Research: How engaged are patients in their healthcare

The Heatth Foundation has released an excellent report on their research into patient engagement. It's one of the most up to date and significant reports I'e seen on this topic for a long time. It makes for some uncomfortable reading, especially regarding patients who have long term conditions.  There is a summary report, but I commend the full version for required reading for all NHS Commissioners and those working on improvemet projects.

Paper: Surgical Safety Checklist - more than checking a box

Fabulous - the authors have published a study where the results show there's a problem. I've been harping on about the lack of negative studies for years. So well done to the authors.

Basically, they've done some follow up work to see how well used the surgical safety checklist is. No surprises to discover that is most cases only 4 of the 13 items were checked. They suggest there is a problem with the fidelity of implementation, and a poor dissemination strategy and implementation.

Fidelity really is key. There's no point in shouting from the rooftops that 100 hospitals are using a checklist, for example, if it is not being used as intended. The results will not be as good as the pilot study. The return on investment for the project will not be as good. And, who knows, in some programs, the results may actually be worse than if the program hadn't been disseminated.

Fidelity. Important.

Surgery. 2012 Jul 6. [Epub ahead of print]
Implementing a surgical checklist: More than checking a box.
Levy SM, Senter CE, Hawkins RB, Zhao JY, Doody K, Kao LS, Lally KP, Tsao K.

Book Review: NO! How one simple word can transform your life, by Jana Kemp

This makes a change from all the "Yes, you can" books! It's basically about getting over the fear of saying now and taking control of any circumstance without negative consequences. A critical aspect as you might imagine is tone of voice and the author words hard to ensure we understand that it's critical we get this right - not too fast, too harsh and to make sure we choos the right words when we do mean it. It is also key to stick to your decision when you've make it.

Kemp has a model called the POWER of No which has an acronym from POWER: Purpose, options, when, emotional ties and rights/responsibilities. She suggests that using this acronym will help us to make a yes / no decision based on the right issues at the time. For me I find it a lot to think about when considering a yes/ no response online, though I suppose you get better at it with practice.

In essence the decision prcess goes like this
- think about the purpose and context of the decision
- what option do you have? What resources are available?
- when is it due? What is the deadline and can you meet it?
- be realistic about the emotional ties
- consider your rights and responsibilities

I'll be trying out some "No's"....

Paper: Complexity science and spread

Well, the best bit about this paper for me is the introduction of the terms SUS - scale up and spread!  It focuses on self organisation (complexity science principle) and how the complexity of healthcare and all the interactions are part of the problem of SUS programs.

Now, I'm biased and I'm with Ralph Stacey who says that when we think we can "control" or "use" self organisation then we are operating with a mindset not much different from Taylorism (see his work on complex responsive processes which superceded complex adaptive systems around 2001).

Whilst using insights from complexity science is useful, it is just that - an insight. When it comes to moving on to a more practical thought about - "so what do we do now", CAS and Complexity Science as such, falls flat.  There is a well trodden, pragmatic and practical systems theory and modelling that would be helpful in understanding interdependences - "Systems Thinking". Unfortunately it requires a bit of effort to grasp and seems not to have the cachet of "complexity science". Shame.

Soc Sci Med. 2012 Jul 4. [Epub ahead of print]
How complexity science can inform scale-up and spread in health care: Understanding the role of self-organization in variation across local contexts.
Lanham HJ, Leykum LK, Taylor BS, McCannon CJ, Lindberg C, Lester RT.

Book Review: The Wisdom of Crowds by James Surowiecki

It's quite annoying to find out that groups make better decisions than you can as an individual - but a very powerful thought. However, the groups need to be diverse, independent and decentralised (so that may exclude a few crowds I can think of...)

We are essentially cooperative beings and meld our behaviour around that of others. One of the examples in the book is how crowds flow in shopping centres, how we move on staircases etc. We do all this even when there are no explicit rules. Mind you, as someone who regularly travels to the US from the UK I know what it is like to accidently move against this flow when I forget to walk on the "right". So maybe there are more socialised rules and logic than the author makes explicit.

One theme in the book which did appeal to me was the notion of the difference making a difference. While it seems inefficient, having a diversity of ideas seems to allow meaningful differences of ideas, especially at the early stages of decision making - and this is important. Groups also need to be able to distinguish good ideas from bad ideas and having more to choose from helps.

There is some helpful work about distinguishing the difference between situations which are easily defined by a single answer, such as the weight of an ox, and those which are more co-ordination problems, such as traffic manageemnt. Co-ordination problems come when all individuals want to go their own way. Here the wisdom of the crowd sound a lot like complexity science and simple rules and I wasn't totally convinced of all of his arguments. However, they were interesting.

A thought provoking book which much more to say that the few bits I have mentioned here.

The book's website is here http://www.randomhouse.com/features/wisdomofcrowds/ where there is a lot of detail and audio to download.

Book Review: New Age of Innovation; Prahalad & Krishnan

If you're interested in large scale change and innovation then you'll find this book fascinating. On the one hand it felt like there was nothing startlingly new to me yet on the other it was neatly put together in a readable way that made sense.

A key premise is the current trend of personalisation and how value is based on the unique experience we all want. The authors refer to this as N=1. Current technology drives this, social networking, web 2.0 etc. How can we co-create value with our users and consumers? What are the challenges with managing who owns the knowledge? All good questions. They also suggest we need to make the most of collaborative networks, electronic and face-to-face, be flexible and ensure scalability. I liked the section on scalability and in my mind there is more in here than what they covered. This is a key element and is also linked to their second premise.

The 2nd key premise is the one that resources need to be global and they use another little formaula: R=G. Here they suggest the issue is that access to resources is more importnat than providing products; namely it is the solutions that matter rather than the kit or pieces. I think I agree with this. Again, scalability comes up.

They mention social movements and how they figure in the process as well as organisational transformation. There was nothing much new in the organisational process other than the context of the infomrational technology infrastructure - well, that is rather new and for some people rather perplexing.

If you've not yet engaged with Web 2.0 and new technology then this is definitely worth a read.

Paper: Developing capable QI leaders

A paper for those who have the pay-for access... Cincinnati Children's Hospital have been running cohorts of leaders through 6-month programs. The results look impressive, with two thirds completing their QI projects and a third of those involved presenting their project work at conferences.

BMJ Qual Saf. 2012 Jul 12. [Epub ahead of print]
Developing capable quality improvement leaders.
Kaminski GM, Britto MT, Schoettker PJ, Farber SL, Muething S, Kotagal UR.

Book Review: The Art of Changing the Brain by James Zull

I was recommended this book by Paul Batalden and he was right - it is excellent.

The subtitle is "Enriching the practice of teaching by exploring the biology of the brain". The author manages to integrate biology and neuroscience with educational and learning tactics. For me the book brought to light the process of learning in the sense of how the structure of the brain influences the process.

Zull explains the natural relationship between the structure of the brain and learning, how brain connections change data into knowledge, the way that evolution of the brain is linked to how we are motivated in our learning, and the importance of emotions in the learning process.

While the book covers some breadth of biology at no time was it too complex to follow for someone like me who has limited knowledge of the subject. I think, if you did know more about biology, then you would possibly get more out of the book than me.

Parts I really like was when Zull got practical and linked the discussion to how teacher can then use this knowledge to provide better learning experiences. Having made the links to brain structure it really made sense. I have been testing out some of the ideas and techniques and they do seem to work for me and for those with whom I work.

If you're a fan of PDSA cycles then on reading this you will probably have a major "Aha" moment as you figure out just how they work!

Report: Cross Sector Working to Support Large Scale Change

The Health Foundation has come up trumps with a fabulous light touch literature scan of evidence around how cross sector working influences large scale change.

I commend you to read it.

Paper: Evidence based surgery - don't show this to the patients!

I stopped to read a summary of this paper, mainly because I was struck by the thought that surgery may not be evidence-based... The best bit about this paper, for me, is that the authors have described the elephant in the room (or should that be in the operating theatre). Well done to them.

World J Surg. 2012 Aug;36(8):1723-31.
Evidence-based surgery: barriers, solutions, and the role of evidence synthesis.
Garas G, Ibrahim A, Ashrafian H, Ahmed K, Patel V, Okabayashi K, Skapinakis P, Darzi A, Athanasiou T.