Using patient knowledge for better health systems

Purpose – This paper describes a “work in progress” research project being carried out with a public health care provider in the UK, a large NHS hospital Trust. Enhanced engagement with patients is one of the Trust’s core principles, but it is recognised that much more needs to be done to achieve this, and that ICT systems may be able to provide some support. The project is intended to find ways to better capture and evaluate the “voice of the patient” in order to lead to improvements in health care quality, safety and effectiveness. Design/methodology/approach – We propose to investigate the use of a patient-orientated knowledge management system (KMS) in managing knowledge about and from patients. The study is a mixed methods (quantitative and qualitative) investigation based on traditional action research, intended to answer the following three research questions: (1) How can a KMS be used as a mechanism to capture and evaluate patient experiences to provoke patient service change (2) How can the KMS assist in providing a mechanism for systematising patient engagement? (3) How can patient feedback be used to stimulate improvements in care, quality and safety? Originality/value –This methodology aims to involve patients at all phases of the study from its initial design onwards, thus leading to an understanding of the issues associated with using a KMS to manage knowledge about and for patients that is driven by the patients themselves. Practical implications – The outcomes of the project for the collaborating hospital will be firstly, a system for capturing and evaluating knowledge about and from patients, and then as a consequence, improved outcomes for both the patients and the service provider. More generally, it will produce a set of guidelines for managing patient knowledge in an NHS hospital that have been tested in one case example.

How innovation can alleviate negative consequences of demanding work contexts:The influence of climate for innovation on organizational outcomes

This study examines climate for innovation as a method by which negative organizational consequences of demanding work may be lessened. It was expected that a climate for innovation would enable employees to develop coping mechanisms or improved work-related processes which counteract negative consequences of work demands. Extending the job demands-resource model (Karasek, 1979), we predicted and found that among the sample of 22,696 respondents from 131 healthcare organizations, organizational climate for innovation alleviated the negative effects of work demands on organizational performance. Thus, this study informs climate theories and guides practitioners' efforts to support the employees. © 2007 The British Psychological Society.

Student input in the development of a marking scheme for improved engineering logbooks

Engineers logbooks are an important part of the CDIO process, as a prequel to the logooks they will be expected to keep when in industry. Previously however, students logbooks were insufficient and students did not appear to appreciate the importance of the logbooks or how they would be assessed. In an attempt to improve the students understanding and quality of logbooks, a group of ~100 1st year CDIO students were asked to collaboratively develop a marking matrix with the tutors. The anticipated outcome was that students would have more ownership in, and a deeper understanding of, the logbook and what is expected from the student during assessment. A revised marking matrix was developed in class and a short questionnaire was implemented on delivery of the adapted matrix to gauge the students response to the process. Marks from the logbooks were collected twice during teaching period one and two and compared to marks from previous years. This poster will deliver the methodology and outcomes for this venture.

Guiding schools to improved performance using data envelopment analysis:an illustration with data from a local education authority

The educational process is characterised by multiple outcomes such as the achievement of academic results of various standards and non-academic achievements. This paper shows how data envelopment analysis (DEA) can be used to guide secondary schools to improved performance through role-model identification and target setting in a way which recognises the multi-outcome nature of the education process and reflects the relative desirability of improving individual outcomes. The approach presented in the paper draws from a DEA-based assessment of the schools of a local education authority carried out by the authors. Data from that assessment are used to illustrate the approach presented in the paper. (Key words: Data envelopment analysis, education, target setting.)

Neurophysiological investigations for the diagnosis of non-epileptic attack disorder in neuropsychiatry services:from safety standards to improved effectiveness

OBJECTIVE: The discipline of clinical neuropsychiatry currently provides specialised services for a number of conditions that cross the traditional boundaries of neurology and psychiatry, including non-epileptic attack disorder. Neurophysiological investigations have an important role within neuropsychiatry services, with video-electroencephalography (EEG) telemetry being the gold standard investigation for the differential diagnosis between epileptic seizures and non-epileptic attacks. This article reviews existing evidence on best practices for neurophysiology investigations, with focus on safety measures for video-EEG telemetry. METHODS: We conducted a systematic literature review using the PubMed database in order to identify the scientific literature on the best practices when using neurophysiological investigations in patients with suspected epileptic seizures or non-epileptic attacks. RESULTS: Specific measures need to be implemented for video-EEG telemetry to be safely and effectively carried out by neuropsychiatry services. A confirmed diagnosis of non-epileptic attack disorder following video-EEG telemetry carried out within neuropsychiatry units has the inherent advantage of allowing diagnosis communication and implementation of treatment strategies in a timely fashion, potentially improving clinical outcomes and cost-effectiveness significantly. CONCLUSION: The identified recommendations set the stage for the development of standardised guidelines to enable neuropsychiatry services to implement streamlined and evidence-based care pathways.

Use of flucinolone acetonide for patients with diabetic macular oedema:patient selection criteria and early outcomes in real world setting

Introduction: Fluocinolone acetonide slow release implant (Iluvien®) was approved in December 2013 in UK for treatment of eyes which are pseudophakic with DMO that is unresponsive to other available therapies. This approval was based on evidence from FAME trials which were conducted at a time when ranibizumab was not available. There is a paucity of data on implementation of guidance on selecting patients for this treatment modality and also on the real world outcome of fluocinolone therapy especially in those patients that have been unresponsive to ranibizumab therapy. Method: Retrospective study of consecutive patients treated with fluocinolone between January and August 2014 at three sites were included to evaluate selection criteria used, baseline characteristics and clinical outcomes at 3-month time point. Results: Twenty two pseudophakic eyes of 22 consecutive patients were included. Majority of patients had prior therapy with multiple intravitreal anti-VEGF injections. Four eyes had controlled glaucoma. At baseline mean VA and CRT were 50.7 letters and 631 μm respectively. After 3 months, 18 patients had improved CRT of which 15 of them also had improved VA. No adverse effects were noted. One additional patient required IOP lowering medication. Despite being unresponsive to multiple prior therapies including laser and anti-VEGF injections, switching to fluocinolone achieved treatment benefit. Conclusion: The patient level selection criteria proposed by NICE guidance on fluocinolone appeared to be implemented. This data from this study provides new evidence on early outcomes following fluocinolone therapy in eyes with DMO which had not responded to laser and other intravitreal agents.