors which influence the relative successes of the PROMPT approach across contexts and healthcare economies, and from a broad range of perspectives. This is an evidence gap we plan to address via an empirical study.

A focus on equity, diversity and inclusion when learning from incidents and improving safety

To kick start some of this work within our theme, we are advertising two fellowships via the Brad-ATTAIN scheme. The scheme is run by the University of Bradford and is specifically committed to addressing systemic inequality and disadvantages experienced by Black, Asian and Minority Ethnic staff and students.

As part of the fellowships we are keen to explore opportunities to enhance the equity, diversity and inclusivity of the current Learn Together guidance further. While the guidance sets the foundations for engagement leads to come together with patients and their families to truly understand them and their needs following safety incidents – we recognise that this will look different, for different people. Health care organisations may also need further guidance to provide more tailored support to communities of people in these sensitive circumstances.

In addition, we are also keen to explore the disproportionate effects of obstetric emergency in maternity care, for groups such as women with intellectual and developmental disabilities, and for  Black, Asian and Minority Ethnic women, and how that can inform the setup and delivery of our study.

What next?
By developing a better understanding of fundamental issues related to these key safety activities, and via the lens of safety equity, we will develop a clearer and practically-grounded understanding of the wider cultural processes. This will then be used to develop a framework that can support organisations and regulators to design and implement the systems, structures and processes that enable strong and sustainable cultures of safety.

Get in touch

If you have any thoughts or questions about the plans shared here, or any other aspects of our theme, please do get in touch. You can drop me an email (L.Ramsey@Leeds.ac.uk) or contact me on X – previously Twitter (@laurenpramsey). You can also follow the wider PSRC account for regular updates (@YHPSRC).

Update from the Rethinking Safety Intelligence for Improvement Theme: Connecting to ‘Connected Bradford’: A Rich & Untapped Source of Patient Safety Intelligence?

Luke Budworth | Senior Research Data Analyst

Patient Safety Research Collaborative: Rethinking Safety Intelligence for Improvement theme

Hi, I’m Luke Budworth and I’m a data analyst for the Yorkshire & Humber Patient Safety Research Collaborative. I work in the Safety Intelligence theme and contribute data science expertise to all projects across our collaborative, including our cross-cutting theme on Safety Inequity.

Our main goal in safety intelligence is to create and test new safety intelligence solutions that improve patient safety across health and care systems. But what exactly do we mean when we refer to ‘safety intelligence’? And what might potential solutions look like?

As the first of our theme’s blogs, I aim to introduce readers to the background to our work, before outlining some of our ongoing projects – primarily in our integrated data sub-theme and related to our close collaboration with Connected Bradford (cBradford) – a large local data linkage project.

Broadly, working with Connected Bradford data, we aim to understand the potential for whole systems data for patient safety intelligence, explore inequalities in patient safety based upon analysis of linked data and patient safety outcomes, and focus on developing tools to manage the risk of deterioration for patients in primary care. However, this is just a small subset of our work and I encourage viewers to read more here.

 

Patient safety & safety intelligence

In 2019 NHS England published their Patient Safety strategy document, highlighting that: ‘we may fail to save around 11,000 lives a year due to safety concerns [and that] the extra treatment needed following incidents may cost at least £1b. ‘

 They also estimate that work to improve patient safety in the NHS can save up to 1,000 lives and £100m in care costs annually.  A key strand of their strategy relates to ‘Insight’: ‘to improve understanding of safety across the whole system by drawing intelligence from multiple sources of patient safety information.’ Identifying a clear need to improve patient safety intelligence.

Patient safety intelligence in the context of the NHS refers to the strategic use of data, information technology, and analytics to improve patient safety across healthcare settings. It encompasses the systematic collection, integration, and analysis of diverse data types, ranging from electronic health records (EHRs) to incident reports and patient feedback.

This approach enables healthcare professionals to identify and understand risks, spot trends, and pinpoint opportunities for enhancing patient care. Crucial in this process is the ability to extract actionable insights from the data, which can inform the development and implementation of more effective safety protocols and practices.

 

Connected Bradford

Bradford, where our research centre is based, is a post-industrial city in Northern England known for its diverse, multi-ethnic population, but also significant deprivation.

In 2007 the Born in Bradford cohort was established here, recruiting 30,000 participants for monitoring and linkage of both their education and health education records, leading to many high-profile findings and changes in policy and practice.

Extending the Born in Bradford project to represent the entire local population, the Connected Bradford Whole System Data Linkage Accelerator (cBradford) was developed.  Covering ~800,000 subjects, cBradford integrates pseudonymised data from five NHS Trusts, 86 GPs, and 200 schools, spanning health, education, social care, environment, and local government (Figure 1).

 

 

Figure 1: Connected Bradford overview

Notes. This gives a sense of the range of data-sources contained within the cBradford infrastructure. Note that the reported figures here fluctuate over time as access to more data is attained.

Investigating inequity in patient safety

From the patient safety intelligence perspective, cBradford represents huge potential.  In the Born in Bradford cohort for instance, linkage of educational and environmental data has revealed new insights into negative associations between educational attainment and pollution levels. One could argue this is a form of ‘epidemiological’ intelligence; by integrating data across a broader set of datasets, similar insights could be derived related to patient safety (Figure 2).

 

In line with the NHS patient safety strategy focus – and indeed, broader NIHR and PSRC strategies – one of main pieces of collaborative work with cBradford has been to begin to explore potential inequities in patient safety based on socio-economic indicators such as wealth, health, and ethnicity.

 

While still in early development, in close collaboration with our lay leader and academic and clinical collaborators, I have for instance begun trying to use cBradford secondary care data to match socio-economic indicators to standardised Patient Safety Indicator (PSI) codes; measures developed by the Agency for Healthcare Research and Quality (AHRQ) to provide information on in-hospital complications and adverse events following surgeries, procedures, and childbirth. These PSIs come as standardised lists of codes in a format that can be matched to those in cBradford, and as such, frequencies can be cross-tabulated with indicators of deprivation.

 

Figure 2: Example potential patient safety research questions

Hyperthetical aim Method Example
Evaluate the effectiveness of new safety protocols Time Series Analysis Track reductions in incidents after implementing new interventions over time
Identify areas vulnerable to high rates of surgical complications Geospatial Analysis using GIS Map organisations with high post-surgical infections to pinpoint potential needs for regional training or resource allocation
Correlate socioeconomic status with healthcare safety incidents Network analysis Trace patterns between low-income areas and higher rates of medication errors
Understand the effect of environmental factors on patient safety outcomes Multilevel Hierarchical Modelling Analyse area level pollutants and individual level exposures as predictors of increased rates of post operative infections
Explore the link between crime, external stressors and patient safety. Survival analysis

 

 

Investigate if patients from high-crime areas have shorter intervals to hospital readmission post-surgery
Assess the impact of patient education on safety outcomes Difference-in-Differences analysis Measure reductions in medication mismanagement cases after initiating an educational intervention
Compare readmission rates related to social care provision Causal modelling/Propensity Score Matching Contrast readmission rates of elderly patients with post-hospitalisation home care against those without
Identify high-risk patient pathways through the healthcare system Latent Class Analysis Segment patient groups by their encounters with safety incidents to pinpoint areas in care delivery that consistently pose risk

 

Notes. By having a massive, interlinked dataset we can apply a range of cutting edge analytic technique to answer a broad range of patient safety-specific research questions.

 

Project example 2 | A tool for predicting primary care deterioration

 

A key benefit of cBradford is its scope to explore patient safety beyond acute care and across contexts.  We will therefore use linked primary and secondary cBradford data to investigate a previously established indicator of deterioration in primary care (Figure 3) – a key target of the NHS patient safety strategy.

 

By using variables across linked datasets, we believe we can build predictive models that can not only accurately predict deterioration as defined in Figure 3 above, but also a range of other patient safety indicators (including those we have yet to develop – see the next section).

 

Once we build and test our models to establish robustness, particularly across socio-demographic indicators, these could be a useful tool in a GPs toolkit for helping them identify and proactively treat vulnerable patients – assuming that the tool was integrated into the GPs workflow in a user-friendly and useful manner (which relates to our other sub-theme work focused on implementation and improvement).

 

Figure 3: Example novel patient safety indicator: ‘Missed’ deterioration

Notes. Here is an example of research where the authors have managed to interlink two data-sources – primary care and emergency care data – to capture a novel patient safety indicator: ‘missed’ acute deterioration. We are currently developing a risk prediction tool to predict this and other outcomes.

 

Project example 3 | A scoping review of research investigating ‘whole systems integrated data’ (WSID)

 

While previous published reviews of the literature have evaluated and found positive impacts on patient safety of improving interoperability of electronic health records; sharing of health information between organisations; and standardisation of health information technology, no review has aimed to scope attempts to answer myriad questions related to whole systems integrated data (as visualised in Figure 4) specifically. Nor have they attempted to outline how the interlinking of data across types can be used to generate predictive indicators of patient safety risk before they occur.

 

So aside from developing, assessing, and user-testing tools as that above, another arm of our work is conducting a scoping review (among several others for other sub-themes) aiming to assess how best to extract insights from whole systems integrated data (WSID) – and how to develop patient safety indicators from it.

 

Of course, it is one thing having novel indicators of patient safety events, and well-constructed mechanisms (e.g dashboards) for having these reach stakeholders (e.g. doctors). It is another to ensure that this information changes stakeholders’ decisions to improve patient outcomes. As such, as a theme, we are aiming to ensure maximal robustness of all stages of our tools from development to implementation.

 

Figure 4. Integrated data across a whole system? Conceptual literature model

 

 

Notes. The red line indicates where most research has focused: evaluating the effects of the introduction of some data exchange-orientated intervention on health or safety outcomes. The yellow area represents the scope of an example WSID, the grey areas methods of standardisation to improve WSID integration, and the black box to the right outlines some other potential related research focuses aside from outcomes.

 

Conclusion

Thank you for reading the first of our theme’s blogs. I hope I have given you some insight into our work and thinking at this stage of our development. The above only relates to a subset of our work, and while our sub-themes are highly inter-linked and overlapping, it was felt best to focus on one here for brevity. I encourage anyone interested in viewing more of our work to read the links above or get in touch with me on the email above.

 

Freeing up Time to Care

Prof Rebecca Lawton, Prof Robbie Foy, Prof David Alldred and Daisy Halligan

Freeing up time to Care

Thank you to everyone who took the time to complete our short survey. We received more than 39 suggestions in response to the question:

Please tell us what you have had to get rid of, do less of or workaround to free up ‘time to care’.

We received responses from managers, doctors, nurses, dentists, pharmacists and volunteers from England and Scotland. They told us about many different things they had had to stop, or do less of, to free up time to care and to get through the day. Some of the things they had stopped doing were seen as vital for patient safety and they felt worried about not doing them. These comments are referred to as those things that staff ‘need to do but can’t’. There were other practices that staff felt were important and that not doing them could compromise patient care. These are referred to as ‘had to stop/reduce’. Finally, there were some were things that staff felt had little value and should be stopped permanently. These are referred to as ‘things that should stop’. Here are the frequency of responses in each of these categories. Below, we give some examples of the types of things that people told us under each of these headings.

Need to do, but can’t. People referred to NOT:

  • having training, even vital life support courses or having to do them in own time
  • having lunch and team breaks
  • attending or organising multi-disciplinary or multi-service meetings
  • finishing work on time
  • documenting patient history, examining patients or doing investigations thoroughly
  • collecting and providing data for local or national audits

This is summarised in the words of one respondent who said:

‘It is an extreme pressure to feel that it is not possible to do our work as we know it should be done’

Have had to stop/reduce. People referred to NOT:

  • reporting in Datix
  • doing audits
  • doing or supporting quality improvement
  • offering student placements
  • providing the same frequency of appointments for patients
  • writing up notes thoroughly
  • covering appointments
  • producing statutory reports
  • looking at patient records
  • having detailed discussions about end of life choices
  • providing retainers (dental) for patients

One person expresses their opinion about the long-term impact as follows:

‘Many of the initiatives (I have had to stop) would save time, money and/or avoid patient distress longer term so its heartbreaking not to be able to move forward, but at some point I have to see my family too

Things that should stop included

  • Paperwork, particularly duplicating or having to complete multiple forms
  • Meetings, Monitoring, reporting, auditing, producing plans and updates
  • Datixing and making changes based on things that sometimes go wrong

As one responded puts it it is ‘Time to reinvest the time from meetings, reporting and planning into safety actions and improvement’

We also received a range of other comments, not directly related to the question about the challenges of providing care (not just care of high quality) in some settings e.g. how distressing it was to work in the Emergency Department and other ideas about how services could be improved to make them more patient friendly e.g. piggy backing one visit (e.g. eye appointment) onto another (e.g. diabetes appointment).

We would like to express our thanks to everyone who shared their ideas when finding time to do this was difficult. We @yh_pstrc will be using these ideas in planning our research on ‘reducing safety clutter’ within our new research centre – The NIHR Yorkshire and Humber Patient Safety Research Collaboration. We will continue to share our findings.

 

 

Working with older patients and their family members to make sense of qualitative data on safe medicines management: insights from the RESI-Med study

By Giorgia Previdoli, Research Fellow

We need to make medicines management safer

Medicines help people to live longer, even when they are living with multiple long-term conditions. If not well-managed and monitored, however, medicines can potentially cause harm.

According to the National Health Service (NHS) in England a third of the population takes eight or more medicines by the age of 80. It is not just the number of medicines that makes life complicated and increases the risk of harm for patients. Some older people, for example, are expected to remember to take different medicines several times a day, manage visits and tests with different specialists, take regular measures and readings (e.g. blood sugar) and dynamically adapt their medicines doses to the results. Researchers and clinicians use the words “regimen complexity” to describe examples like this. And research shows that as things get complicated, mistakes become more likely. In addition, if medicines are not periodically reviewed, patients may experience inappropriate polypharmacy, which means that they are taking medicines that are no longer needed because they may not be providing benefits, or that may, in combination with other medicines, put them at risk of an adverse drug reaction. Research has shown that older people are particularly at risk, especially if they take many different medicines and have a complex regimen. For example, older patients are more likely to spend time in hospital and experience more serious complications if something goes wrong with their medicines.

According to the World Health Organization (WHO), unsafe practices and errors with medicines cost £38billon each year and is a leading cause of injury and avoidable harm. In the UK only, the estimated cost for medicines errors was £237.4. In 2017, WHO launched a global campaign to raise awareness of the scale of medicines-related harm and make medicines management safer. This year, “Medication without harm” was the theme chosen to mark World Patient Safety Day on the 17 September.

The RESI-Med study and the involvement of patients and family members in data analysis

Researchers at the National Institute of Health Research (NIHR) Yorkshire and Humber Patient Safety Translational Research Centre are addressing these challenges in the RESI-Med project. RESI-Med is a two-year study funded by NIHR and aims to develop an intervention to make medicines self-management safer for older patients who manage many medicines at home.

The RESI-Med study has 3 main steps:

  • Step 1
  • Patient interview study (32 people aged 65 or older)
  • Staff interview study (16 healthcare professionals)
  • Review of interventions to improve medicines management for older adult

 

  • Step 2
  • Co-design of solutions using the Experienced Based Co-Design (EBCD) toolkit by Point of Care.
  • EBCD brings patients and staff together to explore new ways to improve healthcare.

 

  • Step 3
  • 2 focus groups with patients
  • 2 focus groups with staff
  • Prototyping to make our intervention ready to be tested in the real world

In addition to a multidisciplinary team of pharmacists and social researchers, the study team includes a patient with lived experience of managing many medicines in older age as well as a group of older patients and family members of patients who advise the team. In the RESI-Med study patient involvement has played a key role in every stage.

The study team also worked with older patient representatives and family members to make sense of the data collected during interviews with patients. Interviewed patients were very open about their struggles taking and manging medicines and the creative solutions they adopt to cope. To fully understand their reflections, we involved our Patient Advisory Group in the early stages to support our interpretation.

We chose to analyse the interviews using thematic analysis, an approach widely used across social sciences.

Patient involvement in healthcare research is becoming more and more common, but patient involvement in data analysis is still relatively unusual. Dr Catherine Powell, who is part of the RESI-Med team, recently involved a group of heart patients as co-analysists in a process evaluation.

While I was still familiarising myself with the data (the transcripts from the 32 interviews with patients), I studied notes made by and codes suggestions received from our Patient Advisory Group. I found this experience extremely insightful because they revealed aspects that had not captured my attention until that point, especially around the burden and the emotional impact of having to fit many medicines into everyday life. The writing up of the findings is still in progress but the influence of the Patient Advisory Group on the way the themes are taking shape is already clear. I am very grateful for that.

Reflections on the data analysis experience

Six people took part in the data analysis workshop and in the subsequent activities. Their feedback on how they found working on interview transcripts was very positive. I have interviewed one of the Patient Advisory Group members about her experience and this is what she told me. You can read the answers below or, if you prefer, you can watch our more informal chat in this short video.

Link to chat: https://youtu.be/xeiRaHEnzEo

Giorgia: Jan, why did you decide to get involved in this study?

Jan: I have cared for both my parents in their later years when they were taking multiple medications. This brings many challenges and complications and I wanted to be involved in trying to create and develop an intervention to help patients and carers to manage this safely.

Giorgia: Tell me more about your previous experience in other studies?

Jan: I have supported several research studies as a public contributor. My experience has been both good and bad, rewarding and at times challenging and disappointing.

Giorgia: How was your involvement in RESI-Med compared to other studies?

In what respect RESI-Med is different from what you have done before?

Jan: Resi-Med has been different because of the deeply personal connection to the subject and the emotional memories that have come back to the surface in discussions. The PPI group have been very involved from the start and views respected and taken into the development of the study. There was more detailed PPI involvement than other studies I have been involved with.

Giorgia: How was the Thematic Analysis workshop for you? Was it challenging? Did you enjoy it?

Jan: Taking part in the workshop and doing some thematic analysis was a challenge but a rewarding one. It felt that it gave the PPI group an empathy with the patients and the researchers in reading the questions and answers given. It was similar to what I expected in respect of trying to find themes in the text. It was different in that I found the responses from patients were raw and real and some showed real resilience in coping with the challenges/shortcomings in their healthcare. I found this quite emotional.

The support from the researcher and the rest of the PPI group was a great help and the experience of doing this task made me much more aware of real front line research.

 Giorgia: Would you do it again?

Jan: Yes I would most definitely do it again as I feel I now have more experience to share in looking for patterns in the transcripts and it is a very rewarding and challenging experience.  For any public contributors it may be helpful to read a section of a transcript prior to a workshop. They are actual conversations with exact representation of any general chat and pauses and this makes it a challenge to find the important points to include in your notes and initial codes.

Giorgia: What differences do you think it would make to qualitative data analysis in health research if there was more PPI involvement?

Jan: PPI involvement gives another perspective to the researchers in their analysis. The public will use their personal experiences as patients, carers and users of healthcare services to make sense of the data and are not bound by a structure of research strategies and constraints. I feel researchers and PPI groups together will give a fuller more real and rounded picture of patients’ experiences.

Giorgia: What was the best thing you learned from looking at the transcripts?

Jan: The best thing was seeing the real resilience of elderly patients coping with their health and their strength and sense of humour in adversities.

Giorgia: What are the key aspects that make PPI involvement in thematic analysis easier and more productive for the researchers and the PPI group?

Jan: I think the key aspects are the support of researchers and the respect of all views expressed both in the transcripts and in the way people code. This allows all views to be captured.

Implementing safe and routine deprescribing in primary care

It is well documented that the use of medicines has been increasing and continues to rise as we improve how we understand, diagnose and treat different medical conditions. The UK alone has seen a 39% increase in number of medicines dispensed from 2007 to 2017 (NHS Digital, 2018). As the number of medicines available to treat patients grows, it is now commonplace for patients to take five or more medicines concurrently – also known as polypharmacy. This is especially the case for patients age 65 years and over (Gao et al., 2017).

Polypharmacy is not inherently negative and is a natural effect of our healthcare system. A patient with multiple diagnoses requires multiple medicines to treat their various conditions effectively to better quality of life. In addition, if patients experience side effects from their initial treatment plan, additional medicine may be prescribed to counteract this. This is known as the prescribing cascade. This is further intensified because clinical practice guidelines that aid prescribers in prescribing appropriate medicines are based on the idea that a patient has a single disease only (as opposed to the reality of many patients having multiple ailments). From this perspective, it’s quite easy to see how a patient may quickly end up on 5 or more long-term medicines. So, it is important to ensure the necessity of each medicine or polypharmacy risks becoming problematic.

The definition of problematic polypharmacy is instances where many medicines are prescribed inappropriately or the intended benefit of a medicine is not realised (Duerden et al., 2013). Such examples involve instances where the number of tablets a patient takes negatively affects their quality of life or when multiple medicines prescribed are hazardous because of a clinical interaction between the medicines or the cumulative effect they have on the body. This can subsequently lead to adverse drug reactions (ADRs), the use of potentially inappropriate medicines (PIMs), non-adherence to medicines and higher care costs (Pirmohamed et al., 2004). Patient safety is compromised when problematic polypharmacy is present.

An avenue for combating problematic polypharmacy is deprescribing. Deprescribing is identifying and discontinuing medicines where harms outweigh benefits in relation to each individual patient and their treatment goals (Scott et al., 2015). This is a shared decision between patients and healthcare professionals. Research has shown deprescribing to be effective in stopping PIMs whilst showing a lack of significant harm, especially when deprescribing long-term medicines (Iyer et al., 2008). However, the process of deprescribing is not completely without risk, with the risk of relapse of symptoms of the original condition or a risk of symptoms associated with stopping a medicine being present. In summary, deprescribing is important in addressing problematic polypharmacy through stopping unnecessary medicine use, but it’s not completely free of risk. It’s important that deprescribing is routinely considered but conducted safely.

Although deprescribing can help in preventing problematic polypharmacy, much of the deprescribing currently in practice is reactive, meaning a medicine is stopped once a patient has already developed side effects. To maintain patient safety, there is a need for proactive deprescribing so that problematic medicines are stopped before side effects can occur. There is a lack of evidence on how routine proactive deprescribing can occur within our current healthcare safely. Multiple obstacles to routine deprescribing have already been highlighted, including a lack of clinician’s time, competing workloads, and the fear that deprescribing may be seen as a cost-cutting exercise or abandonment of care (Reeve et al., 2013, Doherty et al., 2020). There is little guidance on how to overcome these obstacles and implement routine, safe and proactive deprescribing.

In order to combat problematic deprescribing and better patient safety, this has provided us with a drive to research how routine and safe deprescribing can be implemented into our primary healthcare. We aim to understand what patients and healthcare professionals need for routine and safe deprescribing to occur. This is very important to us as we want deprescribing to work for patients, without negatively affecting healthcare professionals. As pharmacists are known as medicine specialists, we’re also interested in the potential roles of pharmacists in supporting routine deprescribing. Research has highlighted the beneficial role of pharmacists in deprescribing, but little is known about their exact roles (Ailabouni et al., 2019).

Ultimately, we then want to co-design resources with patients and healthcare professionals that make it easier for safe and routine deprescribing to be implemented into practice. It is hoped that this will make it easier to tackle problematic polypharmacy without compromising patient safety.

Daniel Okeowo supervised by Professor David Alldred, Dr Beth Fylan and Dr Syed R. Tabish.

References:

AILABOUNI, N., MANGIN, D. & NISHTALA, P. S. 2019. DEFEAT-polypharmacy: deprescribing anticholinergic and sedative medicines feasibility trial in residential aged care facilities. International Journal of Clinical Pharmacy, 41, 167-178.

DOHERTY, A. J., BOLAND, P., REED, J., CLEGG, A. J., STEPHANI, A. M., WILLIAMS, N. H., SHAW, B., HEDGECOE, L., HILL, R. & WALKER, L. 2020. Barriers and facilitators to deprescribing in primary care: a systematic review. BJGP Open, 4.

DUERDEN, M., AVERY, T. & PAYNE, R. 2013. Polypharmacy and medicines optimisation: Making it safe and sound [Online]. The King’s Fund, 11–13 Cavendish Square, London W1G 0AN: The King’s Fund.  [Accessed].

GAO, L., MAIDMENT, I., MATTHEWS, F. E., ROBINSON, L., BRAYNE, C., FUNCTION, O. B. O. T. M. R. C. C. & STUDY, A. 2017. Medication usage change in older people (65+) in England over 20 years: findings from CFAS I and CFAS II. Age and Ageing, 47, 220-225.

IYER, S., NAGANATHAN, V., MCLACHLAN, A. J. & LE COUTEUR, D. G. 2008. Medication withdrawal trials in people aged 65 years and older: a systematic review. Drugs Aging, 25, 1021-31.

NHS DIGITAL. 2018. Prescriptions Dispensed in the Community – Statistics for England, 2007-2017 [Online]. Available: https://digital.nhs.uk/data-and-information/publications/statistical/prescriptions-dispensed-in-the-community/prescriptions-dispensed-in-the-community-england—2007—2017 [Accessed].

PIRMOHAMED, M., JAMES, S., MEAKIN, S., GREEN, C., SCOTT, A. K., WALLEY, T. J., FARRAR, K., PARK, B. K. & BRECKENRIDGE, A. M. 2004. Adverse drug reactions as cause of admission to hospital: prospective analysis of 18 820 patients. BMJ, 329, 15-19.

REEVE, E., TO, J., HENDRIX, I., SHAKIB, S., ROBERTS, M. S. & WIESE, M. D. 2013. Patient Barriers to and Enablers of Deprescribing: a Systematic Review. Drugs & Aging, 30, 793-807.

SCOTT, I. A., HILMER, S. N., REEVE, E., POTTER, K., LE COUTEUR, D., RIGBY, D., GNJIDIC, D., DEL MAR, C. B., ROUGHEAD, E. E., PAGE, A., JANSEN, J. & MARTIN, J. H. 2015. Reducing Inappropriate Polypharmacy: The Process of Deprescribing. JAMA Internal Medicine, 175, 827-834.

 

NIHR PSTRCs Symposium on the future of Patient Safety: Insights from PhD student attendees.

The three NIHR Patient Safety Translational Research Centres (PSTRC) hosted a joint symposium on the 16th June at the Queens Hotel in Leeds to discuss the future of patient safety research. The symposium was an extremely welcomed opportunity to see colleagues face-to-face and despite highlighting many shortcomings in the current landscape of patient safety, the atmosphere was vibrant with encouraging presentations that focused on three key themes: insight, involvement and improvement.

In the ‘Involvement’ session, we heard from Prof Bryony Dean Franklin, Prof Jane O’Hara and Prof Caroline Saunders. As a PhD student, it was great to hear about simple yet effective ways of collaborating with a diverse range of people, particularly groups we traditionally considered ‘hard-to-reach’ but are now understanding that with effective networking with organisations and meaningful engagement, are enthusiastic to be involved. At the end of this session, I felt encouraged that the future of patient safety research will incorporate understanding that to meet the needs of everyone, we need to involve them effectively. I felt empowered to use the techniques suggested by presenters in my own work.

The ‘Insight’ session was led by Dr. Lindsay Dewa from Imperial PSTRC, Dr. Richard Williams from Greater Manchester PSTRC and Prof. Rebecca Lawton from Yorkshire and Humber PTSRC. The session highlighted insight from patients, staff and health data taken from research carried out over the last five years across the PSTRCs. Insight from the following three areas of research was discussed:

– How to pragmatically and meaningfully involve patients and the public throughout the entire process of co-production.

– How electronic patient records stored in the Greater Manchester Care Record can be used to inform interventions to improve patient safety and enhance health research.

– The value of using staff intelligence to better understand problems such as ‘safety clutter’ to improve safety. Learning from staff experiences of previous harm to provide safety intelligence for improvement was also highlighted.

A highlight of this session was learning about the variety of inclusive and person-centred methods that we can use to gather insight from patients and staff to improve patient safety.

The ‘Improvement’ session was led by Dr Jonathan Benn from YH PSTRC, Dr Ana Luisa Neves from Imperial PSTRC and Professor Tony Avery from GM PSTRC. The overall theme was digitally enabled improvement and specifically socio-technical interventions in hospitals and general practice. Examples were the evaluation of a digital hospital command centre, the use of virtual primary care during the COVID19 pandemic and reducing patient harm from medication errors by identifying patients at risk using a pharmacist-led IT-based intervention. For me as a PhD student, the key highlight from this session was the range of research methods that was being used to explore, develop, implement and evaluate digital patient-safety interventions; ranging from systematic reviews and routine data, to ethnographic observations and qualitative interviews, as well as clinical trials and national training packages.

Key learning from the Symposium

Daisy Halligan (PhD Student)

  1. The need to respect unique individuality so that the healthcare system can work for all (Dr. Frances Healy).
  2. It was inspiring to hear the panel discuss what the future of patient safety research should focus on. Some ideas mentioned during the discussion included: tackling inequalities, including more patients and carers as lay researchers, making better use of routinely collected data and improving patient safety in ways other than implementing policies, guidelines and interventions.
  3. The Symposium poster competition was a fantastic opportunity to learn about the different research projects taking place across the three centres. I was really pleased to have won the poster prize for the Yorkshire and Humber PSTRC on a study that explored the barriers and facilitators to de-implementing low-value safety practices.

Caitlin Wilson (PhD Student)

 

 

 

 

 

  1. “Much has been accomplished in patient safety research, but much more needs to be done” (Dr Frances Healey)
  2. If we want to address inequality and inequity in patient safety research then we need to not only consider healthcare providers’ perspectives (freedom from harm) but also patients’ perspectives (“I feel safe”) (Professor Bryony Dean Franklin)
  3. Great opportunity to learn from and network with leaders in the field of patient safety research, as well as NHS organisations, including Dr Fiona Bell, Head of Research at Yorkshire Ambulance Service NHS Trust.

Emily Parker (PhD Student)

A particular highlight for me was seeing presenters from various disciplines make suggestions which rationalised some of my PhD work. For example, it was great to see staff wellbeing being emphasised and patient-centred approaches to clinical risk investigation being prioritised for future research. My three key takeaways from the day were:

  1. Continuing with a career in patient safety research means I will be able to foster strong relationships with communities, organisations and a wide range of people.
  2. Addressing inequalities for patients is impossible without addressing them for staff. This is a key area I am interested in, particularly the experience of non-clinical staff who have not received as much research attention but contribute greatly to patient safety.
  3. I have new ideas for how I can navigate recruitment of a diverse range of patients and staff, with Professor Caroline Saunders boosting my confidence in approaching and involving community organisations.

Overall, we thoroughly enjoyed the joint symposium. It was great to meet researchers from the other PSTRCs and catch-up with colleagues from Yorkshire & Humber. Seeing the artist’s impressions of the day was a particular highlight and a great example of how the key messages of a presentation can be clearly communicated in a really engaging way! The panel of patient safety experts who hosted the Q&A session left us all feeling enthusiastic and intrigued about where our career’s can take us in Patient Safety research. We can’t wait for the next opportunity to collectively meet again.

Symposium, Queens Hotel

Visual artist impression of the symposium


          
        

Can we adapt the way we do research when involving healthcare staff as research participants?

Dr Raabia Sattar, Dr Jane Heyhoe & Professor Rebecca Lawton

 

NHS staff live the health system every day and have much to offer research about healthcare (Marjanovic et al., 2019). Their first-hand experience and insight means that staff have a unique role in applied health research that seeks to improve the delivery of care and support staff wellbeing.  Applied health research is beneficial for patients, healthcare staff, and organisations. A review by Harding et al (2107) found that staff participation in research was associated with increased organisation level patient satisfaction, improved efficiency of care, and lower staff turnover. Increased levels of research engagement by healthcare staff may improve the processes of care (Boaz et al., 2015).

While NHS healthcare staff can make important contributions to research, there are a number of barriers to staff taking part.  These include a lack of time to participate in research (Marjanaovic et al., 2019), a lack of funding to support engagement (Bryant., 2014; Brereton, L., et al., 2017), and a lack of support by leadership (Evanst et al., 2013; French et al., 2016; Mitchell et al., 2015). While research has been at the centre of an effective response to Covid-19, pressures on staff have only increased during the last two years, meaning that staff ability to be involved in research as participants is also under pressure. At the same time, the Covid-19 crisis and the associated changes in practice, work pressures and emotional toll mean that now more than ever the voices of NHS staff need to be heard. This is vital if we are to learn from and respond to their first-hand experiences of delivering care during these unprecedented times and to ensure the development of the most appropriate interventions, policies and frameworks to continue to improve healthcare.

The traditional ways of including staff in research have involved methods such as face-face interviews, focus groups and questionnaires, as well as observations of the work as done via ethnographic studies. Undoubtedly, these types of research techniques are needed to address certain research questions. However, as researchers, it is important that we take into account that when we ask healthcare staff take part in such research activities, they are away from their clinical duties and responsibilities. We must also consider, what are we offering staff in return for their time? Can we adapt the way we involve participants in our research so that there is greater participant gain? Below, we provide an example of an alternative participation approach we have used for one of our research projects.

An example of an innovative approach: CASE (Conversations About Safety and Emotions)
How we express emotion and interpret emotion in others is integral to important aspects of healthcare such as decision making, team functioning and effective leadership.  Healthcare professionals are required to make clinical decisions in contexts that are emotionally charged and require healthcare staff to actively manage their own and others emotions (Kozlowski et al, 2017). Although there is now increasing recognition that emotions play an important role in staff wellbeing, patient experience and the delivery of safe care, research within this area is limited. Therefore, the aim of this study was to explore the role of emotion in maternity practice within hospital settings.

 We were planning this study during the initial months of Covid-19, and we quickly realised that healthcare staff within the NHS were now being faced by immense service pressures. After discussions with a member of our team, a consultant obstetrician, we started to think more about reciprocity as part of the research contract. Most research groups provide feedback to participants about the findings of their research and make recommendations that can be used to improve practice, but benefits associated with the ‘process’ of being a participant in research are less frequently deliberated. This notion of benefits of participation was central to our research design. We worked with our clinical partners to develop a workshop series focusing on delivering evidence and supporting staff to think about the evidence on emotion and safety. The series – Conversations About Safety and Emotion was delivered during scheduled training time (Friday afternoons). Whilst delivering the workshop we planned to collect data by recording the break out room discussions which we ran as short focus groups. Using this innovative approach allowed us as researchers to capture the data we required for our study, whilst also offering healthcare staff training.

This study is now underway and takes the form of a programme of four online interactive training workshops, with a mixture of teaching and group discussions. These workshops are multi-disciplinary in nature, and include maternity clinicians including midwives and obstetricians as well as senior leaders. The workshops are delivered by psychologists and a consultant obstetrician. We have delivered the first workshop which focused on feeling psychologically safe in teams, to a mixture of 37 midwives and obstetricians. All participants signed up and consented to the recording and analysis of discussions during the workshops, at least 24 hours in advance of the training workshop.  Feedback on the experience from staff was that they were supported and encouraged to engage in discussions about challenging issues in a safe space and that both the formal presentation and the discussions contributed to their learning. We believe this is a mutually beneficial method of delivering research, as we are able to collect research data, whilst also providing healthcare staff with evidence-based training and knowledge which they are able to apply to real life settings within their NHS workplace.

Conclusion
Involving NHS healthcare staff within research is fundamental to improving patient care, staff wellbeing and patient safety. However, due to the immense work pressures healthcare staff are facing, as researchers, we must adapt the way we involve staff in our research to ensure that they benefit from taking part. We are keen to hear from others about how they have adapted research so that healthcare staff benefit from the process of being engaged in that research. We also welcome the views of healthcare staff on how they would like to be involved in research and what we, as researchers, can do to reduce the burden and increase the benefits.

Please comment below.

 

Can we adapt the way we do research when involving healthcare staff as research participants?

Can we adapt the way we do research when involving healthcare staff as research participants?

Dr Raabia Sattar, Dr Jane Heyhoe & Professor Rebecca Lawton

NHS staff live the health system every day and have much to offer research about healthcare (Marjanovic et al., 2019). Their first-hand experience and insight means that staff have a unique role in applied health research that seeks to improve the delivery of care and support staff wellbeing.  Applied health research is beneficial for patients, healthcare staff, and organisations. A review by Harding et al (2107) found that staff participation in research was associated with increased organisation level patient satisfaction, improved efficiency of care, and lower staff turnover. Increased levels of research engagement by healthcare staff may improve the processes of care (Boaz et al., 2015).

While NHS healthcare staff can make important contributions to research, there are a number of barriers to staff taking part.  These include a lack of time to participate in research (Marjanaovic et al., 2019), a lack of funding to support engagement (Bryant., 2014; Brereton, L., et al., 2017), and a lack of support by leadership (Evanst et al., 2013; French et al., 2016; Mitchell et al., 2015). While research has been at the centre of an effective response to Covid-19, pressures on staff have only increased during the last two years, meaning that staff ability to be involved in research as participants is also under pressure. At the same time, the Covid-19 crisis and the associated changes in practice, work pressures and emotional toll mean that now more than ever the voices of NHS staff need to be heard. This is vital if we are to learn from and respond to their first-hand experiences of delivering care during these unprecedented times and to ensure the development of the most appropriate interventions, policies and frameworks to continue to improve healthcare.

The traditional ways of including staff in research have involved methods such as face-face interviews, focus groups and questionnaires, as well as observations of the work as done via ethnographic studies. Undoubtedly, these types of research techniques are needed to address certain research questions. However, as researchers, it is important that we take into account that when we ask healthcare staff take part in such research activities, they are away from their clinical duties and responsibilities. We must also consider, what are we offering staff in return for their time? Can we adapt the way we involve participants in our research so that there is greater participant gain? Below, we provide an example of an alternative participation approach we have used for one of our research projects.

An example of an innovative approach: CASE (Conversations About Safety and Emotions)
How we express emotion and interpret emotion in others is integral to important aspects of healthcare such as decision making, team functioning and effective leadership.  Healthcare professionals are required to make clinical decisions in contexts that are emotionally charged and require healthcare staff to actively manage their own and others emotions (Kozlowski et al, 2017). Although there is now increasing recognition that emotions play an important role in staff wellbeing, patient experience and the delivery of safe care, research within this area is limited. Therefore, the aim of this study was to explore the role of emotion in maternity practice within hospital settings.

 

We were planning this study during the initial months of Covid-19, and we quickly realised that healthcare staff within the NHS were now being faced by immense service pressures. After discussions with a member of our team, a consultant obstetrician, we started to think more about reciprocity as part of the research contract. Most research groups provide feedback to participants about the findings of their research and make recommendations that can be used to improve practice, but benefits associated with the ‘process’ of being a participant in research are less frequently deliberated. This notion of benefits of participation was central to our research design. We worked with our clinical partners to develop a workshop series focusing on delivering evidence and supporting staff to think about the evidence on emotion and safety. The series – Conversations About Safety and Emotion was delivered during scheduled training time (Friday afternoons). Whilst delivering the workshop we planned to collect data by recording the break out room discussions which we ran as short focus groups. Using this innovative approach allowed us as researchers to capture the data we required for our study, whilst also offering healthcare staff training.

This study is now underway and takes the form of a programme of four online interactive training workshops, with a mixture of teaching and group discussions. These workshops are multi-disciplinary in nature, and include maternity clinicians including midwives and obstetricians as well as senior leaders. The workshops are delivered by psychologists and a consultant obstetrician. We have delivered the first workshop which focused on feeling psychologically safe in teams, to a mixture of 37 midwives and obstetricians. All participants signed up and consented to the recording and analysis of discussions during the workshops, at least 24 hours in advance of the training workshop.  Feedback on the experience from staff was that they were supported and encouraged to engage in discussions about challenging issues in a safe space and that both the formal presentation and the discussions contributed to their learning. We believe this is a mutually beneficial method of delivering research, as we are able to collect research data, whilst also providing healthcare staff with evidence-based training and knowledge which they are able to apply to real life settings within their NHS workplace.

Conclusion
Involving NHS healthcare staff within research is fundamental to improving patient care, staff wellbeing and patient safety. However, due to the immense work pressures healthcare staff are facing, as researchers, we must adapt the way we involve staff in our research to ensure that they benefit from taking part. We are keen to hear from others about how they have adapted research so that healthcare staff benefit from the process of being engaged in that research. We also welcome the views of healthcare staff on how they would like to be involved in research and what we, as researchers, can do to reduce the burden and increase the benefits.

Please comment below.

From Kingston to Yorkshire: An Internship in Patient Safety

By Kayley Perfetto, Ph.D. Student, Queen’s University, Kingston, Ontario, Canada

 

In March 2020, I was faced with a choice. I was nearing the end of the second semester of my first year in my Ph.D. program in Health Quality (HQ) and the following semester I was expected to begin an internship. In order to apply the knowledge and skills gained during two semesters of course work, first-year Ph.D. HQ students are required to complete a 200-hour internship at a location that aligns with their areas of interest. Based upon a suggestion from my Ph.D. supervisor, planning had been underway since November 2019 and I was excitedly preparing for a trip to Yorkshire, England. I had been looking forward to spending two weeks on-site with the Yorkshire Quality and Safety Research (YQSR) Group which hosts the NIHR Yorkshire and Humber Patient Safety Translational Research Centre (YH PSTRC), assisting with two pre-determined research projects. Unfortunately, at that time the COVID-19 pandemic had started to take hold of the world and my carefully laid out plans had to be abandoned and I needed to decide what to do next. The faculty at Queen’s provided my classmates and I the option of completing, what was supposed to be an in-person internship, virtually, or delaying our internships for a year, and hope for the best that international travel could occur in a year’s time.

To provide a bit of context, I will share a little bit about Queen’s University and the HQ program that I am fortunate to be a part of. Queen’s University is located in beautiful Kingston, Ontario, Canada, a city with a population of 136 000, along Lake Ontario. Queen’s University is Canada’s oldest University as it predates the founding of Canada by 28 years. The university was modeled after universities in Edinburgh and Glasgow.

My PhD colleagues and I onsite during our intensive week in beautiful snowy Kingston, January 2020

I live in London, Ontario, a city that is roughly four hours from Kingston and therefore my Ph.D. is being completed virtually. The HQ Graduate programs are designed for individuals like myself, health care professionals who are working in the field, who want to further their education in quality and patient safety. I am a physiotherapist by training, and I am currently working as a Patient Safety Specialist in a hospital organization in London, Ontario.

 

 

Lovely Queen’s University

Lovely Queen’s University

After careful consideration and meetings with my supervisor and the YQSR team to discuss whether my internship could be made virtual, I decided to give it a go and hope for the best. Utilizing a variety of virtual technologies and many emails, I have been able to contribute to three research projects, (one of which I am currently contributing to) one of which used qualitative data to understand the experiences of patients with learning disabilities and how these experiences impacted patient safety. The other project was a scoping review, completed as the first phase of a large five-phase study, which explored the current involvement of patient and family members in serious incident investigations. Both projects are ongoing at this time and both will be submitted for publication within the next few months. I was invited to present the key learnings from my internship at a virtual YQSR staff meeting in March 2021 and I shared my experiences at the academic series held at Queen’s University.

 

Screen shot of an interview with Professor. Jane O’Hara and Dr. Abigail Albutt (and me)

Through the guidance and support from the YQSR team, this internship allowed me to gain a deeper understanding of my substantive area of interest, patient and family involvement in patient safety, the knowledge that has been invaluable as I develop my thesis. During my internship, I was able to (and continue to!) work alongside and network with some renowned researchers in the field, learn more about their current projects and hear their perspectives on the direction research in this area is heading. Being part of these three projects, allowed me to consolidate what I learned in my first year Ph.D. courses, gaining an increased understanding of the practical aspects of conducting research.

This internship provided me with so many opportunities, but what I feel most fortunate about is having the opportunity to meet such wonderful people. The team at YQSR was warm and welcoming and was genuine in the desire to make this experience a success. They provided resources and experiences that they felt would be helpful for me and shared information about themselves and their experiences going through the pandemic. This internship was possible due to the commitment and collaboration between the team at YQSR and Ph.D. HQ team. When my original plans were unexpectedly altered by COVID-19, both groups worked together to ensure that I was able to continue with and benefit from my internship. For their dedication to ensuring that I had the best experience possible, I offer a heartfelt thank you and hope someday soon I have the opportunity to thank you in person.