Systematic Review of Communities of Practice in Healthcare

I love systematic reviews. They are hard work, major undertakings and make life much easier for the rest of us. Compliments to the authors of this new paper which can be accessed online.



How and why are communities of practice established in the healthcare sector?
A systematic review of the literature.

Geetha Ranmuthugala, Jennifer J Plumb, Frances C Cunningham, Andrew
Georgiou, Johanna I Westbrook, Jeffrey Braithwaite

Australian Institute of Health Innovation, University of New South Wales, Sydney,
NSW 2052, Australia.

Does opinion leadership change over time? New Research

I'm pleased to see useful research is being done to clarify further what we mean by opinion leadership. Too often I hear people reducing what is a very complex topic to a simple slide of Roger's characteristics. Roger's initial work on the Diffusion of Innovations was researched and published before the age fo the Internet and before many staff were born. We need updates and we need to grasp a deeper understanding of the complexities.

There's a new paper out.
Implement Sci. 2011 Oct 11;6(1):117. [Epub ahead of print]
Opinion leaders and changes over time: a survey.
Doumit G, Wright FC, Graham ID, Smith A, Grimshaw J.


I've posted the conclusions to this paper below - and recommend you read the original.


"CONCLUSIONS:
Opinion leaders identified in this study were not stable over a two-year time period and generally appear to be monomorphic with clearly demarcated areas of expertise and limited spheres of influence. These findings may limit the practicability of routinely using opinion leaders to influence practice."

Meeting Agenda Good Practice

I've been on a mission for some years to get agendas for meetings organised and prepared in a way that supports an efficient and effective process.  here are many ways to do this and a recent post from Radcliffe Learning [this link is no longer working but I'm leaving this live while I try to find another way to get to the info as it is really useful. It comes from Radcliffe Publishing and you can view earlier editions of their newsletter here)] has some excellent advice. I particularly like the way they suggest the agenda items are to be divided into:

·       Part 1: Items requiring a decision today

·       Part 2: Items requiring discussion today

·       Part 3: Items for information only today

What's your favourite tip for great meetings?

Overcoming resistance to change

Resistance to change is on that "Top Five" list of topcis I get aksed about.

I think the video below is a great answer to the question on how to overcome resistance to change:

Where are the negative studies?

I've written about his before, but I am still concerned about the lack of will to share what doesn't work in quality improvement initiatives. I worry that improvement leaders are so concerned about telling their sponsors that the work is doing very well, that they can't face the less than successful projects. We all know we learn from mistakes - in fact one of the basic tents of quality improvement is the importance of testing and learning (from the good and the bad).

I keep threatening to start the Journal for Quality and Safety Initiative Learning/Mistakes/Failures/Messes.  When I figure the title I'll get it going.  Any suggestions?

Predicting implementation success from organisational readiness

I've wondered for a while whether there is any evidence that we can predict the success of a change based on the organisation's readiness for the change - else why would we bother with worrying about readiness? As always, loads of researchers have not only been worrying about this issue, they have also been investigating it. I found numerous papers, however, one captured my interest - probably because of the rational and detailed way in which the research was conducted.   The conclusion as I figure it, is that it all depends on the biases (or not) in the readiness instrument.

You can read this paper here.

The meaning of Implementation Climate

I've just read a new paper about implementation climate and how it differs from organisational climate - all part of the "readiness for change" strategies than many of us use.  You can read the whole paper at Implementation Science (online - open access). I've pasted the abstract here, though I recommend you read the whole paper.

The meaning and measurement of implementation climate.

Weiner BJ, Belden CM, Bergmire DM, Johnston M.

Abstract

BACKGROUND:

Climate has a long history in organizational studies, but few theoretical models integrate the complex effects of climate during innovation implementation. In 1996, a theoretical model was proposed that organizations could develop a positive climate for implementation by making use of various policies and practices that promote organizational members' means, motives, and opportunities for innovation use. The model proposes that implementation climate--or the extent to which organizational members perceive that innovation use is expected, supported, and rewarded--is positively associated with implementation effectiveness. The implementation climate construct holds significant promise for advancing scientific knowledge about the organizational determinants of innovation implementation. However, the construct has not received sufficient scholarly attention, despite numerous citations in the scientific literature. In this article, we clarify the meaning of implementation climate, discuss several measurement issues, and propose guidelines for empirical study.

DISCUSSION:

Implementation climate differs from constructs like organizational climate, culture, or context in two important respects: first, it has a strategic focus (implementation), and second, it is innovation-specific. Measuring implementation climate is challenging because the construct operates at the organizational-level, but requires the collection of multi-dimensional perceptual data from many expected innovation users within an organization. In order to avoid problems with construct validity, assessments of within-group agreement of implementation climate measures must be carefully considered. Implementation climate implies a high degree of within-group agreement in climate perceptions. However, researchers might find it useful to distinguish implementation climate level (the average of implementation climate perceptions) from implementation climate strength (the variability of implementation climate perceptions). It is important to recognize that the implementation climate construct applies most readily to innovations that require collective, coordinated behavior change by many organizational members both for successful implementation and for realization of anticipated benefits. For innovations that do not possess these attributes, individual level theories of behavior change could be more useful in explaining implementation effectiveness.

SUMMARY:

This construct has considerable value in implementation science, however, further debate and development is necessary to refine and distinguish the construct for empirical use.

Sustainability - how about 52 years?

After 52 years, the Marshall and Fraser Racing MAY be letting down the tyres and packing away their tools. I say MAY, because, if I know them, they might just, possibly, pop out for a few more races next year...

Many of you will have met this team virtually as I have used them as an example of sustainability. I'll leave you with the question I always leave an audience - how will you sustain the results of your work for 50+ years?  I mean results of course. The car looks very different than it did 50 years ago, but their focus is on the outcome.

Congratulations to the team, who, 52 years later, are still on top.

Class Winners of the Championship in 2011.

Improvement Leaders - role modelling

Improvement leaders know a great deal of theory. One aspect of leading that I am constantly aware of, is the need to role model - practice what you preach. It's no good me pushes for the Lean 5S of a hospital ward if my own office is a complete mess. There's a dissonance here.

I recently attended a workshop at NHS Improvement in the UK. This is a smallish group who are dedicated to working with healthcare professionals to improve care. They are all very practical, work in clinically specific teams, and have good results from their projects. They don't get huge press coverage for their work, largely I think because they are humble - and too busy to do PR and marketing!  I joined the session at dinner and was inspired by the way they were holding a raffle to raise funds for a need close to their own values. Not only did they raise money, but there was a lot of fun in doing it.

I left the session the next day quite inspired - and know they will be inspiring others in their day to day work.

Altering mental content - 3: Changing Minds

I come across clients who are sp captivated by the notion of spreading good ideas by stories that they forget that they also need to provide the theoretical base for the change, as well as the need to identify the key concepts - and - if required, support the development of skills to enable others to change.

I drew the above chart as my way of showign how all these topics need to come together.  Next time I am involved in helping someone draw up a spread plan, I'll spend time working through what we need to do to provide the mental content to help others adopt new practices.

6 different types of change by scale - 2: Changing Minds

Large Scale Change means different things to different people. In his book, Gardner suggests six different types of scale. I found these different levels useful in thinking through the strategies I might use to effect proposed changes.

1. Large scale changes involving diverse populations on a national or regional basis
2. Large scale change involving an homogeneous group (e.g. peer group such as theatre nurses)
3. Changes brought about by technology, science or art (e.g. a whole generation has been influenced by Harry Potter)
4. Changes within formal settings (I think of bounded organisations here).
5. Small gatherings and the more intimate shifts in perspective (e.g. group of friends who decide to change their exercise habits and support each each)
6. Changing one's own mind (which, of course, we never admit is probably the most difficult!)

Seven Key Factors in how minds change - 1: Changing Minds

Notes from the book "Changing Minds" by Howard Gardner (2004)

What I learnt was that if we want to help someone change their mind about what constitutes good practice (and thereby figure their practice is not the best so they need to decide to adopt a better practice), then it helps if we can:

1. Demonstrate what has to be changed in a way that someone can figure out for themselves what the reason is for them to change. Some people do this analytically and others deduce or infer from what they learn that a change is necessary. I think it's important to understand it's the adopter who needs to reason, not the person pushing the change.
2. Research, evidence, statistical analysis etc is crucial when working with healthcare professionals for whom this is the base of their practice. The onus of evidence is on the person pushing the change.
3. The proposed change needs to connect at the emotional and intuitive level with the potential adopter. The really good proponents of change can combine the emotive, rational and evidence content in their rhetoric.
4. The concept of redesciption intrigued me. I can see now that the person who can describe the proposed change in many different ways, whilst remaining true to the core concepts and values, is more likely to be able to convince others to change.  Not least, being able to redescribe means you know your stuff and this enhances the credibility of the proposal.
5. Rewards are obvious - pay someone and they are more likely to do it. But this doesn't always lead to the mind changing. The most basic reward is praise and confirmation of the new behaviour.
6. Real World Events - means tagging your proposals to outside influences. As a friend pointed out to me recently, a great time to raise the profile of pancreatic cancer would have been in the days after Steve Jobs died. To make the most fo these (not always sad) events, is to be prepared.
7. Resistance... it takes two to create resistance. The best way I know to deal with it is to stop pushing and to see things form the other's perspective - then, find a way to break through the debate.

Changing Minds by Howard Gardner

A book with the subtitle "The Art and Science of Changing our Own and Other Peoples' Minds" intrigued me. So much of the change process and scaling up better practice across larger systems involves helping others change their minds.  I've made a few notes from the book which I will post here in a series over the coming days.  I recommend you get hold of a copy and have a read for yourself.

Back to Writing

Today is the end of my 4 month experiment... From mi July to mid-October 2011 I reduced my writing significantly. For years I have written blogs, papers, articles, short stories etc on an almost daily basis.  I often wondered what it would be like if I stopped. Would I forget how to write? Would my creativity go away? Would I forget about all those interesting things I'd like to write about?

No.

I've learnt a few things:

• creativity doesn't always need to be captured and I think I've got better at remembering because I have made less notes. However, there have been some things I'd wish I'd written down - but I knwo they will come back to me
• the break has allowed me to mull over some ideas in more depth. I've performed some "what if's" in my head and thought through scenarios, ideas, theories, plots and characters
• I love to write. Boy, am I desperate to get back to writing!

So here we go again...

How safe are clinical systems - report on the evidence by The Health Foundation

This report for The Health Foundation is excellent. I like the way it is based on research and whilst it doesn't cover any specifically new ground, it does provide insight for anyone wishing to improve the safety of patients in hospital. 

"While the knowledge that poor systems can cause harm is not new, this report provides groundbreaking evidence of the extent to which important clinical systems and processes fail, and the potential these failings have to harm patients.

The results of this study, covering seven NHS organisations, identify the variation in the reliability of five key healthcare systems and processes:

• availability of information when making clinical decisions
• prescribing
• handover
• availability of equipment in operating theatres
• availability of equipment for inserting intravenous lines.

The research, led by Professor Bryony Dean-Franklin, was conducted by The Centre for Patient Safety and Service Quality (CPSSQ) at Imperial College, and Warwick Clinical Systems Improvement (CSI), University of Warwick."

Fully-funded leadership programme open for application - Health Foundation, UK

 Fully-funded leadership programme open for application

The Health Foundation is seeking people who are passionate about transforming healthcare to join GenerationQ, its fully-funded, masters-level programme creating leaders for improvement.

GenerationQ is open to senior leaders in healthcare or the voluntary sector who are in a position to influence improvements to care quality.

Fellows will learn about the evidence base underpinning leadership for quality improvement and how to apply improvement science, leadership and change theories in practice.

Fellows will also deliver a substantial improvement project in their place of work, benefiting their organisation through addressing real-time quality challenges, based on organisational priorities.

This part-time programme takes between 18 months and two years to complete, and leads to a postgraduate certificate, diploma or Masters in Leadership (Quality Improvement), accredited by Ashridge.

The Health Foundation is an independent charity working to continuously improve the quality of healthcare in the UK.

If you are interested in applying, please visit the Health Foundation’s website to find out more and download the application form: www.health.org.uk/generationq Please pass on this information to anyone who may be interested.

The deadline for submitting an application form is 9am on Monday 18 July 2011.

Guide to facial expressions and emotions

I think http://www.cedarseed.com/fire/emotut.jpg should be in every meeting room - if only as a reminder for us all that we say more with our expressions than with what comes out of our mouths...

Get your long documents summarised - Topicmarks

I'm a quick reader but never shy of a short cut I checked out Topicmarks. It promises to summarise the document you load into short easy sentences. I tried it on a complex Dept of Health document and I love the result! The 15 page document of tightly packed text was summarised into a single page of mostly bullet pointed sentences.  I quickly got the gist of what the document was about. And yes, I did then check whether the system produced a good result, by reading the whole thing, and it did.

A great system, though of course, the originator of documents could also provide a short summary list in the first place! I think this will be good for the quick review of academic papers.

It is free (in beta) and I don't get anything for recommending it...

Why do we forget good practice?

I spent a lovely English Spring day visiting the Roman Villa of Chedworth. I came away marvelled by the way in which they had underfloor heating and an hygienic toilet system fifteen hundred (and more) years ago. When the Romans left our small island, those who remained ignored / forgot about (not sure which) these and many other useful inventions.  Why did they do this?

And what other well evidenced business related techniques and products have we forgotten about and are ignoring?

Implementing social media is more than dabbing in a few fun technologies

Technology is really exciting - for those who get excited about it. But technology is useless unless it connects with those who use it. There's the obvious stuff about it needing to be easy to use. But there's also the need to any technology that puts "social" in its marketing blurb - to be just that - social.  And then there's the need for the organisations that want to jump onto the social media bandwagon to make sure they are doing so with thought and concern rather than a random set of activities they can tell everyone they are "into social media".

Here are five sets of questions to ask yourself if you're wanting to involve social media in your business:

1. Why social media and not any other strategy or technique we and our customers are used to?
2. What do we expect to happen? What is our intention? 
3. How will we, and our customers, keep moving with the times as new technologies become available? 
4. To what extend are we building on what works? Does this matter?
5. What policies and legal concerns do we need to take into account?

Oh, and I'll add one more, just in case:

(i) How do we define social media?

Three Collaborative Models for Scaling Up Evidence-Based Practices

A new paper is out is Adm Policy Mental Health (See abstract below). Two of the models are those I've presented on and published about - the rolling cohort and the cascading dissemination model. There are also subsets of these methods - see my book 101 ways to improve your collaborative. 


Three Collaborative Models for Scaling Up Evidence-Based Practices

Chamberlain P, Roberts R, Jones H, Marsenich L, Sosna T, Price JM.

Source

Abstract

The current paper describes three models of research-practice collaboration to scale-up evidence-based practices (EBP): (1) the Rolling Cohort model in England, (2) the Cascading Dissemination model in San Diego County, and (3) the Community Development Team model in 53 California and Ohio counties. Multidimensional Treatment Foster Care (MTFC) and KEEP are the focal evidence-based practices that are designed to improve outcomes for children and families in the child welfare, juvenile justice, and mental health systems. The three scale-up models each originated from collaboration between community partners and researchers with the shared goal of wide-spread implementation and sustainability of MTFC/KEEP. The three models were implemented in a variety of contexts; Rolling Cohort was implemented nationally, Cascading Dissemination was implemented within one county, and Community Development Team was targeted at the state level. The current paper presents an overview of the development of each model, the policy frameworks in which they are embedded, system challenges encountered during scale-up, and lessons learned. Common elements of successful scale-up efforts, barriers to success, factors relating to enduring practice relationships, and future research directions are discussed.

Difficult Conversations 5: The Art of Listening

Conversation requires a talking AND listening, and these actions need to be shared by everyone involved. Some people may need help expressing themselves and other may need help in listening to others.  Usually, it is the listening that is more difficult.

The Art Of Listening

View more webinars from Phil Wylie

Difficult Conversations 4: Fierce Conversations - practical tips

The practical advice in this slideshow is very helpful. I particularly like the "Sixty second" technique for starting off the conversation.

Fierce Conversations

View more presentations from Evan Wood

Difficult Conversations 3: Tips from the psychology viewpoint

There's no one way to approach a difficult conversation. The short slideshow below covers some useful hints and tips - if the psychological viewpoint is interesting and useful to you.

Making Difficult Conversations Less Difficult

View more presentations from John Deely

Difficult Conversations 2: Remembering Body Language

There's research (though controversial) that suggests more than half of our communication with an other comes through body language. We instinctively know this, however, when dealing with difficult situations and conversations we can easily forget this.

Body language is just that - a language. Complete with a syntax and grammar. It is not enough to think that someone who crosses their arms is being defensive. We need to understand the whole "paragraph" they are speaking with their body. They may in fact be cold or they may just be leaning back and relaxing. We need to look at the whole body and its cue.

Secrets of Body Language

View more presentations from Arif Anis

Canadian Best Practices Portal - Healthcare

The Public Health Agency of Canada has a very interesting website: Canadian Best Practices Portal.  I think it is an excellent example of helping to spread good practice.

1. It describes interventions (best practices) without overly classifying them. The reader can make their own judgements of value and worth. I also like the way these are summarised as they are written for the reader and not as corporate sales pitches which is a temptation other organisations fall foul of. 
2. The resources have a great at-glance feature which show how they relate to define, search, appraise, synthesise, adapt, implement, evaluate.
3. Their list of systematic review sites is extensive and pitches these best practices as being based on evidence which is both appropriate and welcome for healthcare interventions.

Difficult Conversations 1: The DED Technique

Dealing with the difficult situation is difficult - usually because emotions are running high and emtoional responses tend to send all good planning straight out the window. One technique I've found useful is simple enough to remember when the flak hits the fan and tends to work well - the DED technique.

D = Describe 

E = Example

D - Discussion

Describe the behaviour you're finding difficult, how it makes you feel and explain the wider impacts of the behaviour. Without any description the other person probably has no idea why you are upset.

Then provide an example of what it is you've just described. Without an example the other person may think you're making it up and may not be able to ground the descriptions in reality.

Discussion - or I prefer the term dialogue as that presumes it is a two-way thing - is the obvious important and final step. If the first D and the E have gone well then the discussion should be fairly straightforward - though posisbly still emotive.

Do you have a favourite technique you'd like to share?

Hans Rosling's 200 Countries, 200 Years, 4 Minutes - The Joy of Stats - BBC Four

This video is pure genius. For anyone who doubts the importance of visualisation for bringing insight to data, then take a few minutes to view this video:

Design a 50 minutes lecture that works

Tired of the person who stands up and delivers a repeat of their presentation (they are as bored as you)? Tired to the point of not being able to concentrate for more than the first few minutes of a presentation? Tired of making it through to someone's lecture to discover afterwards you have no idea what you learnt?

John Medina is a scientist who researches ways to avoid problems like these. He also has some very practical advice. I like his Brain Rules website, with videos (nice to see him practising what he preaches), tips and links to a new book. Each of his 12 rules are available with illustrations and videos.

Advice for a 50 minute presentation? Break it down into 10 minute segments. At the end of every segment add a hook / statement that will generate an emotional response in the listener. I'll be trying that for my next presentation.

Leadership models and theories - some links

I'm often asked what leadership theory I espouse. I'm never sure how to answer because I think leadership is a practice and not a theory. However - as we know, all models and theories can be useful (though remember none are right!).

Here is a collection of a few of the places where I go for leadership theory information

1. Academic online library - this is always my first choice (keep those fingers of the Google Search button!). Here is can find properly thought out, detailed, reviewed and practised theories. It is also here that I learn about the latest research and practice.  For me, these papers are more useful that books as they are not subject to marketing bias.
2. Google Scholar Search - bridges the academic library with the wider Google Search
3. Current books - either buy, download or go to the physical library to borrow
4. The Web...

Some useful web links:

1. Nice summary and overview for those of us who often don't have time to read a whole book or figure out the complexities of a paper
2. A review of leadership theories and competency frameworks - ok, this is a paper, but a useful one...
3. http://www.12manage.com/i_l.html has a page full of ideas and concepts to keep you thinking

Post your favourites in the comments section.

Leadership means putting personal differences aside

Mike Golding is an International Yachtsman.  He is also the man who gave up a winning position in a round the world yacht race to pick up a distressed competitor - someone with whom he'd not had the best of relationships.

Enough said.

How far out of your way will you go to help someone you may not like, but who is struggling?

Leadership notes from a pilot who saved the passengers

Staying with the leadership theme of the previous posts, Capt Peter Burchil has some interesting reflection of the incident where the BA777 from China, in January 2008, landed short of the runway, due to a technical issue. There was no warning and it was skill, maybe a bit of luck, and a cool head that resulted in no loss of life.

One of his taglines was "plan for the expected and prepare for the unexpected" which I think is an excellent mantra for anyone at work - especially during times of great change.

He summed up his talk by explaining how he was taught in the controlled environment of the simulator to "Aviate, Navigate, Communicate". What an excellent three words those are for any manager or director! For "aviate", substitute the verb that best describes what your job requires you to do (the tick here is to remember to keep doing what you're supposed to be doing and not get distracted.). Navigate - similar to aviate, though I think all Executives should keep navigate in their list of three words. Communicate is obvious.

What are your three words that ensure you remain leading in a crisis?

Leadership thoughts from an astronaut

When I heard Tom Henricks speak at a conference, I was inspired in many ways. A few of the notes I captured all seemed to relate to leadership on the very edge of what is important; there is room for mistakes on a Shuttle.

He spent time talking about how leadership is also about teamwork; how you cannot be a leader unless you have a team. But this also means the leader needs to be an excellent team player. You cannot separate leadership from teamwork. I don't think this has been so clearly set out for me before. It is obvious when you think about it, but less obvious in action in the workplace.

He didn't equate leadership with a consensus, soft approach. He quite clearly explained how the buck did stop with him. On launch, he was the person who said the word"Go". His was the final decision. (mmm, now that is taking responsibility!)

Leadership lessons from rugby

A few more wise words from Brendan Venter than I picked up:

When it comes to leaderships, he believes:

• walk the talk
• never be neutral (learn to have a point of view)
• be able to build relationships (learn to like each other)
• stay in the core
• communicate effectively with colleagues

Again, standard stuff, but so hard to do, consistently and predictably.

Most popular posts on the Spread Good Practice blog

Here is the list of the most popular posts on this blog for the last 6 months.  If I'd had to guess I'd not have guessed these - nothing like a good bit of measurement to separate fact from opinion!

Model 2: data, information, knowledge, wisdom 22 Dec 2010, 1 comment 640 Pageviews

The quickest way to spread scale up change 21 Jul 2010 484 Pageviews

Model 1: data, information, knowledge, wisdom 20 Dec 2010 339 Pageviews

Using Twitter in the Classroom or Organisation 2 Sep 2010 320 Pageviews

Productivity 1: Operational Efficiencies are not e... 24 Oct 2010, 1 comment 284 Pageviews

Research into Implementation and Spread: Methods, Findings and Future Agendas by John Ovretveit.

If you were unable to attend John vretveits March 24th VA Cyber Seminar, you can now view the archived video (link below). 

QUERI Implementation Research Seminar

Thursday, March 24 1:00pm-2:00pm ET

Research into Implementation and Spread: Methods, Findings and Future Agendas by John vretveit, Ph.D.

Here is the link to the flash video of the presentation:

http://www.hsrd.research.va.gov/for_researchers/cyber_seminars/archives/qir-032411.cfm

Staying motivated

Brendan Venter, coach of an English rubgy team, explained at conference I attended, how important it is to keep motivated, especially in difficult times. This sounds a bit trite but I was interested in the way he explained for a team that is losing, when you get together at half time, the pep talk is important., However, what really matters is the culture of the team that will support their ability to survive the difficulty and to work through it so they engineer some from of success.

Will healthcare systems all over the world going through significant change, I was left wondering how important past and current culture is - so often the word on the organisational street is "we must develop a new culture" - but it may be too late. It is the existing culture that will determine much of the success of tomorrow.

Brendan also mentioned that people on the team need to know what the purpose is of it all. They need to know this for themselves. It is not something that can be issued in a memo. What is it that keeps people coming back to work?  Ultimately, he suggests, it is friendship. There is nothing else.

Never events: what's on your list of ensuring patient safety?

I was talking about Never Events at a dinner party, trying to explain what they are, and two friends were horrified - at the concept that in healthcare we need to draw up a list of things that should never happen.  I agree, as a patient the list below does feel scary - not because they might happen, but because we need to talk about them not happening...


The NHS in England has just expanded the list to 26 from 8 (details are in this policy document); I'm still not sure whether this is a good thing or not.I have heard that some countries and regions don't bother with Never events lists. I'd be interested in finding out whether they do this for a reason.

There are 25 "never events" on the expanded list. This includes the original eight events from previous years, some of which have been modified, and builds on the draft list published in October 2010. The list is as follows:

1. Wrong site surgery (existing)
2. Wrong implant/prosthesis (new)
3. Retained foreign object post-operation (existing)
4. Wrongly prepared high-risk injectable medication (new)
5. Maladministration of potassium-containing solutions (modified)
6. Wrong route administration of chemotherapy (existing)
7. Wrong route administration of oral/enteral treatment (new)
8. Intravenous administration of epidural medication (new)
9. Maladministration of Insulin (new)
10. Overdose of midazolam during conscious sedation (new)
11. Opioid overdose of an opioid-naïve patient (new)
12. Inappropriate administration of daily oral methotrexate (new)
13. Suicide using non-collapsible rails (existing)
14. Escape of a transferred prisoner (existing)
15. Falls from unrestricted windows (new)
16. Entrapment in bedrails (new)
17. Transfusion of ABO-incompatible blood components (new)
18. Transplantation of ABO or HLA-incompatible Organs (new)
19. Misplaced naso- or oro-gastric tubes (modified)
20. Wrong gas administered (new)
21. Failure to monitor and respond to oxygen saturation (new)
22. Air embolism (new)
23. Misidentification of patients (new)
24. Severe scalding of patients (new)
25. Maternal death due to post partum haemorrhage after elective Caesarean  section (modified)

Publishing negative studies is good for learning

Humans learn by making mistakes. When the mistakes of others are hidden then we all have to go over the same ground to discover the errors - a waste of time, in many cases. The issue of publishing negative studies is a bit one.  When I was researching my book "Why good practice doesn't spread" I could find no-one who was prepared to share, publicly, their experience of a large scale change project that did not achieve what it set out to do. They would talk in private and anonymously - but not openly.

One of my ambitions is to start the online Journal of Quality Improvement and Patient Safety Program Failures. I would love to be able to read about projects that went pear-shaped. I think I would learn more from them than from the ones which advertise greatness.

If you have ideas on what should be included in this Journal then please leave a comment on this blogpost or email me directly.

In the meantime if you want to read a few articiples and papers about the issue check out:
Increased calls for publishing negative clinical trial data
Publish or perish culture distorting research results
The importance of publishing negative results

Is there evidence for your quality improvement intervention?

Is there evidence for the interventions we're using to improve quality of services and to reduce costs? I suspect in many cases there isn't. Sometimes just doing something is better than nothing, though I do find it surprising that some organisations are strong at pushing a particular intervention, even though there are few (unpaid for) independent evaluations. And on the other hand, there are some well evidenced interventions that organisations don't want to use because they are appear old fashioned. Hmmm - we demand of healthcare professionals that they use the best evidenced methods - should we be demanding that of ourselves?

There's an excellent visualisation for the scientific evidence of dietary supplements. When I looked at this I wondered whether we could do something similar for the quality improvement interventions that are being used around the world?

In the meantime, using the SQUIRE Guidelines to write up your projects will go a long way to building up an evidence base of what works - and what doesn't.

The Innovator's DNA - book by Dyer, Gregerson, Christensen

The Innovator's DNA; Mastering the five skills of disruptive innovators is a book that we really need - right now - as we try to rearrange public services so we reduce costs and improve quality. I hear many people talk innovation but few actually doing it. I also think there are many innovators hidden away in organisations; just because they aren't smart at advertising themselves doesn't mean their abilities shouldn't be harnessed. So be on the look out for the following:

1. Associating; innovators connect the dots and see patterns between seemingly unrelated topics, tasks and issues
2. Observing: innovators spot emerging trends long before the formal reviews because they are intense observers of the small details.
3. Experimenting; innovators try things out - they don't necessarily talk about it or spend their time encouraging others to do it - they test things out themselves
4. Questioning; innovators can be a pain in the rear because they are curious and because they like discovering new stuff
5. Networking; it's difficult to spot patterns, notice details and test things out unless you have buddies. Innovators are terrific networkers and often link with others outside what may appear to be "normal" interests. They are also involved with groups outside their employment.

How would you rate yourself on these five categories?

Social Media Policy: The simplest way forward

So many public sector organisations are still banning the use of social media. This seems a bit like being unwilling to give up your horse when the cars are all whizzing past you.  Anyway, the root of this short-sighted vision is often fear. Apart from fear of the unknown (when senior managers have no idea about social media they are more prone to ban it or poo-poo it) there is also the fear of lack of control. In the public sector we're good at writing rules and regulations so when management does get to grips with social media it tends to be via a tortuous and complicated social media policy.

I particularly liked Mike Brown's take on social media policies. He recommends the following (please go to his blogpost to read the whole article:

“Will what you’re about to share online offend, surprise, or shock your

• Spouse
• Mother
• Employer (current or future)
• Clients (current or future)
• Business partners (current or future)
• Coworkers
• Children

in a way which critically jeopardizes your relationship? If you answer even one “Yes” for this short list of people, think long and hard before publishing your content.”