Publications
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Hofer S, Otis M, Barber S, et al., 2023, Evaluating the implementation and impact of a new model of care for integrating children and young people’s acute mental healthcare in a paediatric setting: A protocol for a realist, mixed methods approach, BMJ Open, Vol: 13, Pages: 1-9, ISSN: 2044-6055
IntroductionThe mental health of children and young people in the UK has been declining, and has continued to worsen throughout the pandemic, leading to an increase in mental health related emergencies. In response, the Best for You programme was developed as a new service designed to integrate mental health care for children and young people between acute hospital and community services. The programme is comprised of four new services: a rapid assessment young people’s centre with dual trained staff, a co-located day service offering family-based care and a digital hub, designed to integrate with the fourth element of the model, namely community support and mental health services. This evaluation aims to assess the development, implementation and outcomes of the Best for You programme and develop a scalable model that could be implemented in other parts of the National Health Service (NHS).Methods and analysisThis mixed-methods realist evaluation aims to delineate the components of the system to assess their interdependent relationships within a wider context. Data collection will include interviews, participant observations, focus group discussions and the collection of local quantitative service data. The research will be conducted across four phases. Phase 1-captures the development of the underlying programme theory. Phase 2-a process evaluation testing the programme theory. Phase 3- an outcome and economic evaluation. Phase 4-consolidatation of learning from phases 1-3 to identify barriers, facilitators, and wider contextual factors that have shaped implementation drawing on the Consolidated Framework for Implementation Research.Ethics and disseminationEthical approval for the evaluation was received from the NHS local ethics committee. Embedded within the evaluation is a formative review to feedback and share learning with stakeholders to scale-up the programme. Findings from this study will be disseminated in peer-reviewed journals as well as presentat
Hofer S, Njoku C, Sathyamoorthy G, 2023, The role of accelerator programmes in supporting the adoption of digital health technologies: a qualitative study of the perspectives of small and medium-sized enterprises, Digital Health, Vol: 9, Pages: 1-10, ISSN: 2055-2076
ObjectiveEvidence-based digital health technologies are increasingly important in delivering care to an ageing population with constrained resources. In the United Kingdom, accelerator programmes (APs) have been developed to support the adoption of digital health technologies within the National Health Service. This study aims to explore the perspectives of stakeholders using APs.MethodsStakeholders representing nine small -and medium-sized enterprises (SMEs) that were engaged with three different APs (n = 9). Semi-structured interviews were conducted with key informants between April and September 2018. Framework analysis of the data was performed to explore their perspectives on APs.ResultsFour key themes were generated. Informants reported the need to generate evidence before and during the programme, appreciating different types of evidence and their importance. Informants identified several key factors that were a catalyst for success, including involvement in the programme and access to individuals and organisations that were crucial for support. However, several barriers were identified at the programme and system levels. Finally, informants identified key supporting processes that enhanced the adoption of their innovations.ConclusionSMEs that develop digital health technologies report that, while APs are useful in supporting the adoption of these technologies, some issues remain. These relate to the emphasis on traditional research evidence that remains a challenge for SMEs to generate. Also, several system-level barriers to innovation in healthcare persist. As APs and SMEs continue to create an entrepreneurial ecosystem, there is increased potential for the development of supporting processes and infrastructure to accelerate the efficient and timely adoption of new digital health technologies.
Hofer S, 2020, Complexity, co-creation and social practices – re-constructing quality improvement: a case study in mental health
The use of research evidence to change clinical practice remains a significant challenge. Quality improvement (QI) offers a methodological approach to support this ‘knowledge to practice’ process. However, most research on QI focuses on the use of knowledge and not its creation to improve practice. This research aimed to address this gap through an exploration of the social process of co-creating knowledge within a QI project. The case study aimed to improve the physical health of people with serious mental illness through the introduction of a physical health ‘pathway’. The QI project used participatory approaches to introduce new evidence-based clinical practices, initially on a single ward, and then scaled-up across five additional wards within an acute mental health unit in the National Health Service (NHS) in England. This four-year study used ethnographically-informed qualitative participatory approaches where the researcher was part of the QI project. Data were generated through participant observations, interviews and documentary analysis. The analysis included generating a narrative of the project, and the use of Knowledge Mobilisation and Implementation Science frameworks. This research offers a window on the social construction of a QI project. Improvement is a socio-technical process that relies on social practices to generate the work required to support the ‘knowledge to practice’ process. QI methods draw on the tacit knowledge and experiences of stakeholders which is codified in outputs from workshops, which in turn can be used in the co-design of interventions. This co-constitutive process of simultaneous knowledge ‘use’ and ‘creation’ contributes to the co-creation of collective understandings and meanings, which compose the social practices of QI. However, issues of responsibility and accountability pose a significant challenge, and a careful balance needs to be found between the use of th
Matthews R, Hofer S, Myron R, et al., 2019, Connections: The power of learning together to improve healthcare in the United Kingdom, Patient Engagement: How Patient-provider Partnerships Transform Healthcare Organizations, Editors: Pomey, Denis, Dumez, Publisher: Springer Nature, Pages: 129-167, ISBN: 9783030141011
Patient, service user, health, and disability advocacy movements contribute to a stronger voice for patients in healthcare in the UK. The National Health Service, introduced in 1948, funded through general taxation, and free at the point of delivery, is less characterized by paternalism now than at its inception. Successive health reforms, policy directives, and legislation support increasing patient autonomy and choice. With the introduction of the internet, changes in technology, and the growth of social media, patient expectation and behaviour are shifting further towards active involvement in decision-making. Translating policy rhetoric and research evidence into meaningful patient and public involvement practice presents challenges to healthcare professionals and researchers. Co-designing opportunities to learn collaboratively offers ways to strengthen practice through the exchange of experiential knowledge and to generate emergent insight. This enhances relational skills that underpin quality improvement, research, and transformation. Patient and service users eloquently articulate the benefits of learning together and model attributes that are essential to improvement efforts.
Gilhooly D, Green SA, McCann C, et al., 2019, Barriers and facilitators to the successful development, implementation and evaluation of care bundles in acute care in hospital: A scoping review., Implementation Science, Vol: 14, ISSN: 1748-5908
BackgroundCare bundles are small sets of evidence-based recommendations, designed to support the implementation of evidence-based best clinical practice. However, there is variation in the design and implementation of care bundles, which may impact on the fidelity of delivery and subsequently their clinical effectiveness.MethodsA scoping review was carried out using the Arksey and O’Malley framework to identify the literature reporting on the design, implementation and evaluation of care bundles. The Embase, CINAHL, Cochrane and Ovid MEDLINE databases were searched for manuscripts published between 2001 and November 2017; hand-searching of references and citations was also undertaken. Data were initially assessed using a quality assessment tool, the Downs and Black checklist, prior to further analysis and narrative synthesis. Implementation strategies were classified using the Expert Recommendations for Implementing Change (ERIC) criteria.ResultsTwenty-eight thousand six hundred ninety-two publications were screened and 348 articles retrieved in full text. Ninety-nine peer-reviewed quantitative publications were included for data extraction. These consisted of one randomised crossover trial, one randomised cluster trial, one case-control study, 20 prospective cohort studies and 76 non-parallel cohort studies. Twenty-three percent of studies were classified as poor based on Downs and Black checklist, and reporting of implementation strategies lacked structure.Negative associations were found between the number of elements in a bundle and compliance (Spearman’s rho = − 0.47, non-parallel cohort and − 0.65, prospective cohort studies), and between the complexity of elements and compliance (p < 0.001, chi-squared = 23.05). Implementation strategies associated with improved compliance included evaluative and iterative approaches, development of stakeholder relationships and education and t
Reed JE, Green S, Howe C, 2018, Translating evidence in complex systems: a comparative review of implementation and improvement frameworks, International Journal for Quality in Health Care, Vol: 31, Pages: 173-182, ISSN: 1353-4505
PurposeAn increasing number of implementation and improvement frameworks seek to describe and explain how change is made in healthcare. This paper aims to explore how existing frameworks conceptualize the influence of complexity in translating evidence into practice in healthcare.Data sourcesA database was interrogated using a search strategy to identify publications that present frameworks and models for implementation and improvement.Study selectionTen popular implementation and improvement frameworks were purposively selected.Data extractionComparative analysis was conducted using an analytical framework derived from SHIFT-Evidence, a framework that conceptualizes complexity in implementation and improvement initiatives.ResultsCollectively the frameworks accounted for key concepts of translating evidence in complex systems: understanding the uniqueness of each setting; the interdependency of practices/processes and the need to respond to unpredictable events and emergent learning. The analysis highlighted heterogeneity of the frameworks in their focus on different aspects of complexity. Differences include the extent to which problems and solutions are investigated or assumed; whether endpoints are defined as the uptake of interventions or achievement of goals; and emphasis placed on fixed-term interventions versus continual improvement. None of the individual frameworks reviewed incorporated all the implications of complexity, as described by SHIFT-Evidence.ConclusionThis research identifies the differences in how implementation and improvement frameworks consider complexity, suggesting that SHIFT-Evidence offers a more comprehensive overview compared with the other frameworks. The similarity of concepts across the frameworks suggests growing consensus in the literature, with SHIFT-Evidence providing a conceptual bridge between the implementation and improvement fields.
Green SA, Carnegie W, Barber S, et al., 2018, Co-designing interventions within quality improvement initiatives : notes from the field, Journal of Health Design, Vol: 3, Pages: 49-56, ISSN: 2206-785X
Increasingly, quality improvement programmes are developed with an explicit mandate to involve patients, carers, and members of the public. A quality improvement and research programme in Northwest London has nearly a decade of experience in this field. This article provides an overview of how improvement initiatives supported by the programme have involved patients in the co-design of interventions within various clinical settings. Reflections on some of the challenges and facilitators are offered. Extending roles for patients beyond co- designing interventions to involving them in implementation offers new levels of engagement and transparency
Green SA, 2018, Barriers to delivering mental health services in Georgia with an economic and financial focus: informing policy and acting on evidence, BMC Health Services Research, Vol: 18, ISSN: 1472-6963
Background:Whilst there is recognition that the global burden of disease associated with mental health disordersis significant, the economic resources available, especially in Low and Middle Income Countries, are particularly scarce.Identifying the economic (system) and financial (individual) barriers to delivering mental health services and assessingthe opportunities for reform can support the development of strategies for change.Methods:A mixed methods study was developed, which engaged with a range of stakeholders from mental healthservices, including key informants, service managers, healthcare professional and patients and their care-takers. Datagenerated from interviews and focus groups were analysed using an existing framework that outlines a range ofeconomic and financial barriers to improving mental health practice. In addition, the study utilised health financingand programmatic data.Results:The analysis identified a variety of local economic barriers, including: the inhibition of the diversification of themental health workforce and services due to inflexible resources; the variable and limited provision of services acrossthe country; and the absence of mechanisms to assess the delivery and quality of existing services. The main financialbarriers identified were related to out-of pocket payments for purchasing high quality medications and transportationto access mental health services.Conclusions:Whilst scarcity of financial resources exists in Georgia, as in many other countries, there are clearopportunities to improve the effectiveness of the current mental health programme. Addressing system-widebarriers could enable the delivery of services that aim to meet the needs of patients. The use of existing datato assess the implementation of the mental health programmeoffers opportunities to benchmark and improve servicesand to support the appropriate commissioning and reconfiguration of services.
Green SA, Beveridge E, Evans L, et al., 2018, Implementing guidelines on physical health in the acute mental health setting: A quality improvement approach, International Journal of Mental Health Systems, Vol: 12, ISSN: 1752-4458
BackgroundIn the UK, life expectancy for people living with a serious mental illness, such as schizophrenia and bipolar disorder, is reduced by 15-20 years compared with the general population. In recent years, evidence based guidelines/policies designed to improve their physical health have been published, yet a gap remains between recommendations and practice. This case study describes how guidelines to support physical health were implemented using a quality improvement approach.Case descriptionA quasi-experimental study explored systems and processes for assessing the physical health of patients admitted to an acute mental health unit. The multi-disciplinary team of healthcare professionals, service users and experts in quality improvement methods developed solutions to improve the assessment of physical health, drawing on existing guidelines/policies as well as professional and lived experience. Three key interventions were developed: a comprehensive physical health assessment; a patient-held physical health booklet; and education and training for staff and patients. Interventions were co-designed by front-line healthcare staff and service users with iterative development and implementation through Plan-Do-Study-Act cycles. Real-time weekly data were reported on five measures over a 15-month implementation period (318 patients) and compared to a 10-month baseline period (247 patients) to gauge the success of the implementation of the physical health assessment.Improvements were seen in the numbers of patients receiving a physical health assessment: 81.3% (201/247) vs 96.9% (308/318), recording of Body Mass Index: 21.55% (53/247) vs 58.6% (204/318) and systolic blood pressure: 22.35% (55/247) vs 75.9% (239/318) but a reduction in the recording of smoking status: 80.1% (198/247) vs 70.9% (225/318). However, 31.7% (118/318) patients had a cardiovascular risk-score documented in the implementation phase, compared to none in the baseline. ConclusionThis study demons
Green SA, Bell D, Mays N, 2017, Identification of factors that support successful implementation of care bundles in the acute medical setting: a qualitative study, BMC Health Services Research, Vol: 17, ISSN: 1472-6963
BackgroundClinical guidelines offer an accessible synthesis of the best evidence of effectiveness of interventions, providing recommendations and standards for clinical practice. Many guidelines are relevant to the diagnosis and management of the acutely unwell patient during the first 24–48 h of admission. Care bundles are comprised of a small number of evidence-based interventions that when implemented together aim to achieve better outcomes than when implemented individually. Care bundles that are explicitly developed from guidelines to provide a set of related evidence-based actions have been shown to improve the care of many conditions in emergency, acute and critical care settings. This study aimed to review the implementation of two distinct care bundles in the acute medical setting and identify the factors that supported successful implementation.MethodsTwo initiatives that had used a systematic approach to quality improvement to successfully implement care bundles within the acute medical setting were selected as case studies. Contemporaneous data generated during the initiatives included the review reports, review minutes and audio recordings of the review meetings at different time points. Data were subject to deductive analysis using three domains of the Consolidated Framework for Implementation Research to identify factors that were important in the implementation of the care bundles.ResultsSeveral factors were identified that directly influenced the implementation of the care bundles. Firstly, the availability of resources to support initiatives, which included training to develop quality improvement skills within the team and building capacity within the organisation more generally. Secondly, the perceived sustainability of changes by stakeholders influenced the embedding new care processes into existing clinical systems, maximising their chance of being sustained. Thirdly, senior leadership support was seen as critical not just in supporting im
Green SA, Evans L, Matthews R, et al., 2016, Service user engagement in quality improvement: applying the national involvement standards, Journal of Mental Health Training, Education and Practice, Vol: 11, ISSN: 2042-8707
Lwembe SC, Green SA, Tanna N, et al., 2016, A qualitative evaluation to explore the suitability, feasibility and acceptability of using a ‘celebration card’ intervention in primary care to improve the uptake of childhood vaccinations, BMC Family Practice, Vol: 17, ISSN: 1471-2296
IntroductionChildhood vaccination remains a primary mechanism for reducing the burden of infectiousdisease. In the United Kingdom, as in many countries, a sustained effort is required to ensurethat vaccination targets are met to afford protection to the whole population from vaccinepreventable disease. The Celebrate and Protect programme is a collaborative partnershipdeveloped to improve the uptake of childhood vaccination across a number of boroughswithin London through the use of a celebration card to encourage attendance for vaccinationand enhance relationships between general practices and the parents/carers of children.MethodsThis study was undertaken to assess the suitability, feasibility and acceptability of theCelebrate and Protect programme across nine boroughs in London. Data were collectedeither from telephone interviews (n=24) or from focus groups (n=31). A total of 55 keyinformants were included in the study, representing strategic, commissioning or policy leads,healthcare professionals and primary care teams delivering vaccinations and parents/carersof children under five.ResultsThe analysis of data identified that whilst parents/carers saw the celebration card positivelythis raised the issue of ‘vaccine hesitancy’ and the lack of information that parents/carershave to make informed decisions about vaccination. Similarly, healthcare professionalsviewed the programme positively and felt that it was deliverable within existing resourcesalthough they raised wider questions about on-going sustainability and about quantitativedata collection. In relation to the collaboration between primary care and a pharmaceuticalcompany in developing the Celebrate and Protect programme, it was generally felt that,provided appropriate governance is in place, it was a pragmatic approach in which thebenefits outweighed any perceived disadvantages.DiscussionThe Celebrate and Protect programme was seen as an innovative collaborative programmeto engage with parents
Lwembe SC, Green SA, Chigwende J, et al., 2016, Co-production as an approach to developing stakeholder partnerships to reduce mental health inequalities: an evaluation of a pilot service, Primary health care research & development, Vol: 18, Pages: 14-23, ISSN: 1477-1128
AimThis study aimed to evaluate a pilot cross-sector initiative - bringing together public health, a community group, primary mental health teams and patients - in using co-production approaches to deliver a mental health service to meet the needs of the black and minority ethnic communities.BackgroundBlack and minority ethnic communities continue to face inequalities in mental health service access and provision. They are under-represented in low-level interventions as they are less likely to be referred, and more likely to disengage from mainstream mental health services. Effective models that lead to improved access and better outcomes are yet to be established. It has long been recognised that to be effective, services need to be more culturally competent, which may be achieved through a co-production approach.MethodsThis study aimed to evaluate the role of co-production in the development of a novel community mental health service for black and minority ethnic service users. Qualitative research methods, including semi-structured interviews and focus groups, were used to collect data to examine the use of co-production methods in designing and delivering an improved mental health service.Findings Twenty five patients enrolled into the study; of these, ten were signposted for more intensive psychological support. A 75% retention rate was recorded (higher than is generally the case for black and minority ethnic service users). Early indications are that the project has helped overcome barriers to accessing mental health services. Although small scale, this study highlights an alternative model that, if explored and developed further, could lead to delivery of patient-centred services to improve access and patient experience within mental health services, particularly for black and minority ethnic communities.
Pizzo E, Laverty AA, Phekoo KJ, et al., 2015, A retrospective analysis of the cost of hospitalizations for sickle cell disease with crisis in England, 2010/11, JOURNAL OF PUBLIC HEALTH, Vol: 37, Pages: 529-539, ISSN: 1741-3842
Green SA, Honeybourne E, Chalkley S, et al., 2015, A retrospective observational analysis to identify patient and treatment-related predictors of outcomes in a community mental health programme, BMJ Open, ISSN: 2044-6055
Lovett DA, Poots AJ, Clements JTC, et al., 2014, Using geographical information systems and cartograms as a health service quality improvement tool, Spatial and Spatio-temporal Epidemiology, Vol: 10, Pages: 67-74, ISSN: 1877-5845
Introduction: Disease prevalence can be spatially analysed to provide support for service implementation and health care planning, these analyses often display geographic variation. A key challenge is to communicate these results to decision makers, with variable levels of Geographic Information Systems (GIS) knowledge, in a way that represents the data and allows for comprehension. The present research describes the combination of established GIS methods and software tools to produce a novel technique of visualising disease admissions and to help prevent misinterpretation of data and less optimal decision making. The aim of this paper is to provide a tool that supports the ability of decision makers and service teams within health care settings to develop services more efficiently and better cater to the population; this tool has the advantage of information on the position of populations, the size of populations and the severity of disease. Methods: A standard choropleth of the study region, London, is used to visualise total emergency admission values for Chronic Obstructive Pulmonary Disease and bronchiectasis using ESRI's ArcGIS software. Population estimates of the Lower Super Output Areas (LSOAs) are then used with the ScapeToad cartogram software tool, with the aim of visualising geography at uniform population density. An interpolation surface, in this case ArcGIS' spline tool, allows the creation of a smooth surface over the LSOA centroids for admission values on both standard and cartogram geographies. The final product of this research is the novel Cartogram Interpolation Surface (CartIS). Results: The method provides a series of outputs culminating in the CartIS, applying an interpolation surface to a uniform population density. The cartogram effectively equalises the population density to remove visual bias from areas with a smaller population, while maintaining contiguous borders. CartIS decreases the number of extreme positive values not present in t
Poots AJ, Green SA, Honeybourne E, et al., 2014, Improving mental health outcomes: achieving equity through quality improvement., Int J Qual Health Care, Vol: 26, Pages: 198-204
OBJECTIVE: To investigate equity of patient outcomes in a psychological therapy service, following increased access achieved by a quality improvement (QI) initiative. DESIGN: Retrospective service evaluation of health outcomes; data analysed by ANOVA, chi-squared and Statistical Process Control. SETTING: A psychological therapy service in Westminster, London, UK. PARTICIPANTS: People living in the Borough of Westminster, London, attending the service (from either healthcare professional or self-referral) between February 2009 and May 2012. INTERVENTION: s) Social marketing interventions were used to increase referrals, including the promotion of the service through local media and through existing social networks. MAIN OUTCOME MEASURE: s) (i) Severity of depression on entry using Patient Health Questionnaire-9 (PHQ9). (ii) Changes to severity of depression following treatment (ΔPHQ9). (iii) Changes in attainment of a meaningful improvement in condition assessed by a key performance indicator. RESULTS: Patients from areas of high deprivation entered the service with more severe depression (M = 15.47, SD = 6.75), compared with patients from areas of low (M = 13.20, SD = 6.75) and medium (M = 14.44, SD = 6.64) deprivation. Patients in low, medium and high deprivation areas attained similar changes in depression score (ΔPHQ9: M = -6.60, SD = 6.41). Similar proportions of patients achieved the key performance indicator across initiative phase and deprivation categories. CONCLUSIONS: QI methods improved access to mental health services; this paper finds no evidence for differences in clinical outcomes in patients, regardless of level of deprivation, interpreted as no evidence of inequity in the service with respect to this outcome.
Jones SE, Green SA, Clark AL, et al., 2014, Pulmonary rehabilitation following hospitalisation for acute exacerbation of COPD: referrals, uptake and adherence, THORAX, Vol: 69, Pages: 181-182, ISSN: 0040-6376
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Evans L, Green S, Howe C, et al., 2014, Improving patient and project outcomes using interorganisational innovation, collaboration and co-design., London J Prim Care (Abingdon), Vol: 6, Pages: 29-34, ISSN: 1757-1472
Background Common mental disorders (CMDs) are a leading cause of disability. The Department of Health has launched a large-scale initiative to improve access to evidence-based psychological treatments, such as cognitive behavioural therapy (CBT), through the Improving Access to Psychological Therapy (IAPT) programme. Access to IAPT services by black and minority ethnic (BME) communities is lower than for other groups. Setting The London Borough of Ealing in west London; a diverse borough with areas of high BME population and relatively high deprivation. Aim To compare the outcomes of two linked quality improvement (QI) projects undertaken by Ealing Mental Health and Wellbeing Service (MHWBS), both with the same aim of increasing access to talking therapies for BME communities. Methods Application of QI methodologies supported by the NIHR CLAHRC for northwest London in two different settings in Ealing. One, the 'Southall project', was set within a wider initiative for collaborative improvements and shared learning (the Southall Initiative for Integrated Care) in an ethnically diverse area of Ealing; it was undertaken between April 2010 and September 2011. The second, 'the Ealing project', operated in the two other Ealing localities that did not have the advantage of a broader initiative for collaborative improvements; it was undertaken between April 2011 and September 2012. Results Comparison of the monthly referral rates of BME patients (standardised per 10 000 general practitioner (GP)-registered patients) show that the Southall project was more effective in increasing referrals from BME communities than the Ealing project. Conclusion Broad local participation and ownership in the project design of the Southall project may explain why it was more effective in achieving its aims than the Ealing project which lacked these ownership-creating mechanisms.
Lennox L, Green S, Howe C, et al., 2014, Identifying the challenges and facilitators of implementing a COPD care bundle., BMJ Open Respir Res, Vol: 1, ISSN: 2052-4439
BACKGROUND: Care bundles have been shown to improve outcomes, reduce hospital readmissions and reduce length of hospital stay; therefore increasing the speed of uptake and delivery of care bundles should be a priority in order to deliver more timely improvements and consistent high-quality care. Previous studies have detailed the difficulties of obtaining full compliance to bundle elements but few have described the underlying reasons for this. In order to improve future implementation this paper investigates the challenges encountered by clinical teams implementing a chronic obstructive pulmonary disease (COPD) care bundle and describes actions taken to overcome these challenges. METHODS: An initial retrospective documentary analysis of data from seven clinical implementation teams was undertaken to review the challenges faced by the clinical teams. Three focus groups with healthcare professionals and managers explored solutions to these challenges developed during the project. RESULTS: Documentary analysis identified 28 challenges which directly impacted implementation of the COPD care bundle within five themes; staffing, infrastructure, process, use of improvement methodology and patient and public involvement. Focus groups revealed that the five most significant challenges for all groups were: staff too busy, staff shortages, lack of staff engagement, added workload of the bundle and patient coding issues. The participants shared facilitating factors used to overcome issues including: shifting perceptions to improve engagement, further education sessions to increase staff participation and gaining buy-in from managers through payment frameworks. CONCLUSIONS: Maximising the impact of a care bundle relies on its successful and timely implementation. Teams implementing the COPD care bundle encountered challenges that were common to all teams and sites. Understanding and learning from the challenges faced by previous endeavours and identifying the facilitators to ov
Evans L, Green S, Sharma K, et al., 2014, Improving access to primary mental health services: are link workers the answer?, London J Prim Care (Abingdon), Vol: 6, Pages: 23-28, ISSN: 1757-1472
Background The incidences of common mental disorders such as anxiety, depression and low-level post-traumatic stress are associated with deprivation. Since 2007, the Improving Access to Psychological Therapy (IAPT) programme in Ealing has made it easier for primary care practitioners to refer patients with common mental disorders for treatment. However, fewer patients of a black and minority ethnic (BME) background were referred than expected. Setting Southall, Ealing, is a diverse ethnic community; over 70% of the population is classified as having a BME background. Aim To evaluate the effect of locating mental health link workers in general practitioners' (GP) surgeries on referral of BME patients to IAPT services. Methods In 2009, an initiative in Southall helped practitioners and managers that served geographic areas to work with many different agencies to improve whole systems of care. One strand of this work led to mental health link workers being placed in 6 of the 23 GP practices. They provided psychological therapy and raised awareness of common mental disorders in BME groups and what mental health services can do to improve these. Referrals to the service were monitored and assessed using statistical process control. Results The mean referral rate of BME patients for GP practices without a link worker was 0.35 per week per 10 000 patients and was unchanged throughout the period of the study. The referral rates for the six practices with a link worker increased from 0.65 to 1.37 referrals per week per 10 000 patients. Conclusions Link workers located in GP practices, as part of a collaborative network of healthcare, show promise as one way to improve the care of patients with anxiety and depression from BME communities.
Fleming SL, Jones SE, Green S, et al., 2013, PATIENTS' EXPERIENCES OF EARLY POST-HOSPITALISATION PULMONARY REHABILITATION: A QUALITY IMPROVEMENT INITIATIVE, Winter Meeting of the British-Thoracic-Society, Publisher: BMJ PUBLISHING GROUP, Pages: A94-A94, ISSN: 0040-6376
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AlJuburi G, Laverty AA, Green SA, et al., 2013, Socio-economic deprivation and risk of emergency readmission and inpatient mortality in people with sickle cell disease in England: observational study, Journal of Public Health
Jones SE, Green SA, Clark AL, et al., 2013, Pulmonary rehabilitation following hospitalisation for acute exacerbation of COPD: Fact or fiction?, Publisher: EUROPEAN RESPIRATORY SOC JOURNALS LTD, ISSN: 0903-1936
Woodrow SR, Green SA, Phekoo KJ, et al., 2013, An identification and brief advice programme for low-risk alcohol consumption in an acute medical setting: an implementation study., JRSM Short Rep, Vol: 4, ISSN: 2042-5333
OBJECTIVES: To implement an identification and brief advice (IBA) intervention to detect low-risk/hazardous alcohol consumption. DESIGN: Implementation was guided through the use of quality improvement tools and training. SETTING: This study was conducted over an 18-month period from April 2010 to September 2011 on a 42-bed acute medical unit at a central London acute hospital. PARTICIPANTS: All medical patients over the age of 18 admitted to the acute assessment unit were eligible; any patient unable to provide a medical history either through language barriers or due to illness was excluded. MAIN OUTCOME MEASURES: Percentage of medical patients admitted each week to the acute assessment unit who were screened for low-risk/hazardous alcohol consumption. RESULTS: Weekly data were analysed in time series run charts and cross-referenced to the date of educational sessions and their effect on the uptake of screening monitored. A demonstrable change in the mean percentage number of patients screened was observed in different time periods, 67.3-80.1%, following targeted teaching on the AAU. CONCLUSIONS: Our study demonstrates the successful use of quality improvement methodology to guide the implementation of Alcohol Use Disorders Identification Test-Consumption (AUDIT-C), an IBA intervention, in the acute medical setting. The incorporation of the AUDIT-C into an admission document has been well accepted by the junior doctors, attaining an average (mean) of 80% of patients being screened using the tool. Targeted teaching of clinical staff involved in admitting patients appears to be the most effective method in improving uptake of IBA by junior doctors.
Aljuburi G, Phekoo KJ, Okoye NO, et al., 2012, Patients' views on improving sickle cell disease management in primary care: focus group discussion., JRSM Short Rep, Vol: 3, ISSN: 2042-5333
OBJECTIVES: To assess sickle cell disease (SCD) patient and carer perspectives on the primary care services related to SCD that they receive from their general practitioner (GP). DESIGN: A focus group discussion was used to elicit the views of patients about the quality of care they receive from their primary health-care providers and what they thought was the role of primary care in SCD management. The focus group discussion was video recorded. The recording was then examined by the project team and recurring themes were identified. A comparison was made with notes made by two scribes also present at the discussion. SETTING: Sickle Cell Society in Brent, UK. PARTICIPANTS: Ten participants with SCD or caring for someone with SCD from Northwest London, UK. MAIN OUTCOME MEASURES: Patients' perceptions about the primary care services they received, and a list of key themes and suggestions. RESULTS: Patients and carers often bypassed GPs for acute problems but felt that GPs had an important role to play around repeat prescriptions and general health care. These service users believed SCD is often ignored and deemed unimportant by GPs. CONCLUSION: Participants wanted the health service to support primary health-care providers to improve their knowledge and understanding of SCD. Key themes and suggestions from this focus group have been used to help develop an educational intervention for general practice services that will be used to improve SCD management in primary care.
Musgrave H, Howe C, Green S, et al., 2012, IMPLEMENTING A COPD DISCHARGE CARE BUNDLE: THE CHALLENGES AND FACILITATORS REVEALED, Winter Meeting of the British-Thoracic-Society 2012, Publisher: BMJ PUBLISHING GROUP, Pages: A190-A190, ISSN: 0040-6376
Aljuburi G, Okoye O, Majeed A, et al., 2012, Views of patients about sickle cell disease management in primary care: a questionnaire-based pilot study., JRSM Short Rep, Vol: 3, ISSN: 2042-5333
OBJECTIVES: To determine how patients with sickle cell disease (SCD) perceive the quality of care that they receive from their primary healthcare providers. DESIGN: A questionnaire-based pilot study was used to elicit the views of patients about the quality of care they have been receiving from their primary healthcare providers and what they thought was the role of primary care in SCD management. SETTING: Sickle Cell Society and Sickle Cell and Thalassaemia Centre, in the London Borough of Brent. PARTICIPANTS: One hundred questionnaires were distributed to potential participants with SCD between November 2010 and July 2011 of which 40 participants responded. MAIN OUTCOME MEASURES: Analysis of 40 patient questionnaires collected over a nine-month period. RESULTS: Most patients are generally not satisfied with the quality of care that they are receiving from their primary healthcare providers for SCD. Most do not make use of general practitioner (GP) services for management of their SCD. Collecting prescriptions was the reason most cited for visiting the GP. CONCLUSION: GPs could help improve the day-to-day management of patients with SCD. This could be facilitated by local quality improvement schemes in areas with high disease prevalence. The results of the survey have been used to help develop a GP education intervention and a local enhanced service to support primary healthcare clinicians with SCD's ongoing management.
Poots AJ, Green SA, Barnes R, et al., 2012, Using routine geo-coded data to identify geographical heterogeneity to reduce disparities: case studies in UK., Proceedings of the First ACM SIGSPATIAL International Workshop on Use of GIS in Public Health, Pages: 40-43
Green S, Sullivan P, Bell D, et al., 2012, Aligning quality improvement to population health, INTERNATIONAL JOURNAL FOR QUALITY IN HEALTH CARE, Vol: 24, Pages: 441-442, ISSN: 1353-4505
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