1
|
Lamont T, Chatfield C, Walshe K. Developing the future research agenda for the health and social care workforce in the United Kingdom: Findings from a national forum for policymakers and researchers. Int J Health Plann Manage 2024; 39:917-925. [PMID: 38326287 DOI: 10.1002/hpm.3775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 01/17/2024] [Accepted: 01/25/2024] [Indexed: 02/09/2024] Open
Abstract
There is a gap between healthcare workforce research and decision-making in policy and practice. This matters more than ever given the urgent staffing crisis. As a national research network, we held the first ever United Kingdom (UK) forum on healthcare workforce evidence in March 2023. This paper summarises outputs of the event including an emerging UK healthcare workforce agenda and actions to build research capacity and bridge the gap between academics and decisionmakers. The forum brought together over 80 clinical and system leaders, policymakers and regulators with workforce researchers. Fifteen sessions convened by leading experts combined knowledge exchange with deliberative dialogue over 2 days. Topics ranged from workforce analytics, forecasting, international migration to interprofessional working. In the small groups that were convened, important gaps were identified in both the existing research body and uptake of evidence already available. There had not been enough high quality evaluations of recent workforce initiatives implemented at pace, from virtual wards to e-rostering. The pandemic had accelerated many changes in skillmix and professional roles with little learning from other countries and systems. Existing research was often small-scale or focused on individual, rather than organisational solutions in areas such as staff wellbeing. In terms of existing research, managers were often unaware of accepted high quality evidence in areas like the relationship between registered nurse staffing levels and patient outcomes. More work is needed to engage new disciplines from labour economics and occupational health to academic human resources and to strengthen the emerging diverse community of healthcare workforce researchers.
Collapse
Affiliation(s)
- Tara Lamont
- The Healthcare Improvement Studies Institute, University of Cambridge, Cambridge, UK
| | | | | |
Collapse
|
2
|
Affiliation(s)
- Tara Lamont
- NIHR Coordinating Centre, Southampton University
| |
Collapse
|
3
|
Affiliation(s)
- Tara Lamont
- Health Services Research UK
- THIS Institute, University of Cambridge, UK
| | | | - Kieran Walshe
- Health Services Research UK
- University of Manchester, UK
| |
Collapse
|
4
|
Lamont T, Bower P, Hay E, Mahtani K, Salisbury C. How can we fund research for people, not conditions? BMJ 2022; 379:o2799. [PMID: 36400450 DOI: 10.1136/bmj.o2799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
|
5
|
van der Linden B, Dunham KM, Siegel J, Lazowick E, Bowdery M, Lamont T, Ford A. Health funders' dissemination and implementation practices: results from a survey of the Ensuring Value in Research (EViR) Funders' Forum. Implement Sci Commun 2022; 3:36. [PMID: 35351211 PMCID: PMC8966333 DOI: 10.1186/s43058-022-00273-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 02/19/2022] [Indexed: 11/25/2022] Open
Abstract
Background A significant gap persists between evidence from research and its use in practice. Research funders, important actors in the health research system, can help reduce this gap by initiating dissemination and implementation (D&I) activities. The specific types of D&I activities funders currently lead have not been explored thoroughly. The Ensuring Value in Research (EViR) Funders’ Forum—an international collaboration of health-related research funders—was established in 2017 to address research waste issues and increase the value of research. The Forum surveyed funders to learn about their D&I practices and challenges. Methods We distributed a five-item exploratory survey to participating funders in August 2018. The results informed the development of a survey instrument, distributed in June 2019. The survey instrument contained 15 items prompting respondents to categorize and describe their level of effort in six practice areas: release of findings, dissemination, knowledge exchange/partnering, implementation, building capacity, and implementation research. In addition, funders were asked to describe examples of their practices in detail. Thirty-one funders completed the survey instrument, a 58% response rate. Results Most funders regard D&I as a high priority, but funders vary in levels of activity per practice area. Over half of respondents reported that they have at least some activity in all D&I practice areas surveyed, with the exception of implementation research. The vast majority indicated some or significant activity in release of findings (97%) and dissemination (87%). Nearly one-fifth of funders (19%) indicated that implementation is outside their remit, and 26% indicated that implementation research is outside their remit. Survey respondents shared a broad range of examples of activities in each practice area. Lack of evidence for successful approaches and measuring impact were named frequently as challenges and as potential areas for collaboration. Conclusions Although models of dissemination and implementation vary across organizations, the majority of funders indicated that D&I of research findings is a priority. Funders indicated a need for evidence on effectiveness of various approaches to D&I. Increased collaboration between funders, including sharing good practices, will increase our collective learning and knowledge development. Supplementary Information The online version contains supplementary material available at 10.1186/s43058-022-00273-7.
Collapse
Affiliation(s)
| | - Kelly M Dunham
- Patient-Centered Outcomes Research Institute (PCORI), 1828 L St NW, Washington, DC, 20036, USA
| | - Joanna Siegel
- Patient-Centered Outcomes Research Institute (PCORI), 1828 L St NW, Washington, DC, 20036, USA
| | - Emily Lazowick
- Patient-Centered Outcomes Research Institute (PCORI), 1828 L St NW, Washington, DC, 20036, USA
| | - Michael Bowdery
- Health and Care Research Wales, Crown Buildings, Cathays Park, Cardiff, CF10 3NQ, Wales, UK
| | - Tara Lamont
- NIHR, University of Southampton, Southampton, UK
| | - Alison Ford
- NIHR, University of Southampton, Southampton, UK
| |
Collapse
|
6
|
Rzewuska M, Lamont T, Banister K, Gillies K, Goulao B, Locock L, Nevin G, Clarkson JE, Ramsay CR. Twitter communication of the UK public on dental health and care during a COVID lockdown: "My kingdom for a dentist". Community Dent Health 2021; 38:261-267. [PMID: 34304397 DOI: 10.1922/cdh_00026rzewuska07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND The COVID-19 pandemic forced a UK-wide closure of dental services. An understanding of public concerns about dental care was urgently needed to inform careful resumption of paused dental services. AIM To describe public concerns about dental care during lockdown. BASIC RESEARCH DESIGN Framework analysis of relevant Twitter posts identified collected using the Awario tool. RESULTS Of 1863 tweets manually screened for eligibility, 285 were relevant, as they contained views expressed by the public. The number of tweets by country were proportionate to the population size. The key views expressed in tweets focused on: 'oral health impact' ('oral health and self-care', 'types of dental problems', 'managing symptoms at home', 'views on consequences of delaying treatment') and 'dental service or care provision' ('views on managing dental care response', 'experiences with access to dental care'). CONCLUSIONS The impact of COVID-19 on dental services raised many physical and mental health concerns for the public, highlighting their importance. Online profiles and social media communication platforms can be used to provide convenient, and timely information on public perceptions of dental care.
Collapse
Affiliation(s)
- M Rzewuska
- Health Services Research Unit, University of Aberdeen, United Kingdom
| | - T Lamont
- School of Dentistry, University of Dundee, United Kingdom
| | - K Banister
- Health Services Research Unit, University of Aberdeen, United Kingdom
| | - K Gillies
- Health Services Research Unit, University of Aberdeen, United Kingdom
| | - B Goulao
- Health Services Research Unit, University of Aberdeen, United Kingdom
| | - L Locock
- Health Services Research Unit, University of Aberdeen, United Kingdom
| | - G Nevin
- NHS Education for Scotland, NHS Scotland, United Kingdom
| | - J E Clarkson
- Health Services Research Unit, University of Dundee, United Kingdom
| | - C R Ramsay
- Health Services Research Unit, University of Aberdeen, United Kingdom
| |
Collapse
|
7
|
Lamont T. But Does It Work? Evidence, Policy-Making and Systems Thinking Comment on "What Can Policy-Makers Get Out of Systems Thinking? Policy Partners' Experiences of a Systems-Focused Research Collaboration in Preventive Health". Int J Health Policy Manag 2021; 10:287-289. [PMID: 32610826 PMCID: PMC9056182 DOI: 10.34172/ijhpm.2020.71] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 05/05/2020] [Indexed: 11/09/2022] Open
Abstract
Systems thinking provides new ways of seeing the world, focusing attention on the relationship between elements in complex systems and the spaces inbetween. Haynes study shows that many policy-makers valued systems thinking as a new way to approach old problems. But they also wanted greater focus on useful policy solutions. This raises interesting questions about the tensions between complexity and simple, action-oriented solutions and how evidence is used in decision-making. Backstage understanding of the complexity of policy problems is matched with the frontstage need to focus on what works. This reflects trends in recent public policy for evidence centres providing decision-makers with toolkits and dashboards of 'proven' interventions. There are good examples of evaluations using systems thinking allowing for complexity while addressing policy-maker needs to be accountable for public investment and decisions. Strategic communication skills are needed to provide compelling stories which embrace systems thinking without losing clarity and impact.
Collapse
Affiliation(s)
- Tara Lamont
- Wessex Institute, University of Southampton, Southampton, UK
| |
Collapse
|
8
|
Boyers D, van der Pol M, Watson V, Lamont T, Goulao B, Ramsay C, Duncan A, Macpherson L, Clarkson J. The Value of Preventative Dental Care: A Discrete-Choice Experiment. J Dent Res 2021; 100:723-730. [PMID: 33541186 PMCID: PMC8217903 DOI: 10.1177/0022034521989943] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Scale and polish (SP) and oral hygiene advice (OHA) are commonly provided in primary care dental practice to help prevent periodontal disease. These services are widely consumed by service users, incurring substantial cost, without any clear evidence of clinical benefit. This article aims to elicit general population preferences and willingness to pay (WTP) for preventative dental care services and outcomes. An online discrete-choice experiment (DCE) was completed by a nationally representative sample of the UK general population. Respondents each answered 10 choice tasks that varied in terms of service attributes (SP, OHA, and provider of care), outcomes (bleeding gums and aesthetics), and cost. Choice tasks were selected using a pivoted segmented experimental design to improve task realism. An error components panel logit model was used to analyze the data. Marginal WTP (mWTP) for each attribute and level was calculated. In total, 667 respondents completed the DCE. Respondents valued more frequent SP, care provided by a dentist, and personalized OHA. Respondents were willing to pay for dental packages that generated less frequent ("never" or "hardly ever") bleeding on brushing and teeth that look and feel at least "moderately clean." Respondents were willing to pay more (+£145/y) for improvements in an aesthetic outcome from "very unclean" (-£85/y) to "very clean" (+£60/y) than they were for reduced bleeding frequency (+£100/y) from "very often" (-£54/y) to "never" (+£36/y). The general population value routinely provided SP, even in the absence of reductions in bleeding on brushing. Dental care service providers must consider service user preferences, including preferences for both health and nonhealth outcomes, as a key factor in any service redesign. Furthermore, the results provide mWTP estimates that can be used in cost-benefit analysis of these dental care services.
Collapse
Affiliation(s)
- D Boyers
- Health Economics Research Unit, University of Aberdeen, Aberdeen, UK
| | - M van der Pol
- Health Economics Research Unit, University of Aberdeen, Aberdeen, UK
| | - V Watson
- Health Economics Research Unit, University of Aberdeen, Aberdeen, UK
| | - T Lamont
- School of Dentistry, University of Dundee, Dundee, UK
| | - B Goulao
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - C Ramsay
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - A Duncan
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - L Macpherson
- School of Dentistry, University of Dundee, Dundee, UK
| | - J Clarkson
- School of Dentistry, University of Dundee, Dundee, UK
| |
Collapse
|
9
|
Kersalé M, Meinen CS, Perez RC, Le Hénaff M, Valla D, Lamont T, Sato OT, Dong S, Terre T, van Caspel M, Chidichimo MP, van den Berg M, Speich S, Piola AR, Campos EJD, Ansorge I, Volkov DL, Lumpkin R, Garzoli SL. Highly variable upper and abyssal overturning cells in the South Atlantic. Sci Adv 2020; 6:eaba7573. [PMID: 32821826 PMCID: PMC7406378 DOI: 10.1126/sciadv.aba7573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 06/25/2020] [Indexed: 06/11/2023]
Abstract
The Meridional Overturning Circulation (MOC) is a primary mechanism driving oceanic heat redistribution on Earth, thereby affecting Earth's climate and weather. However, the full-depth structure and variability of the MOC are still poorly understood, particularly in the South Atlantic. This study presents unique multiyear records of the oceanic volume transport of both the upper (<~3100 meters) and abyssal (>~3100 meters) overturning cells based on daily moored measurements in the South Atlantic at 34.5°S. The vertical structure of the time-mean flows is consistent with the limited historical observations. Both the upper and abyssal cells exhibit a high degree of variability relative to the temporal means at time scales, ranging from a few days to a few weeks. Observed variations in the abyssal flow appear to be largely independent of the flow in the overlying upper cell. No meaningful trends are detected in either cell.
Collapse
Affiliation(s)
- M. Kersalé
- Cooperative Institute for Marine and Atmospheric Studies, University of Miami, Miami, FL, USA
- NOAA Atlantic Oceanographic and Meteorological Laboratory, Miami, FL, USA
| | - C. S. Meinen
- NOAA Atlantic Oceanographic and Meteorological Laboratory, Miami, FL, USA
| | - R. C. Perez
- NOAA Atlantic Oceanographic and Meteorological Laboratory, Miami, FL, USA
| | - M. Le Hénaff
- Cooperative Institute for Marine and Atmospheric Studies, University of Miami, Miami, FL, USA
- NOAA Atlantic Oceanographic and Meteorological Laboratory, Miami, FL, USA
| | - D. Valla
- Servicio de Hidrografía Naval, Buenos Aires, Argentina
| | - T. Lamont
- Oceans and Coasts Research Branch, Department of Environmental Affairs, Cape Town, South Africa
- Department of Oceanography, University of Cape Town, Rondebosch 7701, South Africa
| | - O. T. Sato
- Oceanographic Institute, University of São Paulo, São Paulo, Brazil
| | - S. Dong
- NOAA Atlantic Oceanographic and Meteorological Laboratory, Miami, FL, USA
| | - T. Terre
- IFREMER, University of Brest, CNRS, IRD, Laboratoire d'Océanographie Physique et Spatiale (LOPS), IUEM, Plouzané, France
| | - M. van Caspel
- Oceanographic Institute, University of São Paulo, São Paulo, Brazil
| | - M. P. Chidichimo
- Servicio de Hidrografía Naval, Buenos Aires, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Argentina
- Instituto Franco-Argentino sobre Estudio del Clima y sus Impactos (UMI-IFAECI/CNRS-CONICET-UBA), Buenos Aires, Argentina
| | - M. van den Berg
- Oceans and Coasts Research Branch, Department of Environmental Affairs, Cape Town, South Africa
| | - S. Speich
- Laboratoire de Météorologie Dynamique–IPSL, Ecole Normale Supérieure, Paris, France
| | - A. R. Piola
- Servicio de Hidrografía Naval, Buenos Aires, Argentina
- Instituto Franco-Argentino sobre Estudio del Clima y sus Impactos (UMI-IFAECI/CNRS-CONICET-UBA), Buenos Aires, Argentina
- Universidad de Buenos Aires, Buenos Aires, Argentina
| | - E. J. D. Campos
- Oceanographic Institute, University of São Paulo, São Paulo, Brazil
- Department of Biology, Chemistry and Environmental Sciences, School of Arts and Sciences, American University of Sharjah, Sharjah, United Arab Emirates
| | - I. Ansorge
- Department of Oceanography, University of Cape Town, Rondebosch 7701, South Africa
| | - D. L. Volkov
- Cooperative Institute for Marine and Atmospheric Studies, University of Miami, Miami, FL, USA
- NOAA Atlantic Oceanographic and Meteorological Laboratory, Miami, FL, USA
| | - R. Lumpkin
- NOAA Atlantic Oceanographic and Meteorological Laboratory, Miami, FL, USA
| | - S. L. Garzoli
- Cooperative Institute for Marine and Atmospheric Studies, University of Miami, Miami, FL, USA
- NOAA Atlantic Oceanographic and Meteorological Laboratory, Miami, FL, USA
| |
Collapse
|
10
|
Abstract
The studyPeden CJ, Stephens T, Martin G et al. Effectiveness of a national quality improvement programme to improve survival after emergency abdominal surgery (EPOCH): a stepped-wedge cluster-randomised trial. Lancet 2019;393:2213-21.This project was funded by the NIHR Health Services and Delivery Research Programme (project number 12/5005/10).To read the full NIHR Signal, go to https://discover.dc.nihr.ac.uk/content/signal-000789/national-quality-improvement-programmes-need-time-and-resources-to-have-impact.
Collapse
Affiliation(s)
- Rob Cook
- Bazian, Economist Intelligence Unit Healthcare, London, UK
| | - Tara Lamont
- Wessex Institute, University of Southampton, Southampton, UK
| | - Rosie Martin
- Bazian, Economist Intelligence Unit Healthcare, London, UK
| |
Collapse
|
11
|
Abstract
The studyStory A, Aldridge R, Smith C, et al. Smartphone-enabled video-observed versus directly observed treatment for tuberculosis: a multicentre, analyst-blinded, randomised, controlled superiority trial. Lancet 2019;393:1216-24.The study was funded by the NIHR Programme Grants for Applied Research programme (project number RP-PG-0407-10340).To read the full NIHR Signal, go to https://discover.dc.nihr.ac.uk/content/signal-000777/smartphones-for-tb-treatment-observation.
Collapse
Affiliation(s)
- Rob Cook
- Bazian, Economist Intelligence Unit Healthcare, London, UK
| | - Tara Lamont
- Wessex Institute, University of Southampton, Southampton, UK
| | - Rosie Martin
- Bazian, Economist Intelligence Unit Healthcare, London, UK
| |
Collapse
|
12
|
Abstract
The studyFeatherstone K, Northcott A, Harden J, et al. Refusal and resistance to care by people living with dementia being cared for within acute hospital wards: an ethnographic study. Health Serv Deliv Res 2019;7.This study was funded by the National Institute for Health Research Health Services and Delivery Research Programme (project number 13/10/80).To read the full NIHR Signal, go to https://discover.dc.nihr.ac.uk/content/signal-000779/understanding-dementia-care-in-hospitals.
Collapse
Affiliation(s)
- Rob Cook
- Bazian, Economist Intelligence Unit Healthcare, London, UK
| | - Tara Lamont
- Wessex Institute, University of Southampton, Southampton, UK
| | - Rosie Martin
- Bazian, Economist Intelligence Unit Healthcare, London, UK
| |
Collapse
|
13
|
Abstract
The studyFawsitt C, Thom H, Hunt L. Choice of prosthetic implant combinations in total hip replacement: cost-effectiveness analysis using UK and Swedish hip joint registries data. Value Health 2019;22:303-12.This study was funded by the NIHR Research for Patient Benefit Programme (project number PB-PG-0613-31032).To read the full NIHR Signal, go to https://discover.dc.nihr.ac.uk/content/signal-000771/a-traditional-hip-implant-is-as-effective-as-more-expensive-newer-types-for-older-people.
Collapse
Affiliation(s)
- Rob Cook
- Bazian, Economist Intelligence Unit healthcare, London, UK
| | - Tara Lamont
- Wessex Institute, University of Southampton, Southampton, UK
| | - Rosie Martin
- Bazian, Economist Intelligence Unit healthcare, London, UK
| |
Collapse
|
14
|
Cook R, Lamont T, Martin R. Setting goals can help people with early stage dementia improve function. BMJ 2019; 365:l4223. [PMID: 31221622 DOI: 10.1136/bmj.l4223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
The studyClare L, Kudlicka A, Oyebode J R, et al. Goal-oriented cognitive rehabilitation for early-stage Alzheimer's and related dementias: the GREAT RCT. Health Technol Assess 2019;23:1-242.The trial was funded by the NIHR Health Technology Assessment Programme (project number11/15/04).To read the full NIHR Signal, go to: https://discover.dc.nihr.ac.uk/content/signal-000767/goal-setting-in-early-stage-dementia-can-improve-function.
Collapse
Affiliation(s)
- Rob Cook
- Bazian, Economist Intelligence Unit healthcare, London, UK
| | - Tara Lamont
- Wessex Institute, University of Southampton, Southampton UK
| | - Rosie Martin
- Bazian, Economist Intelligence Unit healthcare, London, UK
| |
Collapse
|
15
|
Abstract
The studyA patient-centred intervention to improve the management of multimorbidity in general practice: the 3D RCT. Salisbury C, Man M-S, Chaplin K, et al.Published in Health Serv Deliv Res 2019;7(5). This study was funded by the National Institute for Health Research Health Services and Delivery Programme (project number 12/130/15).To read the full NIHR Signal, go to: https://discover.dc.nihr.ac.uk/content/signal-000658/patient-centred-care-for-multimorbidity-improves-patient-experience-but-quality-of-life-is-unchanged.
Collapse
Affiliation(s)
- Rob Cook
- Bazian, Economist Intelligence Unit healthcare, London, UK
| | - Tara Lamont
- Wessex Institute, University of Southampton, Southampton, UK
| | - Rachel Taft
- Bazian, Economist Intelligence Unit healthcare, London, UK
| |
Collapse
|
16
|
Abstract
The studySheppard JP, Stevens S, Stevens R, Martin U, Mant J, Hobbs R, McManus R. Benefits and harms of antihypertensive treatment in low-risk patients with mild hypertension.Published on 1 December 2018 JAMA Intern Med 2018;178:1626-34.This project was funded by a grant from the National Institute for Health Research (NIHR-RP-R2-12-O15) and the Medical Research Council (MRC) Strategic Skills Postdoctoral Fellowship.To read the full NIHR Signal, go to: https://discover.dc.nihr.ac.uk/content/signal-000713/lifestyle-changes-for-mild-hypertension-rather-than-drugs.
Collapse
Affiliation(s)
- Rob Cook
- Bazian, Economist Intelligence Unit healthcare, London, UK
| | - Tara Lamont
- Wessex Institute, University of Southampton, Southampton, UK
| | - Rosie Martin
- Bazian, Economist Intelligence Unit healthcare, London, UK
| |
Collapse
|
17
|
Affiliation(s)
| | - Tara Lamont
- NIHR Dissemination Centre, University of Southampton, Southampton, UK
| | - Rob Cook
- NIHR Dissemination Centre, University of Southampton, Southampton, UK
| | - Tansy Evans
- NIHR Dissemination Centre, University of Southampton, Southampton, UK
| | - Peter Davidson
- NIHR Dissemination Centre, University of Southampton, Southampton, UK
| |
Collapse
|
18
|
Affiliation(s)
- Tara Lamont
- NIHR Health Services & Delivery Research Programme, University of Southampton, 3 Venture Road, Science Park, Southampton SO16 7NS, UK
| | - Justin Waring
- Nottingham University Business School, University of Nottingham, UK
| |
Collapse
|
19
|
Hibbert P, Healey F, Lamont T, Runciman W. ISQUA16-2335PATIENT SAFETY'S MISSING LINK: USING CLINICAL EXPERTISE TO RECOGNIZE, RESPOND TO AND REDUCE RISKS AT A POPULATION LEVEL. Int J Qual Health Care 2016. [DOI: 10.1093/intqhc/mzw104.62] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
20
|
Lamont T, Richardson A. Better endings: a review of end-of-life services. Nurs Times 2016; 112:16-18. [PMID: 27180460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The NHS has undertaken research on the organisation and quality of end-of-life services, which provides valuable insights for those planning and delivering care for people approaching the end of life, and their families. The review of the findings, structured around the right care in the right place at the right time, highlights what is already known, and how research that is currently underway will address key gaps and uncertainties for frontline staff and clinical leaders. This article summarises the findings outlined in that review.
Collapse
|
21
|
Hibbert PD, Healey F, Lamont T, Marela WM, Warner B, Runciman WB. Patient safety's missing link: using clinical expertise to recognize, respond to and reduce risks at a population level. Int J Qual Health Care 2016; 28:114-21. [PMID: 26573789 PMCID: PMC4767046 DOI: 10.1093/intqhc/mzv091] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2015] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Although incident reporting systems are widespread in health care as a strategy to reduce harm to patients, the focus has been on reporting incidents rather than responding to them. Systems containing large numbers of incidents are uniquely placed to raise awareness of, and then characterize and respond to infrequent, but significant risks. The aim of this paper is to outline a framework for the surveillance of such risks, their systematic analysis, and for the development and dissemination of population-based preventive and corrective strategies using clinical and human factors expertise. REQUIREMENTS FOR A POPULATION-LEVEL RESPONSE The framework outlines four system requirements: to report incidents; to aggregate them; to support and conduct a risk surveillance, review and response process; and to disseminate recommendations. Personnel requirements include a non-hierarchical multidisciplinary team comprising clinicians and subject-matter and human factors experts to provide interpretation and high-level judgement from a range of perspectives. The risk surveillance, review and response process includes searching of large incident and other databases for how and why things have gone wrong, narrative analysis by clinical experts, consultation with the health care sector, and development and pilot testing of corrective strategies. Criteria for deciding which incidents require a population-level response are outlined. DISCUSSION The incremental cost of a population-based response function is modest compared with the 'reporting' element. Combining clinical and human factors expertise and a systematic approach underpins the creation of credible risk identification processes and the development of preventive and corrective strategies.
Collapse
Affiliation(s)
- Peter D. Hibbert
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
- Visiting Research Fellow, Centre for Population Health Research, School of Health Sciences, University of South Australia, Adelaide, Australia
| | | | - Tara Lamont
- National Institute for Health Research, London, UK
- Health Services and Delivery Research Programme, University of Southampton, Southampton, UK
| | | | - Bruce Warner
- Deputy Chief Pharmaceutical Officer, NHS England, London, UK
| | - William B. Runciman
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
- Centre for Population Health Research, School of Health Sciences, University of South Australia, Adelaide, South Australia
- Joanna Briggs Institute, Faculty of Health Sciences, University of Adelaide, Adelaide, Australia
| |
Collapse
|
22
|
Lamont T, Barber N, de Pury J, Fulop N, Garfield-Birkbeck S, Lilford R, Mear L, Raine R, Fitzpatrick R. New approaches to evaluating complex health and care systems. BMJ 2016; 352:i154. [PMID: 26830458 DOI: 10.1136/bmj.i154] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Tara Lamont
- National Institute for Health Research Health Services and Delivery Research Programme, University of Southampton, SO16 7NS, UK
| | | | | | | | | | | | - Liz Mear
- North West Coast Academic Health Science Network, Warrington, UK
| | | | | |
Collapse
|
23
|
Mear L, Fulop N, Lamont T. WHY THE NHS MUST EVALUATE COMPLEX SERVICE CHANGES. Health Serv J 2015; 125:16-17. [PMID: 26642557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
|
24
|
Flood C, Matthew L, Marsh R, Patel B, Mansaray M, Lamont T. Reducing risk of overdose with midazolam injection in adults: an evaluation of change in clinical practice to improve patient safety in England. J Eval Clin Pract 2015; 21:57-66. [PMID: 25109525 DOI: 10.1111/jep.12228] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/16/2014] [Indexed: 01/14/2023]
Abstract
RATIONALE AIMS AND OBJECTIVES This study sought to evaluate potential reductions in risk associated with midazolam injection, a sedating medication, following a UK National Patient Safety Alert. This alert, 'Reducing risk of overdose with midazolam injection in adults', was sent to all National Health Service organizations as a Rapid Response Report detailing actions services should take to minimize risks. METHOD To evaluate any potential changes arising from this alert, a number of data sources were explored including reported incidents to a national reporting system for health care error, clinician survey and audit data, pharmaceutical purchasing patterns and feedback from National Health Service managers. RESULTS Prior to the Rapid Response Report, 498 incidents were received by the National Patient Safety Agency including three deaths. Post-implementation of the Rapid Response Report (June 2009), no incidents resulting in death or severe harm had been received. All organizations reported having completed the Rapid Response Report actions. Purchase and use of risk-prone, high-strength sedating midazolam by health care organizations decreased significantly as did the increased use of safer, lower strength doses (as recommended in the Rapid Response Report). CONCLUSIONS Organizations can achieve safer medication practices, better knowledge, awareness and implementation of national safer practice recommendations. Risks from inadvertent overdose of midazolam injection were reduced post-implementation of national recommendations. Ongoing monitoring of this particular adverse event will be required with a sustained patient safety message to health services to maintain awareness of the issue and reduction in the number of midazolam-related errors.
Collapse
Affiliation(s)
- Chris Flood
- NIHR Health Service & Delivery Research Programme, National Patient Safety Agency, London, UK
| | | | | | | | | | | |
Collapse
|
25
|
Dorling H, White D, Turner S, Campbell K, Lamont T. Developing a checklist for research proposals to help describe health service interventions in UK research programmes: a mixed methods study. Health Res Policy Syst 2014; 12:12. [PMID: 24593794 PMCID: PMC3996017 DOI: 10.1186/1478-4505-12-12] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Accepted: 02/20/2014] [Indexed: 12/02/2022] Open
Abstract
Background One of the most common reasons for rejecting research proposals in the National Institute for Health Research (NIHR) Health Services and Delivery Research (HS&DR) Programme is the failure to adequately specify the intervention or context in research proposals. Examples of failed research proposals include projects to assess integrated care models, use of generic caseworkers, or new specialist nurse services. These are all important service developments which need evaluation, but the lack of clarity about the intervention and context prevented these research proposals from obtaining funding. The purpose of the research presented herein was to develop a checklist, with key service intervention and contextual features, for use by applicants to the NIHR HS&DR Programme to potentially enhance the quality of research proposals. Methods The study used mixed methods to identify the need for and develop and test a checklist. Firstly, this included assessing existing checklists in peer-reviewed literature relevant to organisational health research. Building on existing work, a new checklist was piloted. Two reviewers used a small sample (n = 16) of research proposals to independently assess the relevance of the checklist to the proposal and the degree of overlap or gaps between the constructs. The next two stages externally validated the revised checklist by collecting qualitative feedback from researchers and experts in the field. Results The initial checklist was developed from existing checklists which included domains of intervention and context. The constructs and background to each were developed through review of existing literature. Eight researchers provided feedback on the checklist, which was generally positive. This iterative process resulted in changes to the checklist, collapsing two constructs and providing more prompts for others; the final checklist includes six constructs. Conclusions Features relating to intervention and context should be well described to increase the quality of research proposals and enhance the chances of the research receiving funding. Existing checklists do not have enough focus on areas relevant to research proposals in complex health service interventions, such as workforce. A formative checklist has been developed, and tested by end users. Tentative findings suggest usefulness and acceptability of such a tool but further work is needed for full validation.
Collapse
Affiliation(s)
- Hannah Dorling
- National Institute for Health Research Evaluation, Trials and Studies Coordinating Centre (NETSCC), University of Southampton, Alpha House, Enterprise Road, Southampton SO16 7NS, UK.
| | | | | | | | | |
Collapse
|
26
|
Sherley RB, Ludynia K, Lamont T, Roux JP, Crawford RJM, Underhill LG. The initial journey of an Endangered penguin: implications for seabird conservation. ENDANGER SPECIES RES 2013. [DOI: 10.3354/esr00510] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
|
27
|
|
28
|
Lamont T, Beaumont C, Fayaz A, Healey F, Huehns T, Law R, Lecko C, Panesar S, Surkitt-Parr M, Stroud M, Warner B. Checking placement of nasogastric feeding tubes in adults (interpretation of x ray images): summary of a safety report from the National Patient Safety Agency. BMJ 2011; 342:d2586. [PMID: 21546422 DOI: 10.1136/bmj.d2586] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Tara Lamont
- National Patient Safety Agency, London W1T 5HD, UK.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
29
|
Lamont T, Cousins D, Hillson R, Bischler A, Teblanche M. [Reliable administration of insulin: summary of a safety report by the British National Patient Safety Agency]. Praxis (Bern 1994) 2011; 100:363-366. [PMID: 21412748 DOI: 10.1024/1661-8157/a000468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Affiliation(s)
- T Lamont
- National Reporting and Learning Service, National Patient Safety Agency, London, UK.
| | | | | | | | | |
Collapse
|
30
|
|
31
|
Healey F, Darowski A, Lamont T, Panesar S, Poulton S, Treml J, Wiese M. Essential care after an inpatient fall: summary of a safety report from the National Patient Safety Agency. BMJ 2011; 342:d329. [PMID: 21278215 DOI: 10.1136/bmj.d329] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
32
|
Lamont T, Cousins D, Bischler A, Gerrett D. Safer loading doses of medicines: summary of a safety report from the National Patient Safety Agency. West J Med 2011. [DOI: 10.1136/bmj.d33] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
33
|
Lamont T, Watts F, Panesar S, MacFie J, Matthew D. Early detection of complications after laparoscopic surgery: summary of a safety report from the National Patient Safety Agency. BMJ 2011; 342:c7221. [PMID: 21248017 DOI: 10.1136/bmj.c7221] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Tara Lamont
- National Patient Safety Agency, London W1T 5HD, UK.
| | | | | | | | | |
Collapse
|
34
|
Gerrett D, Lamont T, Paton C, Barnes TRE, Shah A. Prescribing and monitoring lithium therapy: summary of a safety report from the National Patient Safety Agency. BMJ 2010; 341:c6258. [PMID: 21097572 DOI: 10.1136/bmj.c6258] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- David Gerrett
- National Reporting and Learning Service, National Patient Safety Agency, London W1T 5HD, UK.
| | | | | | | | | |
Collapse
|
35
|
Affiliation(s)
- Tara Lamont
- National Reporting and Learning Service, National Patient Safety Agency, London W1T 5HD, UK.
| | | | | |
Collapse
|
36
|
Affiliation(s)
- Tara Lamont
- National Reporting and Learning Service, National Patient Safety Agency, London W1T 5HD, UK.
| | | | | | | | | |
Collapse
|
37
|
Lamont T, Dougall A, Johnson S, Mathew D, Scarpello J, Morris E. Reducing the risk of retained swabs after vaginal birth: summary of a safety report from the National Patient Safety Agency. BMJ 2010; 341:c3679. [PMID: 20643710 DOI: 10.1136/bmj.c3679] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
38
|
Affiliation(s)
- Tara Lamont
- National Reporting and Learning Service, National Patient Safety Agency, London W1T 5HD.
| | | | | | | | | |
Collapse
|
39
|
Healey F, Sanders DS, Lamont T, Scarpello J, Agbabiaka T. Early detection of complications after gastrostomy: summary of a safety report from the National Patient Safety Agency. BMJ 2010; 340:c2160. [PMID: 20442227 DOI: 10.1136/bmj.c2160] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Frances Healey
- National Reporting and Learning Service, National Patient Safety Agency, London W1T 5HD.
| | | | | | | | | |
Collapse
|
40
|
Lamont T, Watts F, Stanley J, Scarpello J, Panesar S. Reducing risks of tourniquets left on after finger and toe surgery: summary of a safety report from the National Patient Safety Agency. BMJ 2010; 340:c1981. [PMID: 20410165 DOI: 10.1136/bmj.c1981] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Tara Lamont
- National Reporting and Learning Service, National Patient Safety Agency, London W1T 5HD.
| | | | | | | | | |
Collapse
|
41
|
Lamont T, Luettel D, Scarpello J, O'Driscoll BR, Connew S. Improving the safety of oxygen therapy in hospitals: summary of a safety report from the National Patient Safety Agency. BMJ 2010; 340:c187. [PMID: 20103511 DOI: 10.1136/bmj.c187] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Tara Lamont
- National Reporting and Learning Service, National Patient Safety Agency, London W1T 5HD.
| | | | | | | | | |
Collapse
|
42
|
Cooper J, Bester M, Chown S, Crawford R, Daly R, Heyns E, Lamont T, Ryan P, Shaw J. Biological survey of the Prince Edward Islands, December 2008. S AFR J SCI 2010. [DOI: 10.4102/sajs.v105i7/8.93] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
|
43
|
Lamont T, Surkitt-Parr M, Scarpello J, Durand M, Hooper C, Maskell N. Insertion of chest drains: summary of a safety report from the National Patient Safety Agency. BMJ 2009; 339:b4923. [PMID: 19955139 DOI: 10.1136/bmj.b4923] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Tara Lamont
- National Reporting and Learning Service, National Patient Safety Agency, London W1T 5HD.
| | | | | | | | | | | |
Collapse
|
44
|
Affiliation(s)
- Tara Lamont
- National Reporting and Learning Service, National Patient Safety Agency, London W1T 5HD.
| | | |
Collapse
|
45
|
Affiliation(s)
- Tara Lamont
- National Reporting and Learning Service, National Patient Safety Agency, London W1T 5HD.
| | | | | | | |
Collapse
|
46
|
Abstract
UNLABELLED AIMS OF THE AUDIT COMMISSION: The Audit Commission has a statutory duty to promote the best use of public money. It does this through value for money studies, such as that reported in Testing Times[1]. This work has been followed with a review of innovative practice in commissioning. These initiatives aim to support the implementation of the diabetes national service framework. The Audit Commission also appoints external auditors to NHS organizations who assess probity and value for money in the NHS; the latter by applying national studies locally and by carrying out local studies. METHODS Research for Testing Times consisted of structured visits to nine acute trusts, a telephone survey of 26 health authorities and a postal survey of 1400 people with diabetes and 250 general practitioners. Local audits used a subset of the original research tools. Case studies were identified through a cascade approach to contacts established during Testing Times and through self-nomination. RESULTS Rising numbers of people with diabetes are placing increasing pressure on hospital services. Some health authorities and primary care organizations have reviewed patterns of service provision in the light of the increasing demands. These reviews show wide variations in patterns of routine care. In addition, there is a widespread lack of data on the delivery of structured care to people with diabetes. People with diabetes report delays in gaining access to services, and insufficient time with staff. There are insufficient arrangements in place for providing information and learning opportunities to support self-management. CONCLUSION As the number of people with diabetes continues to rise, the potential for providing more care in a primary care setting needs to be explored. This will enable specialist services to focus more effectively on those with the most complex needs.
Collapse
Affiliation(s)
- B Fitzsimons
- Public Services Research Directorate, The Audit Commission, London, UK.
| | | | | | | | | |
Collapse
|
47
|
Affiliation(s)
- V A Entwistle
- NHS Centre for Reviews and Dissemination, University of York.
| | | | | | | | | |
Collapse
|
48
|
|
49
|
Jones R, Lamont T, Haines A. Setting priorities for research and development in the NHS: a case study on the interface between primary and secondary care. BMJ 1995; 311:1076-80. [PMID: 7580669 PMCID: PMC2551374 DOI: 10.1136/bmj.311.7012.1076] [Citation(s) in RCA: 27] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Since 1991 the NHS has attempted to identify and prioritise its needs for research and development in a systematic manner. This has not been done before and there is little evidence on which to draw. Multidisciplinary expert groups have identified priorities in different topics using explicit criteria and after widespread consultation within the NHS and research community to identify pressing problems and opportunities for research. This paper focuses on a review completed in 1993 to identify research and development priorities for the NHS in relation to the interface between primary and secondary care. The review covered several recent developments which require evaluation. The authors describe the process used to identify research and development priorities in this complex subject and examine the strengths and weaknesses of the approach. This case study should help to stimulate a wider debate on methods of identifying priorities, particularly those using participatory approaches, in research and non-research contexts.
Collapse
Affiliation(s)
- R Jones
- Department of General Practice, United Medical School of Guy's Hospital, London
| | | | | |
Collapse
|
50
|
Affiliation(s)
- T Lamont
- British Medical Association, London
| |
Collapse
|