Category / Health, Wellbeing & Society

Lessons from Southern Health – leadership to support a culture of voice across complex integrated systems

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Dr Lee-Ann Fenge

Over the past few years there have been a number of reports which have highlighted concerns about failures of care and patient safety within a range of NHS settings raising serious concerns about the leadership of such organisations. Most recently The Care Quality Commission has identified “serious concerns” about the safety of mental health and learning disability patients at Southern Health NHS Trust. The concerns highlight the failures of leaders to deliver, monitor, assure, and safeguard a culture of safety, quality, and compassionate care and services.

This inspection took place following the publication of an independent review (the Mazars report  that described a number of concerns about the way the Trust reported and investigated deaths, particularly of people using its mental health and learning disabilities services, and a lack of leadership, concerning the reporting and investigation of unexpected deaths of mental health and learning disability service users.

So what leadership challenges are there in turning this situation around? Undoubtedly there have already been improvements in the care offered within the Trust, and the commitment of staff to provide high quality care is beyond doubt. However, the problems result from on-going senior leadership failures within the organisation. Leadership is the most influential factor in shaping organisational culture (Faculty for Medical Leadership and Management, 2015), and is essential to ensure high quality, safe and compassionate healthcare. A key failing identified in Southern Healthcare concerns a lack of robust governance arrangements to investigate incidents, resulting in a lost opportunity to learn from these incidents.

This highlights the importance of senior leadership in establishing and maintaining a culture which is open, responsive and able to learn. Such a culture includes a climate in which communication is valued as a two process which values critical upward communication. This requires a culture of ‘voice’ in which concerns raised by patients, carers and staff are listened to and responded to appropriately. This was sadly lacking at Southern Health and action was not taken to address known risks to the safety of patients, including a lack of response to previous concerns highlighted by the CQC in January 2014, October 2014 and August 2015.

The Trust also failed to respond appropriately to staff concerns about their abilities to discharge certain roles and duties. This perhaps illustrates the failure of senior managers to create a culture of ‘psychological safety’ for staff in which to identify, respond and learn from these problems. Psychological safety has been shown to be a crucial element in organizational efforts to detect and prevent problems (Edmondson et al. 2016). A culture which provides psychological safety for staff embraces ‘challenge’ as a pivotal learning mechanism, and this is supported by the work of McSherry and Pearce (2016) who suggest that safe, quality care requires leaders who can challenge and be challenged.

It is important to learn from the failings of Southern Health. Increasingly NHS leaders need to be able to respond to growing complexity across integrated systems of care. They need the ability to support a system of communication which values the ‘voice’ of all stakeholders to create innovative solutions to 21st century challenges. This requires system leadership that works in partnership across organisations ‘to construct the services that are needed’ (HSJ, 2015:4). It also requires a commitment to create a shared vision of care which values the voice and presence of patients, carers and staff as key stakeholders.

References

McSherry, R.and Pearce, P. (2016) ‘What are the effective ways to translate clinical leadership into healthcare quality improvement?’ Journal of Healthcare Leadership; 2016 (8): 11-17

Perspectives from an Early Career Researcher (ECR): Tips for Conference Engagement

PG research

Last week I attended the 20th European Congress of Physical and Rehabilitation Medicine (ESPRM) in Estoril, which covered topics from functional gait analysis-to-household ergonomics. By the morning coffee break of day one, it came back to me that engaging in a conference is an art-form. In this brief report I hope to share some tips, based on my own experiences in academia.

Beforehand, workload-dependent, leave all mobile technologies and laptops in your room. Emails can wait until the day’s end and social media will only serve to distract (Quentin Tarantino bans mobile phones from his film sets, so there).

Firstly, register early and familiarize yourself with the layout of the conference centre. Stop for a coffee; premium-grade typically dispensed by the sponsor’s kiosk.

Secondly, take the time to read the programme, and map your ‘conference schedule’ (i.e., what sessions you intend to attend). Breakfast presents a fine opportunity for planning, on a day-by-day basis. Schedule planning is important for larger meetings, which can deliver many parallel sessions. Attend a conference with an aim(s). Be strategic; balance topics specific to, and outside your research area. For example, I attended i) functional mobility in older adults (subject-specific), ii) Cochrane Review/PGR development (non-specific, CPD), iii) cognitive dual-tasking (semi-specific, interest), and iv) Nordic walking (personal interest) sessions. Specialist workshops, such as ECR sessions, are gold-dust as you gain insight from international perspectives and practices. I also recommend not studiously attending every single session; I did this in my first conference and burnt out post-coffee break on day two. Don’t feel guilty missing a session if you feel it holds no relevance to you (or your personal development), otherwise you risk losing concentration on the sessions you are interested in. Stop for a coffee.

Thirdly, relax, enjoy yourself and don’t be afraid to talk. You can often learn more (and establish links) during coffee breaks, than in the sessions. Yes, you are at work, and yes, you may be abroad, but don’t fall into wi-fi hunting. Ultimately, you will check, and respond to, emails. You can do this back home. Engage with the academic and local cultures. Remember wi-fi may be omnipresent, but it wasn’t until about 6 years ago.

Finally, ask constructive questions. If presenting, welcome questions as they reflect an interested audience, and may highlight areas that you haven’t yet considered. Do not view negative/antagonistic questions as a challenge, they may not agree with your perspective and/or may have misinterpreted you. Data rigour and quality control are imperative, but findings may be serendipitous.

If you can master these, please tell me how, as I’m still learning.

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Dr James Gavin

Lecturer (Exercise Physiology)

Department of Sport & Physical Activity

jgavin@bournemouth.ac.uk

New comparative paper India-Nepal

international, Publishing

India-NepalThis week saw the publication of a new paper co-written by BU staff in the Sociological Bulletin.  This is the first paper comparing Indian and Nepali Maoist rebels providing health services and health promotion to the communities under their influence.  It presents the key provisions either made by rebel health workers themselves or by putting political pressure on government health workers to deliver better services in the areas controlled by rebels. Prof. Edwin van Teijlingen’s co-authors are based in India and Nepal.  Prof. Gaurang R. Sahay is based at the Centre for Study of Developing Societies, Tata Institute of Social Sciences, Mumbai, India, whilst Bhimsen Devkota is Professor in Health Education, Tribhuvan University, Nepal.

This sociological paper is based on a mixed-method approach comprising 15 interviews and a questionnaire survey with 197 Nepalese Maoist health workers and a secondary analysis of policy documents and other published materials on the Maoist health services of India. The paper suggests that rebel health services in India and Nepal followed a fairly similar approach to what and how they offered health care services to local populations. Maoists becoming a government party changed the political landscape for the rebel health workers in Nepal. However, not incorporating the Maoist rebel health workers into the government health system was a missed opportunity. There are lessons that India and Nepal can learn from each other. Should the Maoist rebels and the Government of India come to an agreement, potential for rebel health workers to be integrated in the official health care system should at least be considered.

The paper benefitted from an earlier review through eBU: Online Journal.  The feedback from the eBU: Online Journal’s reviewers helped shape and polish the paper before submission to the Sociological Bulletin.services-ebu-logo

 

Edwin van Teijlingen

CMMPH

 

 

References:

  1. Sahay, G., Devkota, B., van Teijlingen, E.R. (2016) Rebel Health Services in South Asia: Comparing Maoist-led Conflicts in India & Nepal, Sociological Bulletin 65(1):19-39.

HRA Approval for NHS Research

Research Ethics

HRA Approval is the new process for the NHS in England that simplifies the approvals process for research, making it easier for research studies to be set up. It replaces the need for local checks of legal compliance and related matters by each participating organisation in England. This allows participating organisations to focus their resources on assessing, arranging and confirming their capacity and capability to deliver the study.

Laura Purandare, Research Monitor RBCH, has kindly agreed to run a seminar on 4th May at 2pm in BG14 to explain the changes.

The session will cover:

  • What HRA approval is
  • The implementation of changes
  • The difference it proposes to make to health research in England
  • What it means for our researchers
  • Key resources

The session will last approximately an hour, and Laura will be available for questions following the session. We hope to see you there.

Team-work on Team-based Learning Project : My experience as a URA

Centre for Excellence in Learning, conferences

Blog post by Jade Offer, Undergraduate Research Assistant (Innovative Pedagogy)

I applied to become an Undergraduate Research Assistant (URA) as I believed it would help me develop and learn new skills, and it did! As an accounting student, I enjoy working with numbers and that is why I initially applied. The field I choose was unrelated to my degree course and was something I knew little about: the teaching of pathophysiology to student nurses. Despite this I was fully immersed within the research and have really enjoyed my experience.

Fortunately enough I was chosen alongside a fellow student to work on a research project entitled: An Evaluation of Team-based Learning (TBL) in teaching Applied Pathophysiology to Student Nurses. Working with a fellow research assistant made the job even more fun, and was extremely helpful as we could talk and meet with each other to analyse the data, and to aid each other in inputting the data efficiently. We were welcomed into a team with the research leads; Dr Jonathan Branney and Dr Jacqueline Priego, both of whom provided amazing support for us both as we analysed and organised the research they had previously conducted. They both took time out of their schedules to teach us how to use the new research software we needed to use and made regular contact to assist us, which was greatly appreciated.

My involvement in the project

  • Attend regular meeting with the team to discuss next steps
  • Reading previous literature on TBL (relevant articles to our research)
  • Developing spread sheets to organise relevant exam results data
  • Using transcript software to analyse qualitative data
  • Using SPSS to carry out statistical analysis on the quantitative data collected
  • Communication Skills- Composing and delivering presentations

I also had the opportunity to be involved in SUREBU 2016, which is a showcase of research carried out by Bournemouth University students. We were both given the opportunity to present at national conferences, which we hope to attend, as it is an amazing opportunity and privilege. We have also been given the amazing opportunity to be involved in writing a professional research paper that our team hopes to get published, which is very exciting!

What I have gained

  • Presentation skills- delivering a verbal presentation of our findings and how the research was conducted
  • The importance of participant anonymity and the rules of handling important data
  • The important of research in making future changes and trialling new ideas
  • The development of a research project- from raw values to understandable statistics
  • A keen interest and knowledge of Team-based Learning
  • Knowledge in a new field which I would not have otherwise been exposed to

 I would highly recommend applying for a URA job, it has been such a beneficial experience for me; acquiring new skills, developing existing ones and meeting and working along side motivated and friendly individuals. Immerse yourself in the research job and you will find it an invaluable experience alongside your studies.

Jade Offer, BA (Hons) Accounting and Business student, year one

Dr. Jenny Hall on spirituality in midwifery: new publication

Publishing

Dr. Jenny Hall in CMMPH published her latest article ‘Facilitating learning of spirituality in midwifery’ in the academic journal Spiritual Care [1].   She highlights that there has been considerable discussion in the literature around spirituality at the end of life but little relating to childbirth. Perhaps because of this facilitation of learning around the subject is limited. The aim of this article is to raise awareness of these issues and promote future discussion and research.

Congratulations

 

Prof. Edwin van Teijlingen

CMMPH

 

Reference:

Hall, J. (2016) Facilitating learning of spirituality in midwifery, Spiritual Care 5(2): 81–88.  DOI: 10.1515/spircare-2016-0021,

Seminar, Prof Edwin van Teijlingen, ‘Maternal Mortality in Nepal’, Wed 20th April, Royal London House, R303, 13:00-13:50.

BU Challenges, Centre for Excellence in Learning, conferences, Fusion, Fusion Investment Fund, international, Knowledge Exchange, Knowledge Transfer, REF Subjects, Research assessment, Research Ethics, Research Integritiy, Research themes

Maternal Mortality in Nepal
Abstract: The session links various social and political factors that affect maternal mortality. Women dying in pregnancy and childbirth is very much a problem of and in low-income countries. This talk focuses on Nepal, one of the poorer countries of the world, to highlight a range of maternal health issues and wider influencing factors including globalisation and the influence of global organisations such as the World Health Organisation.

For further information regarding the Social Science seminar series, get in touch with Dr Mastoureh Fathi (mfathi@boutnemouth.ac.uk).

Pritchard & Harding paper cited in top journal, but there’s a ‘but…’

Publishing, Research Integritiy, writing

cloudAs an ECR I am delighted to see that a research paper that Prof. Pritchard and myself wrote in 2014 has been cited in one of the most well regarded journals in the field.

Our paper on the occupational backgrounds of Non-executive directors at NHS acute trusts, published in the Journal for the Royal Society of Medicine Open, was also the subject of an article in the now defunct Independent  newspaper and a post on this blog in May 2014.

Last year, in 2015, it was cited by a paper published in the Journal for Health Services Research and Policy. I won’t name which edition or paper because there is a ‘but…’, and it concerns the carelessness of the authors who cited our work.

There is a ‘but…’ because the authors got my name wrong – both in the in text citation and in the bibliography. The good news is that it still links on citation tracking systems (such as the function on Google Scholar) as a paper that I co-wrote. Yet as an ECR, who is trying to make his way in the ‘publish or perish’ world of academia, I can’t help but feel a bit frustrated. Here’s my name in a top journal, but it’s incorrect.

So I took action, I emailed the editors. To their credit I got a response within minutes, with an apology for the carelessness of the authors and that contact with the publisher had been initiated to see if it could be corrected. Yet, due to the inflexibility of doi, apparently this is unlikely.

This then got me thinking about my first publication. I have to admit I did not check the final galley proof thoroughly enough. Indeed, when it was published, it became apparent that I had not corrected some basic incorrect spelling of names in the bibliography. In other words, some very respected authors’ names were wrong! I can happily report that this was corrected, and no offence caused (I hope!).

But the lesson here – check final galley proofs. If you cite an article, I think the very least you can do, out of respect for colleagues, is to get the authors name right. I have made this mistake, and so have authors who have cited me, so it would scream hypocrisy if I was too mad! But it does show that it might be a relatively common problem, so again – check final galley proofs!

However, once the relative pain bypassed, one our papers has still been cited in a top journal – and that is very satisfying indeed.

 

BNAC presentation Jib Acharya

international, Publishing, student research, writing

Jib poster BNAC +Edwin 2016FHSS PhD student Jib Acharya presented a poster from his thesis research at last week’s BNAC (Britain-Nepal Academic Council) Study Days in Liverpool.[1]  Jib’s PhD research focused on the knowledge, attitudes and beliefs of poor women about nutritious food and the study also identify major food barriers.  He used a mixed-methods approached comprising a survey and qualitative research. The poster at BNAC focused on findings related to mothers’ knowledge, attitudes and beliefs about nutritious food.  Jib’s research is supervised by Dr. Jane Murphy, Dr. Martin Hind and Prof. Edwin van Teijlingen.  Some of the preliminary findings of this FHSS thesis have recently been published in two academic journals. [2-3]

 

Prof. Edwin van Teijlingen

CMMPH

References:

  1. Acharya, J, van Teijlingen, E, Murphy, J, Hind, M. ‘A Comparative Study on Nutritional Problems in Preschool Aged Children of Kaski district of Nepal’ poster at Britain-Nepal Academic Council (BNAC) 14th Annual Nepal Study Days (Liverpool April 2016)
  2. Acharya, J., van Teijlingen, E., Murphy, J., Hind, M. (2015) Assessment of knowledge, beliefs and attitudes towards healthy diet among mothers in Kaski, Nepal, Participation 17(16): 61-72.
  3. Acharya, J., van Teijlingen, E., Murphy, J., Hind, M. (2015) Study of nutritional problems in preschool aged children in Kaski District in Nepal, Journal of Multidisciplinary Research in Healthcare 1(2): 97-118. http://dspace.chitkara.edu.in/jspui/bitstream/1/560/1/12007_JMRH_Acharya.

Higher Education Innovation Fund (HEIF) – events coming soon

HEIF, innovation, Knowledge Exchange, Knowledge Transfer

events

A number of current HEIF projects are running events over the next few months. Please feel to register to attend and/or circulate to contacts you may feel would be interested:

Explore the application of rewilding concepts to Dorset.

Date: Thursday 5 May

Venue: Charlton Down Village Hall, near Dorchester, Dorset. DT2 9UA

For more information on the HEIF project click here.

Click here for more information on the event and to register.

FoodBiz

Date: Wednesday 18 May

Venue: Executive Business Centre, Bournemouth University

Follow  on Twitter: @EU_FoodSMART and visit the project website  www.foodsmartproject.net 

Agenda and register for FREE

Psychiatric  Genetic Counselling Workshops

Dates: Various in June and July 2016

Venue: Bournemouth University

For more information on this HEIF project click here.

Click here for more information on the event and to register.