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Affiliation(s)
- P Sampson
- University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - J Back
- Healthcare Safety Investigation Branch, Farnborough, UK
| | - S Drage
- Healthcare Safety Investigation Branch, Farnborough, UK.,Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
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2
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Anderson JE, Ross AJ, Back J, Duncan M, Snell P, Hopper A, Jaye P. Beyond ‘find and fix’: improving quality and safety through resilient healthcare systems. Int J Qual Health Care 2020; 32:204-211. [DOI: 10.1093/intqhc/mzaa007] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 12/09/2019] [Accepted: 02/05/2020] [Indexed: 11/13/2022] Open
Abstract
Abstract
Objective
The aim was to develop a method based on resilient healthcare principles to proactively identify system vulnerabilities and quality improvement interventions.
Design
Ethnographic methods to understand work as it is done in practice using concepts from resilient healthcare, the Concepts for Applying Resilience Engineering model and the four key activities that are proposed to underpin resilient performance—anticipating, monitoring, responding and learning.
Setting
Accident and Emergency Department (ED) and the Older People’s Unit (OPU) of a large teaching hospital in central London.
Participants
ED—observations 104 h, and 14 staff interviews. OPU—observations 60 h, and 15 staff interviews.
Results
Data were analysed to identify targets for quality improvement. In the OPU, discharge was a complex and variable process that was difficult to monitor. A system to integrate information and clearly show progress towards discharge was needed. In the ED, patient flow was identified as a complex high-intensity activity that was not supported by the existing data systems. The need for a system to integrate and display information about both patient and organizational factors was identified. In both settings, adaptive capacity was limited by the absence of systems to monitor the work environment.
Conclusions
The study showed that using resilient healthcare principles to inform quality improvement was feasible and focused attention on challenges that had not been addressed by traditional quality improvement practices. Monitoring patient and workflow in both the ED and the OPU was identified as a priority for supporting staff to manage the complexity of the work.
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Affiliation(s)
- J E Anderson
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King’s College London, London, UK
| | - A J Ross
- Dental School, School of Medicine, University of Glasgow, Glasgow, UK
| | - J Back
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King’s College London, London, UK
| | - M Duncan
- Department of Psychology, IOPPN, King’s College London, London, UK
| | - P Snell
- Patricia Snell Healthcare Consulting, London, UK
| | - A Hopper
- Guy’s and St. Thomas’ NHS Foundation Trust, London, UK
| | - P Jaye
- Simulation and Interactive Learning (SaIL) Centre, St Thomas’ Hospital, King's Health Partners, London, UK
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Gudi G, Ca V, Gn S, von Gunten C, Fluhler E, Back J. Preliminary pharmacokinetic results from a phase I study of GBR 1302 in patients with HER2 positive cancers. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy487.027] [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: 11/13/2022] Open
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Wermke M, Alt J, Kauh J, Back J, Salhi Y, Reddy V, Barve M, Ochsenreither S. Preliminary results from a phase I study of GBR 1302, a bispecific antibody T-cell engager, in HER2 positive cancers. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy288.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Macoin J, Lissilaa R, Sancheti P, Reddy V, Back J. 1100 Targeting OX40 with GBR 830, an OX40 antagonist, inhibits T cell-mediated pathological responses. J Invest Dermatol 2018. [DOI: 10.1016/j.jid.2018.03.1113] [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: 11/24/2022]
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Gudi G, A V, Gn S, von Gunten C, Back J, Fang H, Salhi Y, Grossman F, Wolff G. 1094 Clinical pharmacokinetics and immunogenicity of GBR 830, a first-in-class humanized monoclonal antibody inhibiting OX40 to treat atopic dermatitis. J Invest Dermatol 2018. [DOI: 10.1016/j.jid.2018.03.1107] [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: 10/17/2022]
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7
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Guttman-Yassky E, Pavel A, Estrada Y, Zhou L, Salhi Y, Gudi G, A V, Macoin J, Back J, Grossman F, Wolff G. 453 GBR 830 induces progressive and sustained changes in atopic dermatitis biomarkers in patient skin lesions. J Invest Dermatol 2018. [DOI: 10.1016/j.jid.2018.03.460] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Macoin J, Blein S, Monney T, Lissilaa R, Sancheti P, Reddy V, Back J. 1099 GBR 830: An OX40 antagonist antibody with a favorable toxicity profile in non-human primates. J Invest Dermatol 2018. [DOI: 10.1016/j.jid.2018.03.1112] [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: 10/17/2022]
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Back J. GBR1302-BEAT® bispecific antibody targeting CD3 and HER2 demonstrates a higher anti-tumor potential than current HER2-targeting therapies. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw525.04] [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: 11/13/2022] Open
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Wermke M, Schmidt H, Ochsenreither S, Back J, Salhi Y, Bayever E. A phase 1 study of GBR 1302 in subjects with HER2-positive cancers. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw525.52] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Anderson JE, Ross AJ, Back J, Duncan M, Snell P, Walsh K, Jaye P. Implementing resilience engineering for healthcare quality improvement using the CARE model: a feasibility study protocol. Pilot Feasibility Stud 2016; 2:61. [PMID: 27965876 PMCID: PMC5154109 DOI: 10.1186/s40814-016-0103-x] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [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: 10/27/2015] [Accepted: 10/01/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Resilience engineering (RE) is an emerging perspective on safety in complex adaptive systems that emphasises how outcomes emerge from the complexity of the clinical environment. Complexity creates the need for flexible adaptation to achieve outcomes. RE focuses on understanding the nature of adaptations, learning from success and increasing adaptive capacity. Although the philosophy is clear, progress in applying the ideas to quality improvement has been slow. The aim of this study is to test the feasibility of translating RE concepts into practical methods to improve quality by designing, implementing and evaluating interventions based on RE theory. The CARE model operationalises the key concepts and their relationships to guide the empirical investigation. METHODS The settings are the Emergency Department and the Older Person's Unit in a large London teaching hospital. Phases 1 and 2 of our work, leading to the development of interventions to improve the quality of care, are described in this paper. Ethical approval has been granted for these phases. Phase 1 will use ethnographic methods, including observation of work practices and interviews with staff, to understand adaptations and outcomes. The findings will be used to collaboratively design, with clinical staff in interactive design workshops, interventions to improve the quality of care. The evaluation phase will be designed and submitted for ethical approval when the outcomes of phases 1 and 2 are known. DISCUSSION Study outcomes will be knowledge about the feasibility of applying RE to improve quality, the development of RE theory and a validated model of resilience in clinical work which can be used to guide other applications. Tools, methods and practical guidance for practitioners will also be produced, as well as specific knowledge of the potential effectiveness of the implemented interventions in emergency and older people's care. Further studies to test the application of RE at a larger scale will be required, including studies of other healthcare settings, organisational contexts and different interventions.
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Affiliation(s)
- J E Anderson
- Florence Nightingale Faculty of Nursing and Midwifery, King's College London, James Clerk Maxwell Building, 57 Waterloo Road, London, SE1 8WA UK
| | - A J Ross
- Dental School, School of Medicine, University of Glasgow, Glasgow, UK
| | - J Back
- Florence Nightingale Faculty of Nursing and Midwifery, King's College London, James Clerk Maxwell Building, 57 Waterloo Road, London, SE1 8WA UK
| | - M Duncan
- Florence Nightingale Faculty of Nursing and Midwifery, King's College London, James Clerk Maxwell Building, 57 Waterloo Road, London, SE1 8WA UK
| | - P Snell
- Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - K Walsh
- BMJ Learning, BMJ, London, UK
| | - P Jaye
- Simulation and Interactive Learning (SaIL) Centre, St Thomas' Hospital, King's Health Partners, London, UK
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Duncan M, Anderson J, Back J, Ross A. ISQUA16-2509QUALITY AND SAFETY IN THE OLDER PERSON'S UNIT: A RESILIENCE ENGINEERING APPROACH. Int J Qual Health Care 2016. [DOI: 10.1093/intqhc/mzw104.76] [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: 11/13/2022] Open
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13
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Croset A, Macoin J, Ollier R, Pluess M, Delon C, Skegro D, Blein S, Hou S, Back J. 139 GBR1302: a BEAT® bispecific antibody for the treatment of HER2 positive cancers. Eur J Cancer 2014. [DOI: 10.1016/s0959-8049(14)70265-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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14
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Lawrie SR, Faircloth DC, Letchford AP, Perkins M, Whitehead MO, Wood T, Gabor C, Back J. Development of the front end test stand and vessel for extraction and source plasma analyses negative hydrogen ion sources at the Rutherford Appleton Laboratory. Rev Sci Instrum 2014; 85:02B127. [PMID: 24593567 DOI: 10.1063/1.4826109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The ISIS pulsed spallation neutron and muon facility at the Rutherford Appleton Laboratory (RAL) in the UK uses a Penning surface plasma negative hydrogen ion source. Upgrade options for the ISIS accelerator system demand a higher current, lower emittance beam with longer pulse lengths from the injector. The Front End Test Stand is being constructed at RAL to meet the upgrade requirements using a modified ISIS ion source. A new 10% duty cycle 25 kV pulsed extraction power supply has been commissioned and the first meter of 3 MeV radio frequency quadrupole has been delivered. Simultaneously, a Vessel for Extraction and Source Plasma Analyses is under construction in a new laboratory at RAL. The detailed measurements of the plasma and extracted beam characteristics will allow a radical overhaul of the transport optics, potentially yielding a simpler source configuration with greater output and lifetime.
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Affiliation(s)
- S R Lawrie
- STFC ISIS Pulsed Spallation Neutron and Muon Facility, Rutherford Appleton Laboratory, Harwell Oxford, Harwell, United Kingdom
| | - D C Faircloth
- STFC ISIS Pulsed Spallation Neutron and Muon Facility, Rutherford Appleton Laboratory, Harwell Oxford, Harwell, United Kingdom
| | - A P Letchford
- STFC ISIS Pulsed Spallation Neutron and Muon Facility, Rutherford Appleton Laboratory, Harwell Oxford, Harwell, United Kingdom
| | - M Perkins
- STFC ISIS Pulsed Spallation Neutron and Muon Facility, Rutherford Appleton Laboratory, Harwell Oxford, Harwell, United Kingdom
| | - M O Whitehead
- STFC ISIS Pulsed Spallation Neutron and Muon Facility, Rutherford Appleton Laboratory, Harwell Oxford, Harwell, United Kingdom
| | - T Wood
- STFC ISIS Pulsed Spallation Neutron and Muon Facility, Rutherford Appleton Laboratory, Harwell Oxford, Harwell, United Kingdom
| | - C Gabor
- ASTeC Intense Beams Group, Rutherford Appleton Laboratory, Harwell Oxford, Harwell, United Kingdom
| | - J Back
- High Energy Physics Department, University of Warwick, Coventry, United Kingdom
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Erdmann T, Back J, Tkachov R, Ruff A, Voit B, Ludwigs S, Kiriy A. Dithienosilole-based all-conjugated block copolymers synthesized by a combination of quasi-living Kumada and Negishi catalyst-transfer polycondensations. Polym Chem 2014. [DOI: 10.1039/c4py00747f] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The synthesis of diblock copolymers containing poly(dithieno[3,2-b:2’,3’-d]silole) and poly(3-hexylthiopnene) blocks was accomplished by a combination of quasi-living Kumada and Negishi catalyst-transfer polycondensations.
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Affiliation(s)
- T. Erdmann
- Leibniz-Institut für Polymerforschung Dresden e. V. Hohe Straße 6
- 01069 Dresden, Germany
- Technische Universität Dresden
- Center for Advancing Electronics Dresden and Chair of Organic Chemistry of Polymers
- 01062 Dresden, Germany
| | - J. Back
- University of Stuttgart
- IPOC-Functional Polymers
- 70569 Stuttgart, Germany
| | - R. Tkachov
- Leibniz-Institut für Polymerforschung Dresden e. V. Hohe Straße 6
- 01069 Dresden, Germany
| | - A. Ruff
- University of Stuttgart
- IPOC-Functional Polymers
- 70569 Stuttgart, Germany
| | - B. Voit
- Leibniz-Institut für Polymerforschung Dresden e. V. Hohe Straße 6
- 01069 Dresden, Germany
- Technische Universität Dresden
- Center for Advancing Electronics Dresden and Chair of Organic Chemistry of Polymers
- 01062 Dresden, Germany
| | - S. Ludwigs
- University of Stuttgart
- IPOC-Functional Polymers
- 70569 Stuttgart, Germany
| | - A. Kiriy
- Leibniz-Institut für Polymerforschung Dresden e. V. Hohe Straße 6
- 01069 Dresden, Germany
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Back J, Baecklund E, Birgegard G. THU0061 Anemia in patients with rheumatoid arthritis: A cross-sectional study. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2012-eular.2026] [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: 11/03/2022]
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17
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Back J, Lee W. Three new species of the genusParamesochraT. Scott, 1892 (Copepoda: Harpacticoida: Paramesochridae) from Yellow Sea, Korea with a redescription ofParamesochra similisKunz, 1936. J NAT HIST 2013. [DOI: 10.1080/00222933.2012.742585] [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: 10/27/2022]
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Jackson FE, Back J, Pratt R, Fleming P. Artillery fragment in 3rd ventricle of brain producing delayed block of Iter of acqueduct of Sylvius: case report. Mil Med 1971; 136:900-3. [PMID: 5005355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
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